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Merle JL, Benbow N, Li DH, Zapata JP, Queiroz A, Zamantakis A, McKay V, Keiser B, Villamar JA, Mustanski B, Smith JD. Improving Delivery and Use of HIV Pre-Exposure Prophylaxis in the US: A Systematic Review of Implementation Strategies and Adjunctive Interventions. AIDS Behav 2024; 28:2321-2339. [PMID: 38564136 PMCID: PMC11199103 DOI: 10.1007/s10461-024-04331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States. To date, the literature has focused on identifying determinants of PrEP use, with a lesser focus on developing and testing change methods to improve PrEP implementation. Moreover, the change methods available for improving the uptake and sustained use of PrEP have not been systematically categorized. To summarize the state of the literature, we conducted a systematic review of the implementation strategies used to improve PrEP implementation among delivery systems and providers, as well as the adjunctive interventions used to improve the uptake and persistent adherence to PrEP among patients. Between November 2020 and January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer reviewed articles. We identified 44 change methods (18 implementation strategies and 26 adjunctive interventions) across a variety of clinical and community-based service settings. We coded implementation strategies and adjunctive interventions in accordance with established taxonomies and reporting guidelines. Most studies focused on improving patient adherence to PrEP and most conducted pilot trials. Just over one-third of included studies demonstrated a positive effect on outcomes. In order to end the human immunodeficiency virus (HIV) epidemic in the U.S., future, large scale HIV prevention research is needed that develops and evaluates implementation strategies and adjunctive interventions for target populations disproportionately affected by HIV.
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Affiliation(s)
- James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Juan P Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
| | - Virginia McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Juan A Villamar
- Public Health and Epidemiology Unit, Westat, Rockville, MD, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Seattle, WA, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Seattle, WA, USA
- Department of Infectious Diseases, Northwestern University, Seattle, WA, USA
- Medical Social Sciences Department, Northwestern University, Seattle, WA, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Harris MT, Weinberger E, O'Brien C, Althoff M, Paltrow-Krulwich S, Taylor JL, Judge A, Samet JH, Walley AY, Gunn CM. PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs. Addict Sci Clin Pract 2024; 19:47. [PMID: 38831359 PMCID: PMC11145858 DOI: 10.1186/s13722-024-00476-4] [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: 09/04/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Women who engage in sex work and use drugs (WSWUD) experience disproportionate HIV risks. Substance use treatment bridge clinics offer an opportunity to increase HIV pre-exposure prophylaxis (PrEP) delivery to WSWUD, but research on best practices is lacking. Therefore, we explored facilitators and barriers to PrEP across the PrEP care continuum in these settings. METHODS Bridge clinic and affiliated harm reduction health service providers and WSWUD from Boston were recruited using passive and active outreach between December 2021 and August 2022. Participants were invited to take part in semi-structured phone or in-person interviews to explore HIV prevention and PrEP care experiences overall and within bridge clinic settings. Deductive codes were developed based on HIV risk environment frameworks and the Information-Motivation-Behavioral Skills model and inductive codes were added based on transcript review. Grounded content analysis was used to generate themes organized around the PrEP care continuum. RESULTS The sample included 14 providers and 25 WSWUD. Most WSWUD were aware of PrEP and more than half had initiated PrEP at some point. However, most who initiated PrEP did not report success with daily oral adherence. Providers and WSWUD described facilitators and barriers to PrEP across the steps of the care continuum: Awareness, uptake, adherence, and retention. Facilitators for WSWUD included non-stigmatizing communication with providers, rapid wraparound substance use treatment and HIV services, having a PrEP routine, and service structures to support PrEP adherence. Barriers included low HIV risk perceptions and competing drug use and survival priorities. Provider facilitators included clinical note templates prompting HIV risk assessments and training. Barriers included discomfort discussing sex work risks, competing clinical priorities, and a lack of PrEP adherence infrastructure. CONCLUSION WSWUD and bridge clinic providers favored integrated HIV prevention and substance use services in harm reduction and bridge clinic settings. Harm reduction and bridge clinic programs played a key role in HIV prevention and PrEP education for WSWUD. Effective behavioral and structural interventions are still needed to improve PrEP adherence for WSWUD.
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Affiliation(s)
- Miriam Th Harris
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA.
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA.
| | - Emma Weinberger
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
| | - Christine O'Brien
- Project Trust Boston Area Substance Abuse and Harm Reduction, Boston Medical Center, Boston, MA, 02118, USA
| | - Mary Althoff
- AIDS Action Committee, Cambridge, MA, 02119, USA
| | - Samantha Paltrow-Krulwich
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Abigail Judge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, 03756, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
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Merle JL, Zapata JP, Quieroz A, Zamantakis A, Sanuade O, Mustanski B, Smith JD. Pre-exposure prophylaxis (PrEP) among people who use drugs: a qualitative scoping review of implementation determinants and change methods. Addict Sci Clin Pract 2024; 19:46. [PMID: 38816889 PMCID: PMC11138081 DOI: 10.1186/s13722-024-00478-2] [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: 09/20/2023] [Accepted: 05/24/2024] [Indexed: 06/01/2024] Open
Abstract
Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States, particularly among people who use drugs (PWUD). PrEP research among PWUD is scarce, and the factors that impact implementation are largely unknown. Therefore, we conducted a scoping review of implementation determinants (i.e., barriers and facilitators), as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to increase PrEP implementation and use among PWUD. We identified 32 peer-reviewed articles assessing determinants and five that evaluated change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR), which is an established framework to understand the multilevel barriers and facilitators associated with implementation. Findings indicate that most research was conducted among PrEP recipients (i.e., patients), focusing on awareness and willingness to use PrEP, with less focus on factors impacting clinicians and service delivery systems. Moreover, very few change methods have been evaluated to improve clinician adoption and adherence to CDC guidelines for PrEP provision and/or recipient uptake and adherence to PrEP. Future research is needed that focuses on factors impacting implementation from a clinician standpoint as well as innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence to guidelines. Implementation Science offers a wealth of knowledge to speed up the effort to end the HIV epidemic in the United States.
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Affiliation(s)
- James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Juan P Zapata
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Artur Quieroz
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Alithia Zamantakis
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Olutobi Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA
- Department of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Libman H, Krakower D, Taylor JL, Burns RB. How Would You Manage HIV Pre-exposure Prophylaxis in This Patient With Medical Comorbidities? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2024; 177:518-526. [PMID: 38588544 DOI: 10.7326/m24-0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Despite advances in treatment, HIV infection remains an important cause of morbidity and mortality, with more than 30 000 new cases diagnosed in the United States each year. There are several interventions traditionally used to prevent HIV transmission, but these vary in effectiveness and there are challenges to their implementation. In 2014, the Centers for Disease Control and Prevention published initial guidance on the use of antiretroviral pre-exposure prophylaxis (PrEP) to prevent transmission of HIV infection in persons at risk based on multiple studies that showed it to be highly efficacious in various populations. It was updated in 2021 to reflect new drug options. The U.S. Preventive Services Task Force also recently updated its recommendations for PrEP, which strongly support its use in persons at risk. Despite its well-established effectiveness, the implementation of PrEP in clinical practice has been variable, especially among populations underserved by the medical system and marginalized by society. Fewer than one third of persons in the United States who are eligible for PrEP currently receive it. Here, 2 physicians experienced in HIV PrEP debate how best to identify patients who might benefit from PrEP, how to decide what regimen to use, and how to monitor therapy.
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Affiliation(s)
- Howard Libman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (H.L., D.K., R.B.B.)
| | - Douglas Krakower
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (H.L., D.K., R.B.B.)
| | - Jessica L Taylor
- Boston University School of Medicine, Section of General Internal Medicine, Boston, Massachusetts (J.L.T.)
| | - Risa B Burns
- Beth Israel Deaconess Medical Center, Boston, Massachusetts (H.L., D.K., R.B.B.)
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McKellar MS, Des Marais AC, Chen H, Choi Y, Lilly R, Ayers D, Bennett J, Kestner L, Perry B, Poley S, Corneli A, Meade CS, Sachdeva N. Providing medication for opioid use disorder and HIV pre-exposure prophylaxis at syringe services programs via telemedicine: a pilot study. Harm Reduct J 2024; 21:69. [PMID: 38532395 PMCID: PMC10967138 DOI: 10.1186/s12954-024-00983-2] [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: 10/31/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at high risk for opioid overdose and infectious diseases including HIV. We piloted PARTNER UP, a telemedicine-based program to provide PWID with medication for opioid use disorder (MOUD) with buprenorphine/naloxone (bup/nx) and oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine through two syringe services programs (SSP) in North Carolina. We present overall results from this project, including participant retention rates and self-reported medication adherence. METHODS Study participants met with a provider for an initial in-person visit at the SSP, followed by weekly telemedicine visits in month 1 and then monthly until program end at month 6. Participants were asked to start both MOUD and PrEP at initiation but could choose to discontinue either at any point during the study. Demographics and health history including substance use, sexual behaviors, and prior use of MOUD/PrEP were collected at baseline. Follow-up surveys were conducted at 3- and 6-months to assess attitudes towards MOUD and PrEP, change in opioid use and sexual behaviors, and for self-reported medication adherence. Participant retention was measured by completion of visits; provider notes were used to assess whether the participant reported continuation of medication. RESULTS Overall, 17 persons were enrolled and started on both bup/nx and PrEP; the majority self-identified as white and male. At 3 months, 13 (76%) remained on study; 10 (77%) reported continuing with both MOUD and PrEP, 2 (15%) with bup/nx only, and 1 (8%) with PrEP only. At 6 months, 12 (71%) remained on study; 8 (67%) reported taking both bup/nx and PrEP, and 4 (33%) bup/nx only. Among survey participants, opioid use and HIV risk behaviors decreased. Nearly all reported taking bup/nx daily; however, self-reported daily adherence to PrEP was lower and declined over time. The most common reason for not continuing PrEP was feeling not at risk for acquiring HIV. CONCLUSIONS Our study results show that MOUD and PrEP can be successfully administered via telemedicine in SSPs. PrEP appears to be a lower priority for participants with decreased continuation and adherence. Low perception of HIV risk was a reason for not continuing PrEP, possibly mitigated by MOUD use. Future studies including helping identify PWID at highest need for PrEP are needed. TRIAL REGISTRATION Providing Suboxone and PrEP Using Telemedicine, NCT04521920. Registered 18 August 2020. https://clinicaltrials.gov/study/NCT04521920?term=mehri%20mckellar&rank=2 .
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Affiliation(s)
- Mehri S McKellar
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, P.O. Box 102359, Durham, NC, 27710, USA.
| | - Andrea C Des Marais
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Hillary Chen
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Yujung Choi
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Lilly
- North Carolina Harm Reduction Coalition, Wilmington, NC, USA
- Port City Harm Reduction, Wilmington, NC, USA
| | - Denae Ayers
- Queen City Harm Reduction, Charlotte, NC, USA
| | - Jesse Bennett
- North Carolina Harm Reduction Coalition, Wilmington, NC, USA
| | | | - Brian Perry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie Poley
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Amy Corneli
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, P.O. Box 102359, Durham, NC, 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Wake Forest University, Winston-Salem, NC, USA
| | - Nidhi Sachdeva
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- North Carolina Association of County Commissioners, Raleigh, NC, USA
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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [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: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Scheidell JD, Elliott LC, Bennett AS, Mahachi M, Lapple D, Nelson JA, Hobbs MM. Evaluation of self-directed specimen collection for chlamydia and gonorrhea testing among people who use drugs. Int J STD AIDS 2024; 35:217-227. [PMID: 37970785 DOI: 10.1177/09564624231215859] [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: 11/19/2023]
Abstract
Background: People who use drugs (PWUD) often have elevated sexually transmitted infection (STI) risk and unmet healthcare needs. Self-directed STI specimen collection (i.e., individuals collect the specimen and mail to the laboratory) may be valuable in addressing STI testing barriers among PWUD. Methods: Within a cohort study among PWUD in New York City, we conducted a cross-sectional substudy from November 2021-August 2022 assessing sexual health with a one-time online survey (n = 120); participants could opt-in to receive a self-collection kit. Participants who opted-in were mailed a kit containing collection materials (males: urine cup, females: vaginal swab), pre-paid return label, instructions, and educational information. Specimens were sent to the laboratory and tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). We measured the number of kits requested, delivered, mailed to the lab, and CT/GC positive; and examined differences in requesting a kit by sociodemographic and behavioral characteristics. Results: Sixty-three total kits were requested by 44 unique participants. Of the 63 requested, 41 were delivered; one kit was undeliverable at the provided address and the rest were not sent due to no address provided or being duplicate requests. Of the 41 kits delivered, three participants returned the kit to the lab; of those, one was positive for CT and GC. The greatest differences in those who did and did not request a kit were observed by age, sexual orientation, past-year sex trade and casual partnerships, and experiences of relationship violence. Conclusions: Self-directed specimen collection may be desirable for PWUD, but research is needed to understand barriers to this testing approach for this population.
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Affiliation(s)
- Joy D Scheidell
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
- Center for Drug Use and HIV/HCV Research, New York University, New York, NY, USA
| | - Luther C Elliott
- Center for Drug Use and HIV/HCV Research, New York University, New York, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Alex S Bennett
- Center for Drug Use and HIV/HCV Research, New York University, New York, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Muthoni Mahachi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Dana Lapple
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie Ae Nelson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marcia M Hobbs
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kamitani E, Mizuno Y, Koenig LJ. Strategies to Eliminate Inequity in PrEP Services in the US South and Rural Communities. J Assoc Nurses AIDS Care 2024; 35:153-160. [PMID: 37963267 PMCID: PMC11090982 DOI: 10.1097/jnc.0000000000000437] [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: 11/16/2023]
Abstract
ABSTRACT Inequity in preexposure prophylaxis (PrEP) care in the US South and rural communities is likely attributed to Social Determinants of Health and structural issues beyond individuals' control. We describe three approaches to modify PrEP care practice models to make access easier-"normalizing," "digitalizing," and "simplifying." "Normalizing" approaches are defined as practice models where medical providers who have access to PrEP candidates prescribe PrEP routinely (e.g., primary care providers, community pharmacists); these approaches are found to be highly applicable in real-world settings. Telehealth and other dHealth tools are examples of "digitalizing" PrEP, and their use has been increasing rapidly since the COVID-19 pandemic. "Simplifying" PrEP care (e.g., with HIV self-testing, on-demand PrEP) is highlighted in the most recent World Health Organization PrEP guideline. Identifying, implementing, and scaling up these new strategies can allow PrEP candidates to access it, potentially addressing inequities and promoting HIV risk reduction in the US South and rural communities.
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Affiliation(s)
- Emiko Kamitani
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| | - Linda J. Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
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Kamusiime B, Beima-Sofie K, Chhun N, Nalumansi A, Nalukwago GK, Kasiita V, Twesige CC, Kansiime R, Muwonge TR, Kyambadde P, Kadama H, Mudiope P, Glick S, Lambdin B, Mujugira A, Heffron R. "Take services to the people": strategies to optimize uptake of PrEP and harm reduction services among people who inject drugs in Uganda. Addict Sci Clin Pract 2024; 19:13. [PMID: 38395940 PMCID: PMC10893723 DOI: 10.1186/s13722-024-00444-y] [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: 09/02/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of HIV acquisition and often encounter barriers to accessing healthcare services. Uganda has high HIV prevalence among PWID and lacks integrated pre-exposure prophylaxis (PrEP) and harm reduction services. Understanding PWID experiences accessing and using harm reduction services and PrEP will inform strategies to optimize integration that align with PWID needs and priorities. METHODS Between May 2021 and March 2023, we conducted semi-structured interviews with PWID in Kampala, Uganda. We recruited participants with and without previous experience accessing harm reduction services and/or PrEP using purposive and snowball sampling. Interviews were audio recorded, translated, and transcribed. We used thematic analysis to characterize motivations for uptake of harm reduction and HIV prevention services, and strategies to optimize delivery of needle and syringe programs (NSP), medications for opioid use disorder (MOUD), and PrEP. RESULTS We conducted interviews with 41 PWID. Most participants were relatively aware of their personal HIV risk and accurately identified situations that increased risk, including sharing needles and engaging in transactional sex. Despite risk awareness, participants described engaging in known HIV risk behaviors to satisfy immediate drug use needs. All reported knowledge of harm reduction services, especially distribution of sterile needles and syringes, and many reported having experience with MOUD. Participants who had accessed MOUD followed two primary trajectories; limited resources and relationships with other PWID caused them to discontinue treatment while desire to regain something they believed was lost to their drug use motivated them to continue. Overall, PrEP knowledge among participants was limited and few reported ever taking PrEP. However, participants supported integrating PrEP into harm reduction service delivery and advocated for changes in how these services are accessed. Stigma experienced in healthcare facilities and challenges acquiring money for transportation presented barriers to accessing current facility-based harm reduction and HIV prevention services. CONCLUSIONS Meeting the HIV prevention needs of PWID in Uganda will require lowering barriers to access, including integrated delivery of PrEP and harm reduction services and bringing services directly to communities. Additional training in providing patient-centered care for healthcare providers may improve uptake of facility-based services.
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Affiliation(s)
- Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA.
| | - Nok Chhun
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
| | | | | | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Ritah Kansiime
- Most-At-Risk Populations Initiative (MARPI), National STI Control Unit, Kampala, Uganda
| | | | - Peter Kyambadde
- Most-At-Risk Populations Initiative (MARPI), National STI Control Unit, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
| | | | | | - Sara Glick
- Department of Medicine, University of Washington, Seattle, USA
| | - Barrot Lambdin
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- Research Triangle Institute, Berkeley, USA
- University of California San Francisco, San Francisco, USA
| | - Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Global Health, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
| | - Renee Heffron
- Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
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Wyllie TJS, Brown JL, Meisman A, Bayyari N, Mangeot C, Sun Q, Mullins TLK. Attitudes and Intentions toward Use of HIV Pre-Exposure Prophylaxis (PrEP) among Adults Receiving Treatment for Opioid Use. Subst Use Misuse 2024; 59:369-379. [PMID: 37917069 DOI: 10.1080/10826084.2023.2275556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background: Although pre-exposure prophylaxis (PrEP) prevents HIV, little is known about PrEP awareness and factors associated with intention to take PrEP among people with opioid use disorder (OUD). Methods: HIV-negative adults recruited from an outpatient treatment program in Cincinnati, Ohio completed self-administered surveys. Items derived from literature and health behavioral theory included demographics, sexual and drug use behaviors, HIV prevention practices, PrEP knowledge, and attitudes toward PrEP. Primary outcomes were 1) intention to ask a clinician about PrEP and 2) intention to accept PrEP if recommended by a clinician. Outcomes were dichotomized into higher vs. lower intention for analyses in logistic regression models. Results: Among 198 participants, 60.3% reported past injection drug use. Among 58 participants (29.3%) meeting criteria for PrEP, 24% were aware of PrEP, 15.5% had discussed it with a clinician, and 5% had taken it. Factors associated with intention to ask a clinician about PrEP included being somewhat confident about consistent condom use (p < 0.01), motivation to comply with normative beliefs (p < 0.01), and reporting that PrEP fits very well (p < 0.01) and is easy to fit (p < 0.01) into current prevention practices. Factors associated with intention to accept PrEP if recommended by a clinician included motivation to comply with normative beliefs (p < 0.01) and PrEP being easy to fit into current prevention practices (p < 0.01). Conclusion: Among participants meeting indications for PrEP, only 24% were aware of it and few had taken it. Interventions that normalize PrEP and target incorporating PrEP into current prevention practices may improve uptake among individuals with OUD.
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Affiliation(s)
- Tornia J S Wyllie
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Jennifer L Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Andrea Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nadia Bayyari
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
- College of Allied Health Sciences - School of Social Work, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colleen Mangeot
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Qin Sun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tanya L Kowalczyk Mullins
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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11
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Bonett S, Mahajan A, da Silva DT, Williams J, Brady K, Bauermeister J, Wood SM. Advancing the community plan to end the HIV Epidemic in Philadelphia: a qualitative descriptive evaluation of low-threshold PrEP services in sexual health clinics. Implement Sci Commun 2024; 5:4. [PMID: 38183133 PMCID: PMC10768374 DOI: 10.1186/s43058-023-00543-y] [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: 04/17/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method and a key component of Philadelphia's Community Plan to End the HIV Epidemic (EHE). However, significant barriers to accessing PrEP exist among people at risk for HIV. Low-threshold models for PrEP services that minimize barriers to entry and service engagement could help bolster access to PrEP through community-based clinics. This study aimed to describe the initial implementation of low-threshold PrEP services in three sexual health clinics funded by the Philadelphia Department of Public Health and explore strategies for delivering low-threshold PrEP services. METHODS We conducted three focus groups with staff (i.e., providers, prevention navigators, and administrative staff, N = 21) at each of three participating PDPH-funded sexual health clinics from November 2021 to January 2022. Discussion topics included details about the PrEP delivery process, clinic strengths and assets, resource gaps, and PrEP implementation goals. Follow-up interviews with staff members (N = 8) between March 2022 and May 2022 focused on identifying successful strategies for PrEP delivery and adaptations needed to optimize low-threshold PrEP service delivery. Rapid qualitative methods and the Consolidated Framework for Implementation Science were used to analyze data from focus groups and interviews. RESULTS Participants collaborated to create process maps that visualized the steps involved in delivering PrEP services within their respective settings. These maps highlighted several stages in PrEP service delivery, such as connecting individuals to services, providing prevention navigation, conducting clinical encounters, and ensuring follow-up care. Participants described effective strategies for implementing PrEP, which included integrating and co-locating services on-site, strengthening staffing resources and capacity, and addressing barriers experienced by clients. CONCLUSIONS Lessons from the implementation of low-threshold PrEP service delivery in Philadelphia can guide ongoing local adaptations and future scale-up of these models to improve access to PrEP and advance the goals of the EHE initiative.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | - Kathleen Brady
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah M Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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12
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Pines HA, Eger WH, Skaathun B, Vera CF, Harvey-Vera A, Rangel G, Strathdee SA, Bazzi AR. Willingness to use and distribute HIV self-testing kits among people who inject drugs in the San Diego-Tijuana border region. Harm Reduct J 2024; 21:4. [PMID: 38172795 PMCID: PMC10765917 DOI: 10.1186/s12954-023-00922-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND HIV self-testing (HIVST) could increase HIV testing access among people who inject drugs (PWID), and secondary distribution (i.e., peer-delivery) of HIVST kits in PWID social networks could further expand coverage. We assessed willingness to use and distribute HIVST kits among PWID in the San Diego-Tijuana border region. METHODS From 2020 to 2021, HIV-negative PWID in San Diego, USA, and Tijuana, Mexico, completed surveys and provided data on individual (N = 539) and social network (N = 366) characteristics. We used modified Poisson regression to examine the effects of individual and social network characteristics on willingness to use and distribute HIVST kits. RESULTS Most participants were willing to use (81%) and distribute (81%) HIVST kits. At the individual level, prior HIV testing was positively associated with willingness to use (adjusted prevalence ratio [aPR] = 1.24, 95% confidence interval [CI] 1.10-1.40) and distribute (aPR = 1.27, 95% CI 1.12-1.43) HIVST kits, while perceiving oneself to be at higher HIV risk than others was negatively associated with willingness to use HIVST kits (aPR = 0.83, 95% CI 0.74-0.93). At the network level, willingness to distribute HIVST kits was positively associated with network size (aPR = 1.04 per member, 95% CI 1.01-1.08) and greater proportions of one's network encouraging them to use drugs (aPR = 1.29, 95% CI 1.16-1.44) and having a history of homelessness (aPR = 1.51, 95% CI 1.31-1.74) or detention/arrest (aPR = 1.57, 95% CI 1.36-1.82), and negatively associated with a greater proportion of one's network including "very close" persons (aPR = 0.80, 95% CI 0.69-0.94). CONCLUSIONS We found high potential for HIVST kits and their secondary distribution to increase HIV testing among PWID who face the greatest barriers to facility-based testing.
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Affiliation(s)
- Heather A Pines
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
| | - William H Eger
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Britt Skaathun
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Carlos F Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Gudelia Rangel
- Mexico Section of the US-Mexico Border Health Commission, Tijuana, Baja California, Mexico
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | | | - Angela R Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- School of Public Health, Boston University, Boston, MA, USA
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13
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Dumchev K, Kornilova M, Makarenko O, Antoniak S, Liulchuk M, Cottrell ML, Varetska O, Morozova O. Low daily oral PrEP adherence and low validity of self-report in a randomized trial among PWID in Ukraine. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104284. [PMID: 38061223 PMCID: PMC10872244 DOI: 10.1016/j.drugpo.2023.104284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The efficacy of daily oral pre-exposure prophylaxis (PrEP) in preventing HIV transmission among people who inject drugs (PWID) was demonstrated over a decade ago. However, only a few studies among PWID have since measured PrEP adherence using laboratory markers. METHODS In this trial, we randomized recently injecting PWID in Kyiv, Ukraine, to receive daily oral TDF/FTC with or without SMS reminders. Enrollment and PrEP initiation took place at an HIV clinic. Subsequent visits at months 1, 3, and 6 were conducted at a community harm reduction center and included a structured interview, adherence counseling, PrEP dispensing, and dried blood spot collection. PrEP adherence was assessed using standard self-reported measures and TDF/FTC biomarkers. RESULTS A total of 199 PWID (99 SMS, 100 No-SMS) were enrolled, of whom 24 % were women, with a median age of 37. At month 6, 79.4 % (158/199) of participants were retained, with 84 % (133/158) reporting opioid injection and 20 % (31/158) reporting stimulant injection in the past 30 days. 77 % (122/158) reported taking >95 % of PrEP doses in the past month, and 87 % reported taking the last dose within 2 days. Tenofovir diphosphate was detected in 17 % (28/158) of participants, and emtricitabine triphosphate was detected in 25 % (40/158). Only 3 % (5/158) had metabolite levels indicative of consistent PrEP uptake at 4+ doses per week. There was no association between the SMS intervention and TDF/FTC metabolite detection. CONCLUSION Adherence to daily oral PrEP among actively injecting PWID, without daily supervision or incentives, was extremely low, despite supportive counseling and SMS reminders. We also observed a high rate of discordance between self-report and classification by a validated biomarker of adherence. Given the scarcity of evidence and emerging data suggesting low oral PrEP adherence among PWID, additional implementation studies with TDF/FTC biomarkers are needed to study whether a sufficient level of adherence to daily PrEP is attainable among PWID, especially as long-acting injectable PrEP offers a promising alternative.
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Affiliation(s)
| | - Marina Kornilova
- International Charitable Foundation "Alliance for Public Health", Kyiv, Ukraine
| | | | - Svitlana Antoniak
- Gromashevsky Institute of Epidemiology and Infectious Diseases, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Mariia Liulchuk
- Gromashevsky Institute of Epidemiology and Infectious Diseases, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Mackenzie L Cottrell
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States of America
| | - Olga Varetska
- International Charitable Foundation "Alliance for Public Health", Kyiv, Ukraine
| | - Olga Morozova
- Department of Public Health Sciences, Biological Sciences Division, University of Chicago, Chicago, Illinois, United States of America
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14
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Miley KL, Tran NK, Elopre L, Groves A, Stockman JK, Bazzi AR, Carrico A, Mazzella S, Roth AM. A Note on Preexposure Prophylaxis Preferences Among Women Who Inject Drugs. Sex Transm Dis 2023; 50:671-674. [PMID: 36728264 DOI: 10.1097/olq.0000000000001768] [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] [Indexed: 02/03/2023]
Abstract
ABSTRACT We informed women who inject drugs about different preexposure prophylaxis (PrEP) formulations; they then ranked their preferences. Daily oral PrEP was most preferred, followed by injectable PrEP and vaginal rings/gels, especially among women of color. Multiple PrEP options should be discussed with women who inject drugs to increase uptake.
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Affiliation(s)
- Kerry L Miley
- From the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Nguyen K Tran
- Department of Medicine, Stanford University, Palo Alto, CA
| | - Latesha Elopre
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Allison Groves
- From the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jamila K Stockman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Angela R Bazzi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL
| | | | - Alexis M Roth
- From the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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15
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Biello KB, Chan PA, Holcomb R, Ndoye CD, Valente PK, Maynard M, Gandhi M, Mayer KH, Mimiaga MJ. PrEPare for Work: A Pilot Randomized Controlled Trial of an Intervention to Optimize HIV PrEP Outcomes Among Male Sex Workers. AIDS Behav 2023; 27:3294-3305. [PMID: 36976389 PMCID: PMC10753039 DOI: 10.1007/s10461-023-04050-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) use is limited among male sex workers, who are at exceptionally high-risk for HIV infection. We developed a theory-informed, two-pronged intervention ("PrEPare-for-Work") to optimize PrEP initiation and adherence among male sex workers, which was preliminarily evaluated in a two-stage pilot randomized controlled trial of 110 male sex workers in the US Northeast. Individuals randomized to the Stage 1 PrEPare-for-Work Case Management arm were three times as likely as those in the standard of care (SOC) arm to initiate PrEP (RR = 2.95, 95% CI = 1.57-5.57). Participants who initiated PrEP and were randomized to the Stage 2 PrEPare-for-Work Adherence Counseling arm had higher rates of prevention-effective adherence (measured via tenofovir in hair) compared to those in the SOC arm (RR = 1.7, 95% CI 0.64-4.77; 55.6% vs. 28.6%, respectively); though not statistically significant. Given the need and the promise of this pilot RCT, further efficacy testing is warranted and should be prioritized.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- , 121 South Main Street, Providence, RI, 02912, USA.
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Medicine, Brown University, Providence, RI, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
- Rhode Island Department of Health, Providence, RI, USA
| | | | | | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, CT, USA
| | - Michaela Maynard
- Department of Medicine, Brown University, Providence, RI, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), CA, USA
| | | | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- UCLA Center for LGBTQ Advocacy, Research, and Health (C-LARAH), Los Angeles, CA, USA
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16
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Richterman A, Ghadimi F, Teitelman AM, Moore K, Acri T, North H, Lopez K, Ou V, Van Pelt AE, Momplaisir F. Acceptability and Feasibility of a Mobile Phone Application to Support HIV Pre-exposure Prophylaxis Among Women with Opioid Use Disorder. AIDS Behav 2023; 27:3460-3467. [PMID: 37036593 PMCID: PMC10526719 DOI: 10.1007/s10461-023-04060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
Despite evidence supporting HIV pre-exposure prophylaxis (PrEP) effectiveness, very few women with opioid use disorder (OUD) take PrEP. Interventions that improve medication assisted treatment (MAT) uptake and adherence may also be beneficial for PrEP. The reSET-O mobile phone app is a component of the evidence-based Therapeutic Education System, which improves retention and abstinence for people with OUD. To better understand use of this mobile health tool as a support for PrEP among women with OUD, pre-implementation contextual inquiry is needed. Therefore, we set out to assess target user characteristics, implementation barriers, feasibility, and acceptability of reSET-O. We recruited women with OUD receiving care from a community-based organization in Philadelphia to complete semi-structured interviews. All participants were prescribed reSET-O. We interviewed 20 participants (average age 37 years; 70% white, 15% Hispanic, 5% Black) from 5/2021 to 2/2022. We used an integrated analysis approach combining modified grounded theory and implementation science constructs. Half reported recent injection drug use, and 6 were taking buprenorphine. Mental health symptoms were common, and half described engaging in transactional sex. The majority expressed strong interest in PrEP. Participants reported the app would be highly acceptable for PrEP and MAT adherence support, but only two redeemed the prescription. The most common barriers included phone and internet access. Our findings highlight potential implementation challenges for the use of such an app to support PrEP use in this population. Poor uptake of the app at follow-up indicates that initial prescription redemption is a major barrier to reSET-O implementation.
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Affiliation(s)
- Aaron Richterman
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Vuthy Ou
- Courage Medicine, Philadelphia, PA, USA
| | - Amelia E Van Pelt
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Florence Momplaisir
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
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17
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Bartholomew TS, Tookes HE, Chueng TA, Bluthenthal RN, Wenger LD, Kral AH, Lambdin BH. Availability of telehealth-based services at syringe services programs under the COVID-19 Public Health Emergency. Harm Reduct J 2023; 20:122. [PMID: 37660029 PMCID: PMC10475193 DOI: 10.1186/s12954-023-00861-3] [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: 06/09/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION The expanded capacity of syringe services programs (SSPs) in the USA to integrate telehealth services was largely related to flexibility of buprenorphine prescription in response to the COVID-19 pandemic. SSPs demonstrated the potential of using telehealth to reach participants with both medical and non-medical services. The present study examines the implementation of medical and non-medical telehealth-based health services in 2020 at SSPs in the USA and organizational characteristics associated with adopting specific telehealth services. METHODS We administered a cross-sectional survey among all known SSPs operating in the USA as of 2021. The two primary study outcomes were (1) implementation of medical telehealth and (2) implementation of non-medical telehealth in 2020. Medical services included HIV counseling/care, hepatitis C virus (HCV) counseling/care, and buprenorphine. Non-medical services included wellbeing/check-ins, overdose prevention training, health navigation, harm reduction and psychological counseling. Bivariate and multivariable mixed effects logistic regression models were used to directly estimate the odds ratio associated with organizational characteristics on the implementation of telehealth-based health services. RESULTS Thirty percent of programs (n = 290) reported implementing telehealth-based health services. In multivariable logistic regression models, community-based organization SSPs had higher odds of implementing medical (aOR = 4.69, 95% CI [1.96, 11.19]) and non-medical (aOR = 2.18, 95% CI [1.10, 4.31]) health services compared to public health department SSPs. SSPs that received governmental funding had higher odds of implementing medical services via telehealth (aOR = 2.45, 95% CI [1.35, 4.47]) compared to programs without governmental funding. CONCLUSION Community-based organization SSPs and those with government funding had the highest odds of telehealth implementation in response to the COVID-19 Public Health Emergency. Federal, state, and local governments must increase funding for low-barrier venues like SSPs to support telehealth implementation to serve the needs of people who use drugs.
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Affiliation(s)
| | - Hansel E Tookes
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA.
| | - Teresa A Chueng
- University of Miami, 1120 NW 14th St #860, Miami, FL, 33136, USA
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18
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Strathdee SA, Abramovitz D, Harvey-Vera AY, Stamos-Buesig T, Vera CF, Artamonova I, Logan J, Patterson TL, Servin AE, Bazzi AR. A Brief Peer-Led Intervention to Increase COVID-19 Vaccine Uptake Among People Who Inject Drugs in San Diego County: Results From a Pilot Randomized Controlled Trial. Open Forum Infect Dis 2023; 10:ofad392. [PMID: 37547856 PMCID: PMC10404005 DOI: 10.1093/ofid/ofad392] [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: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Background We evaluated the impact of a brief peer-led intervention on COVID-19 vaccination among people who inject drugs (PWID) presenting at syringe services program (SSP) locations in San Diego County, California. Methods Between March and July 2022, PWID aged ≥18 years without recent voluntary COVID-19 testing who were not up to date on COVID-19 vaccinations received a single-session motivational interviewing intervention (LinkUP) or an attention-matched didactic control condition from trained peer counselors at SSP sites randomized by week. Following either 30-minute session, counselors offered referrals to local vaccination services. Multivariable log binomial regression via generalized estimating equations assessed LinkUP effects on (1) acceptance of COVID-19 vaccination referrals immediately postintervention and (2) COVID-19 vaccine uptake at 6-month follow-up. Results COVID-19 vaccination outcomes were obtained on 135 (90.6%) of 149 participants. In multivariable analysis, participants receiving LinkUP had greater acceptance of COVID-19 vaccination referrals than controls (adjusted relative risk, 3.50; 95% CI, 1.01-12.2) and were marginally more likely to report receiving a new COVID-19 vaccine dose (adjusted relative risk, 1.57; 95% CI, .99-2.48). After 6 months, 20% reported receiving a new vaccine dose; however, if COVID-19 vaccine had been available at SSPs, this proportion could have been as high as 34.3% (45.3% LinkUP vs 24.3% control; P = .01). Conclusions A brief peer-led SSP-based intervention significantly improved COVID-19 vaccination among PWID. Further improvements could likely be obtained by supporting SSPs to offer COVID-19 vaccination on-site instead of relying on referrals. Clinical Trials Registration ClinicalTrials.gov NCT05181657.
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Affiliation(s)
| | - Daniela Abramovitz
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alicia Y Harvey-Vera
- School of Medicine, University of California San Diego, La Jolla, California, USA
- Facultad de Medicina, Universidad Xochicalco, Tijuana, Mexico
- United States–Mexico Border Health Commission, Tijuana, Mexico
| | - Tara Stamos-Buesig
- OnPoint, Harm Reduction Coalition of San Diego, San Diego, California, USA
| | - Carlos F Vera
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Irina Artamonova
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jenna Logan
- OnPoint, Harm Reduction Coalition of San Diego, San Diego, California, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Argentina E Servin
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
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19
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Rosen JG, Zhang L, Pelaez D, Park JN, Glick JL. A Capacity-Strengthening Intervention to Support HIV Pre-exposure Prophylaxis (PrEP) Awareness-Building and Promotion by Frontline Harm Reduction Workers in Baltimore, Maryland: A Mixed Methods Evaluation. AIDS Behav 2023; 27:2440-2453. [PMID: 36596866 PMCID: PMC9810241 DOI: 10.1007/s10461-022-03971-4] [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] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention tool among people who inject drugs (PWID). We developed and piloted an intervention to bolster PrEP promotion competencies among frontline harm reduction workers (FHRW) serving PWID clients in Baltimore, Maryland. Between December 2021 and February 2022, we developed and facilitated four trainings, which included didactic and practice-based/role-playing components, with 37 FHRW from four organizations. FHRW completed three structured surveys (pretest, posttest, 6-week posttest) and in-depth interviews (n = 14) to measure changes in PrEP promotion competencies attributable to training participation. PrEP knowledge and self-efficacy increased significantly (p < 0.001) from pretest to posttest, sustained through 6-week posttest. The proportion of FHRW discussing PrEP with clients doubled during the evaluation period (30-67%, p = 0.006). Feeling empowered to discuss PrEP and provision of population-tailored PrEP information were facilitators of PrEP promotion, while limited client interaction frequency/duration, privacy/confidentiality concerns, and anticipated PrEP stigma by clients inhibited PrEP promotion. Our capacity-strengthening intervention successfully increased PrEP knowledge, self-efficacy, and promotion among FHRW, affirming the adaptability and feasibility of integrating our training toolkit into FHRW practice across implementation settings.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center of Biomedical Research Excellent on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Paulus K, Kelly PJ, Brajuha J, D’Avanzo P, Dauria EF, Trainor A, Alrez A, Bass SB. The relationship of PrEP beliefs to perceived personal, interpersonal and structural benefits and barriers to PrEP use in women who inject drugs. BMC Womens Health 2023; 23:303. [PMID: 37291563 PMCID: PMC10251529 DOI: 10.1186/s12905-023-02452-7] [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: 09/15/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Women who inject drugs (WWID) have significant biological, behavioral, and gender-based barriers to accessing HIV prevention services, including Pre-Exposure Prophylaxis (PrEP) medication. Little is known about how beliefs about PrEP impact both perceived barriers and benefits of PrEP use and how they may be related to the decision-making process. METHODS Surveys were conducted with 100 female clients of a large syringe services program in Philadelphia, Pennsylvania. The sample was categorized into three groups based on mean PrEP beliefs scores using terciles: accurate beliefs, moderately accurate beliefs, and inaccurate beliefs. Oneway ANOVA tests were used to compare groups by perceived benefits and barriers to PrEP, drug use stigma, healthcare beliefs, patient self-advocacy, and intention to use PrEP. RESULTS Participants had a mean age of 39 years (SD 9.00), 66% reported being White, 74% finished high school, and 80% reported having been homeless within the past 6 months. Those with the most accurate PrEP beliefs reported highest intent to use PrEP and were more likely to agree that benefits of PrEP included it preventing HIV and helping them "feel in charge". Those with inaccurate beliefs were more likely to strongly agree that barriers, such as fear of reprisal from a partner, potential theft, or feeling they "might get HIV anyway", were reasons not to use PrEP. CONCLUSIONS Results indicate perceived personal, interpersonal and structural barriers to PrEP use are associated with accuracy of beliefs is, pointing to important intervention targets to increase uptake among WWID.
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Affiliation(s)
- Kirsten Paulus
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Patrick J.A. Kelly
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, USA
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, USA
| | - Paul D’Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Emily F. Dauria
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, 130 De Soto Street, Pittsburgh, 15261 USA
| | - Aurora Trainor
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Annabelle Alrez
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
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21
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Martin AK, Perryman T, Bernstein JA, Taylor JL, Cruz R, Muroff J, Samet JH, Assoumou SA. Peer recovery coaching for comprehensive HIV, hepatitis C, and opioid use disorder management: The CHORUS pilot study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100156. [PMID: 37113387 PMCID: PMC10126838 DOI: 10.1016/j.dadr.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023]
Abstract
Introduction Amidst a surge in HIV and hepatitis C virus (HCV) infections in persons who use drugs, medications that effectively prevent HIV and treat opioid use disorder and HCV remain underutilized. Methods We developed a 6-month peer recovery coaching intervention (brief motivational interviewing followed by weekly virtual or in-person coaching) and collected data on uptake of medications for opioid use disorder (MOUD), HIV pre-exposure prophylaxis (PrEP), and HCV treatment. The primary outcomes were intervention acceptability and feasibility. Results At a Boston substance use disorder bridge clinic, we enrolled 31 HIV-negative patients who used opioids. Participants reported high intervention satisfaction at 6 months (95% "satisfied" or "very satisfied"). At study completion, 48% of the participants were on MOUD, 43% who met CDC guidelines were on PrEP, and 22% with HCV were engaged with treatment. Conclusions A peer recovery coaching intervention is feasible and acceptable, with positive preliminary findings regarding MOUD, PrEP and HCV treatment uptake.
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Affiliation(s)
- Anna K. Martin
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Tyshaun Perryman
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Judith A. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Jessica L. Taylor
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, United States
| | - Ricardo Cruz
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jordana Muroff
- Boston University School of Social Work, Boston, MA, United States
| | - Jeffrey H. Samet
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, United States
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22
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Bazzi AR, Abramovitz D, Harvey-Vera A, Stamos-Buesig T, Vera CF, Artamonova I, Logan J, Patterson TL, Strathdee SA. Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial. Ann Behav Med 2023; 57:472-482. [PMID: 37029714 PMCID: PMC10205139 DOI: 10.1093/abm/kaad012] [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: 04/09/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) have low rates of COVID-19 testing yet are vulnerable to severe disease. In partnership with a mobile syringe service program (SSP) in San Diego County, CA, we developed the evidence-, community-, and Social Cognitive Theory-informed "LinkUP" intervention (tailored education, motivational interviewing, problem-solving, and planning) to increase COVID-19 testing uptake among PWID. PURPOSE To assess preliminary efficacy of LinkUP in increasing PWID COVID-19 testing in a pilot randomized controlled trial (RCT). METHODS We referred participants (PWID, ≥18 years old, San Diego County residents who had not recently undergone voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week) to offer the active LinkUP intervention or didactic attention-control conditions delivered by trained peer counselors. Following either condition, counselors offered on-site rapid COVID-19 antigen testing. Analyses estimated preliminary intervention efficacy and explored potential moderation. RESULTS Among 150 participants, median age was 40.5 years, 33.3% identified as Hispanic/Latinx, 64.7% were male, 73.3% were experiencing homelessness, and 44.7% had prior mandatory COVID-19 testing. The LinkUP intervention was significantly associated with higher COVID-19 testing uptake (p < .0001). Homelessness moderated intervention effects; LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.80; 95% CI: 1.56-2.09; p < .0001) than those not experiencing homelessness (aRR: 1.20; 95% CI: 1.01-1.43; p = .04). CONCLUSIONS Findings from this pilot RCT support the preliminary efficacy of the "LinkUP" intervention to increase COVID-19 testing among PWID and underscore the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Daniela Abramovitz
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
| | - Alicia Harvey-Vera
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
- Universidad Xochicalco, Facultad de Medicina, Tijuana, BC, Mexico
- United States-Mexico Border Health Commission, Tijuana, BC, Mexico
| | | | - Carlos F Vera
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
| | - Irina Artamonova
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
| | - Jenna Logan
- OnPoint, Harm Reduction Coalition of San Diego, San Diego, CA, USA
| | | | - Steffanie A Strathdee
- Department of Medicine, School of Medicine, University of California, San Diego; La Jolla, CA, USA
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23
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Glick JL, Zhang L, Rosen JG, Yaroshevich K, Atiba B, Pelaez D, Park JN. A Novel Capacity-Strengthening Intervention for Frontline Harm Reduction Workers to Support Pre-exposure Prophylaxis Awareness-Building and Promotion Among People Who Use Drugs: Formative Research and Intervention Development. JMIR Form Res 2023; 7:e42418. [PMID: 37052977 PMCID: PMC10141312 DOI: 10.2196/42418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. OBJECTIVE We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. METHODS Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. RESULTS The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. CONCLUSIONS This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide.
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Affiliation(s)
- Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Bakari Atiba
- Charm City Care Connection, Baltimore, MD, United States
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Ju Nyeong Park
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center of Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, RI, United States
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Tanner MR, Zhu W, Iqbal K, Dominguez KL, Yu L, Hayes TD, Wiener J, Koenig LJ, Batey S, Burgess S, Elamin F, Fox A, Price A, Wood L, Hoover KW. HIV Pre-exposure Prophylaxis Services for Black and Hispanic or Latino Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in THRIVE, 2015-2020. J Acquir Immune Defic Syndr 2023; 92:286-292. [PMID: 36484556 DOI: 10.1097/qai.0000000000003138] [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: 06/16/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND SETTING From 2015 to 2020, the THRIVE project supported 7 US health departments to improve HIV prevention services for Black or African American (Black) and Hispanic or Latino gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). METHODS We described services provided in the THRIVE PrEP continuum. Using Poisson regression models, we estimated associations between race or ethnicity and age and PrEP screening, linkage, and prescription. We examined associations between colocation of services and PrEP linkage and prescription for 2 sites. RESULTS THRIVE served 12,972 GBM without HIV; 37% of PrEP-eligible GBM were prescribed PrEP. THRIVE served 1185 TGW without HIV; 45% of PrEP-eligible TGW were prescribed PrEP. Black and Hispanic or Latino GBM were 29% (RR = 0.71, 95% CI: 0.66-0.77) and 19% (RR = 0.81, 95% CI: 0.75-0.87) less likely, respectively, to be prescribed PrEP than White GBM. GBM aged 18-24 years and 55 years or older were 19% (RR = 0.81, 95% CI: 0.75-0.87) and 22% (RR = 0.78, 95% CI: 0.67-0.9) less likely, respectively, to be prescribed PrEP compared with those aged 35-44 years. Colocated services were associated with a 54% (RR = 1.54, 95% CI: 1.44-1.64) and a 31% (RR = 1.31, 95% CI: 1.19-1.43) greater likelihood of PrEP linkage and prescription, respectively, compared with services at different locations. CONCLUSIONS THRIVE provided PrEP to higher proportions of PrEP-eligible persons than current national estimates; however, PrEP use disparities persist. Colocation of services may be a useful component of jurisdictional strategies to increase PrEP coverage.
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Affiliation(s)
- Mary R Tanner
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Weiming Zhu
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kashif Iqbal
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kenneth L Dominguez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lei Yu
- DLH Corporation, Atlanta, GA
| | | | - Jeffrey Wiener
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda J Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Scott Batey
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | - Anthony Fox
- District of Columbia Department of Health, Washington, DC
| | - Ashley Price
- Baltimore City Health Department, Baltimore, MD; and
| | - Lucila Wood
- New York City Department of Health and Mental Hygiene, New York City, New York
| | - Karen W Hoover
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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25
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Bazzi AR, Bordeu M, Baumgartner K, Sproesser DM, Bositis CM, Krakower DS, Mimiaga MJ, Biello KB. Study protocol for an efficacy trial of the "PrEP for Health" intervention to increase HIV PrEP use among people who inject drugs. BMC Public Health 2023; 23:513. [PMID: 36932369 PMCID: PMC10021034 DOI: 10.1186/s12889-023-15429-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND HIV incidence has recently increased among people who inject drugs (PWID) across the United States, with outbreaks occurring in states with long-standing syringe service programs (SSPs) including Massachusetts (MA). Antiretroviral pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy recommended for PWID, but uptake in this marginalized population is extraordinarily low. METHODS We describe the design and procedures for a National Institute on Drug Abuse (NIDA)-funded (R01) randomized controlled trial (RCT) testing the efficacy of "PrEP for Health," a multicomponent behavioral intervention to increase PrEP uptake, adherence, and persistence among HIV-negative PWID attending SSPs in two areas of the U.S. Northeast that are heavily affected by injection-related HIV transmission. Participants are equally randomized to receive the "PrEP for Health" intervention (involving individually tailored HIV and PrEP education, motivational interviewing, problem-solving skills and planning, and ongoing navigation support) or an enhanced standard of care (eSOC) control condition involving a brief educational video on the utility of PrEP for HIV prevention. Co-primary outcomes are PrEP uptake (using medical/pharmacy records) and adherence (using tenofovir quantification in hair samples); a secondary outcome is PrEP persistence (using medical/pharmacy records) over 12 months. Major assessments occur at baseline, 1-, 3-, 6-, and 12-month follow-up visits. Planned analyses will examine intervention efficacy, specific hypothesized conceptual mediators of the intervention effect (e.g., self-perceived HIV risk; PrEP knowledge, interest in use, motivation, and behavioral skills) and epidemiologically linked moderators (e.g., age; gender; condomless vaginal or anal sex). DISCUSSION Findings from our extensive preliminary research with the study population revealed that a multicomponent, theory-based intervention targeting PrEP knowledge, motivation, self-efficacy, behavioral skills, and structural barriers to PrEP access is urgently needed for PWID who are at risk of HIV acquisition. We also learned that SSPs represent a highly acceptable service setting for delivering such interventions. In this study, we are evaluating the efficacy of the "PrEP for Health" intervention. If efficacious, findings from our implementation evaluation could help guide its dissemination to diverse SSPs and possibly other community-based settings accessed by this population. TRIAL REGISTRATION ClinicalTrials.gov number NCT04430257, registered June 12, 2020.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, San Diego, La Jolla, 92093, CA, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, 92161, CA, USA.
| | | | | | | | - Christopher M Bositis
- Greater Lawrence Family Health Center, Lawrence, MA, USA
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Douglas S Krakower
- Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew J Mimiaga
- Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Katie B Biello
- Fenway Health, Boston, MA, USA.
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, 02912, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
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26
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Bazzi AR, Shaw LC, Biello KB, Vahey S, Brody JK. Patient and Provider Perspectives on a Novel, Low-Threshold HIV PrEP Program for People Who Inject Drugs Experiencing Homelessness. J Gen Intern Med 2023; 38:913-921. [PMID: 35614171 PMCID: PMC9132566 DOI: 10.1007/s11606-022-07672-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND HIV outbreaks among people who inject drugs (PWID) and experience homelessness are increasing across the USA. Despite high levels of need, multilevel barriers to accessing antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention persist for this population. The Boston Health Care for the Homeless Program (BHCHP) initiated a low-threshold, outreach-based program to support engagement in PrEP services among PWID experiencing homelessness. METHODS To inform dissemination efforts, we explored patient and provider perspectives on key program components. From March to December 2020, we conducted semi-structured qualitative interviews with current and former BHCHP PrEP program participants and prescribers, patient navigators, and outreach workers (i.e., providers). Thematic analysis explored perspectives on key program components. RESULTS Participants (n = 21) and providers (n = 11) identified the following five key components of BHCHP's PrEP program that they perceived to be particularly helpful for supporting patient engagement in PrEP services: (1) community-driven PrEP education; (2) low-threshold, accessible programming including same-day PrEP prescribing; (3) tailored prescribing supports (e.g., on-site pharmacy, short-term prescriptions, medication storage); (4) intensive outreach and navigation; and (5) trusting, respectful patient-provider relationships. DISCUSSION Findings suggest that more patient-centered services formed the basis of BHCHP's innovative, successful PrEP program. While contextual challenges including competing public health emergencies and homeless encampment "sweeps" necessitate ongoing programmatic adaptations, lessons from BHCHP's PrEP program can inform PrEP delivery in a range of community-based settings serving this population, including syringe service programs and shelters.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, CA, 92161, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Leah C Shaw
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Seamus Vahey
- Boston Healthcare for the Homeless Program, Boston, MA, USA
| | - Jennifer K Brody
- Boston Healthcare for the Homeless Program, Boston, MA, USA
- Harvard Medical School, Boston, USA
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Shaw G, Schaefer R, Schmidt HMA, Madden A, Chang J, Mozalevskis A, Msimanga-Radebe B, Mangadan Konath N, Verster A, Baggaley R, Rodolph M, Macdonald V. Pre-exposure prophylaxis (PrEP) for HIV prevention among people who inject drugs: a global mapping of service delivery. Harm Reduct J 2023; 20:16. [PMID: 36782321 PMCID: PMC9924874 DOI: 10.1186/s12954-023-00729-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends oral pre-exposure prophylaxis (PrEP) for all people at substantial risk of HIV as part of combination prevention. The extent to which this recommendation has been implemented globally for people who inject drugs is unclear. This study mapped global service delivery of PrEP for people who inject drugs. METHODS Between October and December 2021, a desk review was conducted to obtain information on PrEP services for people who inject drugs from drug user-led networks and HIV, harm reduction, and human rights stakeholders. Websites of organizations involved in HIV prevention or services for people who inject drugs were searched. Models of service delivery were described in terms of service location, provider, and package. RESULTS PrEP services were identified in 27 countries (15 high-income). PrEP delivery models varied within and across countries. In most services, PrEP services were implemented in healthcare clinics without direct links to other harm reduction services. In three countries, PrEP services were also provided at methadone clinics. In 14 countries, PrEP services were provided through community-based models (outside of clinic settings) that commonly involved peer-led outreach activities and integration with harm reduction services. CONCLUSIONS This study indicates limited PrEP availability for people who inject drugs. There is potential to expand PrEP services for people who inject drugs within harm reduction programs, notably through community-based and peer-led services. PrEP should never be offered instead of evidence-based harm reduction programs for people who inject drugs; however, it could be offered as an additional HIV prevention choice as part of a comprehensive harm reduction program.
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Affiliation(s)
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Heather-Marie A Schmidt
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland ,UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | - Annie Madden
- International Network of People who Use Drugs, London, UK
| | - Judy Chang
- International Network of People who Use Drugs, London, UK
| | - Antons Mozalevskis
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | | | | | - Annette Verster
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Rachel Baggaley
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Michelle Rodolph
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Virginia Macdonald
- grid.3575.40000000121633745Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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Corneli A, Perry B, Des Marais A, Choi Y, Chen H, Lilly R, Ayers D, Bennett J, Kestner L, Meade CS, Sachdeva N, McKellar MS. Participant perceptions on the acceptability and feasibility of a telemedicine-based HIV PrEP and buprenorphine/naloxone program embedded within syringe services programs: a qualitative descriptive evaluation. Harm Reduct J 2022; 19:132. [PMID: 36463214 PMCID: PMC9719634 DOI: 10.1186/s12954-022-00718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at risk for HIV and opioid overdose. We piloted PARTNER UP, a telemedicine-based program to provide PWID with access to both oral pre-exposure prophylaxis (PrEP) for HIV prevention and medication for opioid use disorder (MOUD) through two syringe services programs (SSPs) in North Carolina. We conducted a qualitative evaluation to assess the acceptability and feasibility of PARTNER UP from the participant perspective. METHODS PARTNER UP participants met with a provider for an initial in-person visit at the SSP, followed by weekly telemedicine visits in month 1 and then monthly telemedicine visits until program end at month 6. Using a qualitative descriptive study design, we conducted in-depth interviews with a subsample of PARTNER UP participants at 1 month and 4 months. Informed by the technology acceptance model, we assessed participant perceptions of the usefulness and ease of use of PARTNER UP, as well as their intent to continue to use the program's components. We audio-recorded all interviews with participants' permission and used applied thematic analysis to analyze the verbatim transcripts. RESULTS We interviewed 11 of 17 people who participated in PARTNER UP-10 in the month 1 interview and 8 in the month 4 interview. Nearly all participants were motivated to join for consistent and easy access to buprenorphine/naloxone (i.e., MOUD); only a few joined to access PrEP. Most were comfortable accessing healthcare at the SSP because of their relationship with and trust toward SSP staff, and accessing services at the SSP was preferred compared with other healthcare centers. Some participants described that telemedicine allowed them to be honest and share more information because the visits were not in-person and they chose the location, although the initial in-person meeting was helpful to build provider trust and rapport. Most participants found the visit schedule to be feasible, although half described needing to reschedule at least once. Nearly all participants who were interviewed intended to continue with MOUD after the program ended, whereas none were interested in continuing with PrEP. CONCLUSIONS Participant narratives suggest that the PARTNER UP telemedicine program was acceptable and feasible. Future studies should continue to explore the benefits of embedding both PrEP and MOUD into SSPs with larger numbers of participants. Trial registration Clinicaltrials.gov Identifier: NCT04521920.
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Affiliation(s)
- Amy Corneli
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA ,grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA
| | - Brian Perry
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Andrea Des Marais
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Yujung Choi
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Hillary Chen
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA
| | - Rebecca Lilly
- North Carolina Harm Reduction Coalition, Wilmington, NC USA ,Present Address: Port City Harm Reduction, Wilmington, NC USA
| | - Denae Ayers
- Queen City Harm Reduction, Charlotte, NC USA
| | - Jesse Bennett
- North Carolina Harm Reduction Coalition, Wilmington, NC USA
| | | | - Christina S. Meade
- grid.26009.3d0000 0004 1936 7961Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Nidhi Sachdeva
- grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC 27701 USA ,grid.10698.360000000122483208Present Address: North Carolina Association of County Commissioners, Raleigh, NC USA
| | - Mehri S. McKellar
- grid.26009.3d0000 0004 1936 7961Department of Medicine, Duke University School of Medicine, Durham, NC USA
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Barry MP, Austin EJ, Bhatraju EP, Glick SN, Stekler JD, Tung EL, Hansen RN, Williams EC, Gojic AJ, Pickering EI, Tsui JI. Qualitative inquiry into perceptions of HIV pre-exposure prophylaxis among people who inject drugs living with hepatitis C in Seattle, WA, USA. Harm Reduct J 2022; 19:121. [PMID: 36320005 PMCID: PMC9628120 DOI: 10.1186/s12954-022-00706-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/07/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The incidence of HIV among persons who inject drugs (PWID) in the USA has been increasing since 2014, signaling the need to identify effective ways to engage PWID in HIV prevention services, namely pre-exposure prophylaxis (PrEP). Yet, the uptake of PrEP in this population is minimal compared to other populations at risk of HIV acquisition. In this work, we sought to explore knowledge, attitudes, and perspectives of PrEP acceptability among PWID. METHODS In the context of a pilot study to explore the acceptability of pharmacy-based hepatitis C virus (HCV) treatment, we conducted semi-structured interviews (n = 24) and focus groups (n = 4, 16 participants) with people who were living with HCV and reported active injection drug use (≤ 90 days since last use). Participants were asked open-ended questions about their familiarity with and motivation to use PrEP. As part of a sub-analysis focused on PrEP, qualitative data were analyzed using a Rapid Assessment Process, where three coders used structured templates to summarize qualitative data and iteratively reviewed coded templates to identify themes. Participants also completed short quantitative questionnaires regarding drug use history and attitudes toward health concerns. RESULTS Forty-seven percent of participants expressed having little or no concern regarding HIV acquisition. Targeted analyses focused on HIV prevention identified three themes, which help characterize behavioral determinants of nonadoption. First, knowledge of PrEP was limited among PWID and influenced by infrequent open community discussions around HIV risk. Second, PWID perceived sexual behaviors-but not injection drug use-as a motivator for HIV risk prevention. Finally, PWID identified many individual and environmental barriers that hinder PrEP uptake. CONCLUSION Among PWID, PrEP is rarely discussed and concerns about the feasibility of using daily PrEP are common. Taken with the prevalent perception that drug use is not a high risk for HIV acquisition, our findings point to opportunities for public health work to target PrEP education to PWID and to leverage other successful interventions for PWID as an opportunity to provide PrEP to this vulnerable population.
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Affiliation(s)
- Michael P Barry
- Department of Epidemiology, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 8th Floor, Box 351619, Seattle, WA, 98195, USA
- HIV/STD Program, Public Health - Seattle and King County, 401 5th Ave. Suite 1300, Seattle, WA, 98104, USA
| | - Elizabeth J Austin
- Department of Health Systems and Population Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 4th Floor, Box 351621, Seattle, WA, 98195, USA
| | - Elenore P Bhatraju
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA
| | - Sara N Glick
- HIV/STD Program, Public Health - Seattle and King County, 401 5th Ave. Suite 1300, Seattle, WA, 98104, USA
- Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA
| | - Joanne D Stekler
- Department of Epidemiology, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 8th Floor, Box 351619, Seattle, WA, 98195, USA
- Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific St., Box 356423, Seattle, WA, 98195, USA
- Department of Global Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 7th Floor, Seattle, WA, 98195, USA
| | - Elyse L Tung
- Kelley-Ross Pharmacy Group, Seattle, WA, USA
- Department of Pharmacy, University of Washington, H375 Health Science Building, Box 357630, Seattle, WA, 98195-7630, USA
| | - Ryan N Hansen
- Department of Health Systems and Population Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 4th Floor, Box 351621, Seattle, WA, 98195, USA
- Kelley-Ross Pharmacy Group, Seattle, WA, USA
- Department of Pharmacy, University of Washington, H375 Health Science Building, Box 357630, Seattle, WA, 98195-7630, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, Hans Rosling Center, School of Public Health, University of Washington, 3980 15th Ave. NE, 4th Floor, Box 351621, Seattle, WA, 98195, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound, 1660 South Columbia Way, Building 101, Room 4E51, Seattle, WA, 98108, USA
| | - Alexander J Gojic
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA
| | - Eleanor I Pickering
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA.
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HIV Exposure Prophylaxis Delivery in a Low-barrier Substance Use Disorder Bridge Clinic during a Local HIV Outbreak at the Onset of the COVID-19 Pandemic. J Addict Med 2022; 16:678-683. [PMID: 36383918 PMCID: PMC9653062 DOI: 10.1097/adm.0000000000000991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES People who inject drugs (PWID) may experience high human immunodeficiency virus (HIV) risk and inadequate access to biomedical HIV prevention. Emerging data support integrating HIV post-exposure and pre-exposure prophylaxis (PEP, PrEP) into services already accessed by PWID. We describe PEP/PrEP eligibility and receipt in a low-barrier substance use disorder bridge clinic located in an area experiencing an HIV outbreak among PWID at the onset of the COVID-19 pandemic. METHODS Retrospective chart review of new patients at a substance use disorder bridge clinic in Boston, MA (January 15, 2020-May 15, 2020) to determine rates of PEP/PrEP eligibility and prescribing. RESULTS Among 204 unique HIV-negative patients, 85.7% were assessed for injection-related and 23.0% for sexual HIV risk behaviors. Overall, 55/204 (27.0%) met CDC criteria for HIV exposure prophylaxis, including 7/204 (3.4%) for PEP and 48/204 (23.5%) for PrEP. Four of 7 PEP-eligible patients were offered PEP and all 4 were prescribed PEP. Thirty-two of 48 PrEP eligible patients were offered PrEP, and 7/48 (14.6%) were prescribed PrEP. Additionally, 6 PWID were offered PrEP who lacked formal CDC criteria. CONCLUSIONS Bridge clinics patients have high rates of PEP/PrEP eligibility. The majority of patients with identified eligibility were offered PEP/PrEP, suggesting that upstream interventions that increase HIV risk assessment may support programs in initiating PEP/PrEP care. Additional work is needed to understand why patients declined PEP/PrEP. PrEP offers to PWID who did not meet CDC criteria also suggested provider concern regarding the sensitivity of CDC criteria among PWID. Overall, bridge clinics offer a potential opportunity to increase biomedical HIV prevention service delivery.
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Inghels M, Kim HY, Tanser F, Hettema A, McMahon SA, Oldenburg CE, Matse S, Kohler S, Geldsetzer P, Bärnighausen T. PrEP uptake and delivery setting preferences among clients visiting six healthcare facilities in Eswatini. AIDS Behav 2022; 26:3345-3355. [PMID: 35429309 PMCID: PMC9474345 DOI: 10.1007/s10461-022-03646-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/01/2022]
Abstract
Due to the high HIV incidence among the general population of Eswatini, pre-exposure prophylaxis (PrEP) for HIV-exposed individuals is recommended. However, little is known about PrEP uptake and preferences in PrEP delivery healthcare setting among the general population. We conducted a secondary analysis of a randomized trial that aimed to increase PrEP uptake. All clients eligible for PrEP in one of six public-sector healthcare facilities in Eswatini were included. PrEP uptake was stratified by initial reason for visit (e.g. outpatient). Preferences in PrEP delivery setting were collected among those clients who initiated PrEP. A total of 1782 clients had their HIV acquisition risk assessed. Of these, 72% (1277/1782) were considered at risk by healthcare providers and, among them, 40% (517/1277) initiated PrEP. Uptake was higher among clients visiting specifically to initiate PrEP (93%), followed by HIV testing visits (45.8%) and outpatient visits (40%). Among those who initiated PrEP, preferred delivery settings were outpatient services (31%), HIV testing services (26%), family planning (21%) and antenatal services (14%). Men or those at high risk of HIV acquisition were more likely to prefer HIV testing and outpatient services, while young women were more likely to visit and express a preference for antenatal and family planning services. Outpatient services and HIV testing services could be preferable choices for PrEP delivery integration, due to the high PrEP uptake and delivery setting preferences of the populations who use these services. Antenatal and family planning could also be considered with a view to targeting the youngest women.
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Affiliation(s)
- Maxime Inghels
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, LN6 7TS, Lincoln, UK.
- Centre Population et Développement, UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France.
| | - Hae-Young Kim
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
- KwaZulu-Natal Innovation and Sequencing Platform, KwaZulu-Natal, South Africa.
| | - Frank Tanser
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, LN6 7TS, Lincoln, UK.
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
| | - Anita Hettema
- Clinton Health Access Initiative, H100, Mbabane, Eswatini, Swaziland.
| | - Shannon A McMahon
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, 69120, Heidelberg, Germany.
- Bloomberg School of Public Health, Johns Hopkins University, 21205, Baltimore, MD, USA.
| | - Catherine E Oldenburg
- Department of Ophthalmology, University of California, San Francisco, 94115, San Francisco, CA, USA.
- Francis I. Proctor Foundation, University of California, San Francisco, 94122, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, 94158, San Francisco, CA, USA.
| | - Sindy Matse
- Eswatini Ministry of Health, Mbabane, Eswatini, Swaziland.
| | - Stefan Kohler
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, 69120, Heidelberg, Germany.
- Institute of Social Medicine, Epidemiology and Health Economics, Charité?Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States.
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa.
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, 69120, Heidelberg, Germany.
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Bazzi AR, Harvey-Vera A, Buesig-Stamos T, Abramovitz D, Vera CF, Artamonova I, Patterson TL, Strathdee SA. Study protocol for a pilot randomized controlled trial to increase COVID-19 testing and vaccination among people who inject drugs in San Diego County. Addict Sci Clin Pract 2022; 17:48. [PMID: 36064745 PMCID: PMC9444113 DOI: 10.1186/s13722-022-00328-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) have low rates of COVID-19 testing and vaccination and are vulnerable to severe disease. We partnered with a local, community-based syringe service program (SSP) in San Diego County, CA, to develop the single-session theory- and evidence-informed "LinkUP" intervention to increase COVID-19 testing and vaccination. This paper details the protocol for a pilot randomized controlled trial (RCT) of the LinkUP intervention. METHODS With significant community input into study design considerations, including through our Community and Scientific Advisory Board, the LinkUP pilot RCT leverages an ongoing cohort study with adult (≥ 18 years) PWID in San Diego County to recruit participants who have not recently undergone voluntary COVID-19 testing and are unvaccinated. Eligible participants are referred to SSP locations randomized to offer the active intervention (involving tailored education, motivational interviewing, and problem-solving strategies) or a didactic attention-control condition (information sharing only). Both conditions are delivered by trained peer counselors hired by the SSP and were designed to be delivered at mobile (outdoor) SSP sites in ~ 30 min. Intake data assesses COVID-19 testing and vaccination history, health status, and harm reduction needs (to facilitate SSP referrals). At the end of either intervention condition, peer counselors offer onsite rapid COVID-19 antigen testing and COVID-19 vaccination referrals. Out-take and follow-up data (via SSP and state health department record linkages) confirms whether participants received the intervention, COVID-19 testing (and results) onsite or within six months, and vaccination referrals (and uptake) within six months. Planned analyses, which are not powered to assess efficacy, will provide adequate precision for effect size estimates for primary (COVID-19 testing) and secondary (vaccination) intervention outcomes. Findings will be disseminated widely including to local health authorities, collaborating agencies, and community members. DISCUSSION Lessons from this community-based pilot study include the importance of gathering community input into study design, cultivating research-community partnerships based on mutual respect and trust, and maintaining frequent communication regarding unexpected events (e.g., police sweeps, neighborhood opposition). Findings may support the adoption of COVID-19 testing and vaccination initiatives implemented through SSPs and other community-based organizations serving vulnerable populations of people impacted by substance use and addiction. Trial registration This trial was registered prospectively at ClinicalTrials.gov (identifier NCT05181657).
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0631, USA
- Department of Community Health Sciences, School of Public Health, Boston University, 715 Albany St, Boston, MA, USA
| | - Alicia Harvey-Vera
- School of Medicine, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0507, USA
- Facultad de Medicina, Universidad Xochicalco, Rampa Yumalinda 4850, Chapultepec Alamar, 22110, Tijuana, B.C, Mexico
- United States-Mexico Border Health Commission, Paseo del Centenario 10851, Zona Urbana Rio Tijuana, 22320, Tijuana, B.C, Mexico
| | - Tara Buesig-Stamos
- OnPoint, Harm Reduction Coalition of San Diego, 1389 Windmill Road, El Cajon, CA, USA
| | - Daniela Abramovitz
- School of Medicine, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0507, USA
| | - Carlos F Vera
- School of Medicine, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0507, USA
| | - Irina Artamonova
- School of Medicine, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0507, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0680, USA
| | - Steffanie A Strathdee
- School of Medicine, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, MC0507, USA.
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Alves J, Stewart J, Ruiz-Mercado G, Taylor JL. When Perfect Is the Enemy of Tested: a Call to Scale Rapid HIV Testing for People Who Inject Drugs. J Gen Intern Med 2022; 37:2851-2852. [PMID: 35132547 PMCID: PMC8821779 DOI: 10.1007/s11606-022-07436-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/25/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Justin Alves
- Clinical Addiction Research & Education (CARE) Unit & Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA
| | - Jessica Stewart
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Glorimar Ruiz-Mercado
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jessica L Taylor
- Clinical Addiction Research & Education (CARE) Unit & Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
- Section of General Internal Medicine, Boston University School of Medicine & Boston Medical Center, Boston, MA, USA.
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Haldane V, Jung AS, De Foo C, Shrestha P, Urdaneta E, Turk E, Gaviria JI, Boadas J, Buse K, Miranda JJ, Strathdee SA, Barratt A, Kazatchkine M, McKee M, Legido-Quigley H. Integrating HIV and substance misuse services: a person-centred approach grounded in human rights. Lancet Psychiatry 2022; 9:676-688. [PMID: 35750060 DOI: 10.1016/s2215-0366(22)00159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/13/2022]
Abstract
Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.
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Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anne-Sophie Jung
- School of Politics and International Studies, University of Leeds, Leeds, UK.
| | - Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore
| | | | - Eva Turk
- Institute for Health and Society, University of Oslo, Oslo, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Juan I Gaviria
- Coordinación de Vigilancia Epidemiologica e Infectologia, Hospital del Instituto Ecuatoriano del Seguro Social (IESS) Sur de Quito, Quito, Ecuador
| | - Jesus Boadas
- Centro de Rehabilitación Mental ANSALUD, Santo Domingo, Dominican Republic
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
| | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia, Lima, Peru; The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | | | - Ashley Barratt
- Positive21, London, UK; ReShape/International HIV Partnerships-European Chemsex Forum, London, UK
| | | | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; National University Health System, Singapore; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Streed CG, Morgan JR, Gai MJ, Larochelle MR, Paasche-Orlow MK, Taylor JL. Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use. JAMA Netw Open 2022; 5:e2221346. [PMID: 35819784 PMCID: PMC9277489 DOI: 10.1001/jamanetworkopen.2022.21346] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Importance Although HIV preexposure prophylaxis (PrEP) implementation among persons who inject drugs has been inadequate, national HIV monitoring programs do not include data on PrEP, and specific trends in PrEP use are not well understood. Objective To estimate HIV PrEP uptake among commercially insured persons with opioid or stimulant use disorder by injection drug use (IDU) status. Design, Setting, and Participants This cross-sectional study used deidentified data from the MarketScan Commercial Claims and Encounters Database to identify a sample of 547 709 commercially insured persons without HIV but with opioid and/or stimulant use disorder, including 110 592 with evidence of IDU between January 1, 2010, and December 31, 2019. Data were analyzed from November 1, 2020, to July 1, 2021. Exposures Persons with opioid and/or stimulant use disorder and evidence of IDU were identified through claims data. Main Outcomes and Measures The outcome was receipt of tenofovir disoproxil fumarate and emtricitabine for PrEP as identified from filled pharmacy claims. Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with receipt of PrEP. Results The study cohort included 211 609 (28.6%) females and 336 100 (61.4%) males with a combined mean (SD) age of 34.8 (13.1) years, including 110 592 individuals with evidence of IDU. During the study period, 508 (0.09%) persons with opioid and/or stimulant use disorder, including 170 (0.15%) with evidence of IDU, received PrEP. Receipt of PrEP increased from 0.001 to 0.243 per 100 person-years from 2010 through 2019 among the entire cohort and from 0.000 to 0.295 per 100 person-years among those with IDU. In multivariable analysis, PrEP use was more likely among males (adjusted odds ratio [aOR] 8.72; 95% CI, 6.39-11.89), persons with evidence of IDU (aOR, 1.47; 95% CI, 1.21-1.79), and persons with evidence of sexual risk indications for PrEP (aOR, 23.68; 95% CI, 19.57-28.66). Conclusions and Relevance In this cross-sectional study of commercially insured persons with opioid and/or stimulant use disorder, HIV PrEP delivery remained low, including among those with evidence of IDU. PrEP should be consistently offered alongside substance use disorder treatment and other harm reduction and HIV prevention services.
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Affiliation(s)
- Carl G. Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
- Center for Transgender Medicine and Surgery, Boston Medical Center, Massachusetts
| | - Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Mam Jarra Gai
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
| | - Marc R. Larochelle
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Massachusetts
| | - Michael K. Paasche-Orlow
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
| | - Jessica L. Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Massachusetts
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Bazzi AR, Valasek CJ, Streuli SA, Vera CF, Harvey-Vera A, Philbin MM, Biello KB, Roth AM, Strathdee SA, Pines HA. Long-Acting Injectable Human Immunodeficiency Virus Pre-Exposure Prophylaxis Preferred Over Other Modalities Among People Who Inject Drugs: Findings from a Qualitative Study in California. AIDS Patient Care STDS 2022; 36:254-262. [PMID: 35727647 PMCID: PMC9464050 DOI: 10.1089/apc.2022.0068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People who inject drugs (PWID) have extraordinarily low uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) despite high levels of need. Long-acting PrEP modalities hold promise for HIV prevention among PWID, but product preferences remain poorly understood. From September to November 2021, we conducted qualitative interviews with 28 HIV-negative, adult (≥18 years) PWID in San Diego County, CA, to explore their perspectives on daily oral PrEP pills and long-acting PrEP modalities (i.e., injections, implants, intravaginal rings, and broadly neutralizing antibodies), which we explained using standard scripts. Thematic analysis identified variations in PrEP modality interest and acceptability. We identified three key factors across the 28 interviews that appeared to influence PrEP modality preferences: perceived convenience of use, invasiveness, and familiarity (based on past experience). Overall, most participants preferred injectable PrEP over other modalities because they viewed injectable medications as convenient, noninvasive, and familiar. While injectable PrEP was recently approved for use in the United States and was most the acceptable PrEP modality in this sample, our findings suggest that intervention and implementation research is urgently needed to improve our understanding of strategies that could support access, uptake, and sustained adherence to longer-acting PrEP for PWID.
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Affiliation(s)
- Angela R. Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chad J. Valasek
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Samantha A. Streuli
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Carlos F. Vera
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Alicia Harvey-Vera
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Morgan M. Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katie B. Biello
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexis M. Roth
- Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Steffanie A. Strathdee
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Heather A. Pines
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, 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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Tran NK, Van Der Pol B, Shrestha R, Bazzi AR, Bellamy SL, Sherman SG, Roth AM. Limited Risk Compensation Among Women Who Inject Drugs: Results From the Project Sexual Health Equity Preexposure Prophylaxis Demonstration Study in Philadelphia. Sex Transm Dis 2022; 49:e64-e66. [PMID: 34694276 PMCID: PMC9018480 DOI: 10.1097/olq.0000000000001577] [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: 11/25/2022]
Abstract
ABSTRACT The impact of preexposure prophylaxis uptake on sexual and injection-related behaviors among women who inject drugs is poorly understood. Over 24 weeks, preexposure prophylaxis uptake among women who inject drugs was associated with increased sharing of injection equipment but not syringes and no changes in condomless sex, providing limited evidence of risk compensation in this vulnerable population.
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Affiliation(s)
- Nguyen K. Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Barbara Van Der Pol
- Division of Infectious Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Angela R. Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Scarlett L. Bellamy
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexis M. Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Calabrese SK, Kalwicz DA, Modrakovic D, Earnshaw VA, Edelman EJ, Bunting SR, Del Río-González AM, Magnus M, Mayer KH, Hansen NB, Kershaw TS, Rosenberger JG, Krakower DS, Dovidio JF. An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments. AIDS Behav 2022; 26:1393-1421. [PMID: 34750695 PMCID: PMC9434708 DOI: 10.1007/s10461-021-03495-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/16/2023]
Abstract
Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - E Jennifer Edelman
- Department of General Internal Medicine, Yale University, New Haven, CT, USA
| | - Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ana María Del Río-González
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Manya Magnus
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - John F Dovidio
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Jalil EM, Torres TS, Luz PM, Monteiro L, Moreira RI, de Castro CRV, Leite IDC, Cunha M, de Cássia Elias Estrela R, Ramos M, Hoagland B, Wagner Cardoso S, Anderson P, Veloso VG, Wilson E, Grinsztejn B. Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study. J Int AIDS Soc 2022; 25:e25896. [PMID: 35255199 PMCID: PMC8901149 DOI: 10.1002/jia2.25896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/08/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction We aimed to evaluate daily oral pre‐exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non‐attendance and low PrEP adherence in a Brazilian trans‐specific 48‐week study (PrEParadas). Methods We enrolled transgender women (TGW) engaging in high‐risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p‐value<0.10 in the univariate analysis. Results From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non‐attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18–24 (adjusted odds ratio [aOR] = 8.76, 95% CI: 2.09–36.7) and 25–34 years (aOR = 6.79, 95% CI: 1.72–26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37–18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30–34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94–47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16–0.88). No participant seroconverted over the course of the study. Conclusions Although high PrEP retention can be achieved in a gender‐affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale‐up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.
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Affiliation(s)
- Emilia M Jalil
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Thiago S Torres
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | | | - Iuri da C Leite
- Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brazil
| | - Marcello Cunha
- Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brazil
| | | | - Michelle Ramos
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Peter Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Valdilea G Veloso
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Erin Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Beatriz Grinsztejn
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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Killelea A, Johnson J, Dangerfield DT, Beyrer C, McGough M, McIntyre J, Gee RE, Ballreich J, Conti R, Horn T, Pickett J, Sharfstein JM. Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:8-23. [PMID: 35902089 PMCID: PMC9341207 DOI: 10.1017/jme.2022.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The U.S. has the tools to end the HIV epidemic, but progress has stagnated. A major gap in U.S. efforts to address HIV is the under-utilization of medications that can virtually eliminate acquisition of the virus, known as pre-exposure prophylaxis (PrEP). This document proposes a financing and delivery system to unlock broad access to PrEP for those most vulnerable to HIV acquisition and bring an end to the HIV epidemic.
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42
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Scheidell JD, Ataiants J, Lankenau SE. Miscarriage and Abortion Among Women Attending Harm Reduction Services in Philadelphia: Correlations With Individual, Interpersonal, and Structural Factors. Subst Use Misuse 2022; 57:999-1006. [PMID: 35277115 PMCID: PMC9101319 DOI: 10.1080/10826084.2022.2046100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Reproductive health research among women who use drugs has focused on pregnancy prevention and perinatal/neonatal outcomes, but there have been few investigations of miscarriage and abortion, including prevalence and associated factors. Methods: Using cross-sectional data from a sample of non-pregnant women receiving harm reduction services in Philadelphia in 2016-2017 we examined lifetime miscarriage and abortion (n = 187). Separately for both outcomes, we used modified Poisson regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations with each correlate. We also explored correlates of reporting both miscarriage and abortion. Results: Approximately 47% experienced miscarriage, 42% experienced abortion, and 18% experienced both. Miscarriage correlates included: prescription opioid misuse (e.g., OxyContin PR 1.82, 95% CI 1.23, 2.69); 40% increase in prevalence associated with housing instability, 50% increase with survival sex, and two-fold increase with arrest. Abortion correlates included: mental health (e.g., depression PR 2.09, 95% CI 1.18, 3.71), stimulant use (e.g., methamphetamine PR 1.83, 95% CI 1.22, 2.74), and drug injection (PR 1.76, 95% CI 1.03, 3.02); partner controlling access to people/possessions, physical and emotional violence; and a two-fold increase associated with survival sex and arrest. Experiencing both reproductive outcomes was correlated with mental health, opioid and simulant use, housing instability, survival sex, and arrest. Conclusion: Miscarriage and abortion was common among women with history of drug misuse suggesting a need for expanded access to family planning, medication-assisted therapy, and social support services, and for the integration of these with substance use services. Future research in longitudinal data is needed.
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Affiliation(s)
- Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Guy D, Doran J, White TM, van Selm L, Noori T, Lazarus JV. The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review. Front Psychiatry 2022; 13:951682. [PMID: 36090369 PMCID: PMC9459118 DOI: 10.3389/fpsyt.2022.951682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION People who inject drugs have a substantial risk for HIV infection, especially women who inject drugs (WWID). HIV pre-exposure prophylaxis (PrEP), a highly-effective HIV prevention drug, is uncommonly studied among WWID, and we aimed to synthesize existing knowledge across the full PrEP continuum of care in this population. METHODS We systematically searched for peer-reviewed literature in three electronic databases, conference abstracts from three major HIV conferences, and gray literature from relevant sources.Eligibility criteria included quantitative, qualitative or mixed-methods studies with primary data collection reporting a PrEP-related finding among WWID, and published in English or Spanish between 2012 and 2021. The initial search identified 2,809 citations, and 32 were included. Data on study characteristics and PrEP continuum of care were extracted, then data were analyzed in a narrative review. RESULTS Our search identified 2,809 studies; 32 met eligibility requirements. Overall, awareness, knowledge, and use of PrEP was low among WWID, although acceptability was high. Homelessness, sexual violence, unpredictability of drug use, and access to the healthcare system challenged PrEP usage and adherence. WWID were willing to share information on PrEP with other WWID, especially those at high-risk of HIV, such as sex workers. CONCLUSIONS To improve PrEP usage and engagement in care among WWID, PrEP services could be integrated within gender-responsive harm reduction and drug treatment services. Peer-based interventions can be used to improve awareness and knowledge of PrEP within this population. Further studies are needed on transgender WWID as well as PrEP retention and adherence among all WWID.
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Affiliation(s)
- Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Doran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,National Infection Service, UK Health Security Agency, London, United Kingdom.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Abstract
Opioid use disorder (OUD) is a treatable chronic disorder with episodes of remission and recurrence characterized by loss of control of opioid use, compulsive use, and continued use despite harms. If untreated, OUD is associated with significant morbidity and mortality. Buprenorphine and methadone reduce fatal and nonfatal opioid overdose and infectious complications of OUD and are the first-line treatment options. Physicians have an important role to play in diagnosing OUD and its comorbidities, offering evidence-based treatment, and delivering overdose prevention and other harm reduction services to people who continue to use opioids. Interdisciplinary office-based addiction treatment programs support high-quality OUD care.
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Affiliation(s)
- Jessica L Taylor
- Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
| | - Jeffrey H Samet
- Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, and Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
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The Influence of PrEP-Related Stigma and Social Support on PrEP-Use Disclosure among Women Who Inject Drugs and Social Network Members. AIDS Behav 2021; 25:3922-3932. [PMID: 34014430 DOI: 10.1007/s10461-021-03312-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention strategy for Women who Inject Drugs (WWID). Stigma and disclosure concerns have been key barriers to PrEP use among women in PrEP efficacy trials. Social support has been found to buffer against some PrEP stigma, though these factors have been largely unexplored among WWID. Investigating how WWID disclose PrEP use is important given evidence that disclosure is associated with higher adherence. We aimed to identify the impact of stigma and support on PrEP disclosure within social networks of WWID participating in a PrEP demonstration project in Philadelphia, PA, USA. PrEP-using WWID ≥ 18 years completed social network surveys. Generalized estimating equations were used to account for the correlation of network structure. Thirty-nine WWID (i.e. egos) named an average of 9.5 ± 3.3 network members (i.e. alters), for a total sample of 371 unique relationships. Egos disclosed their PrEP use to an average of 4.0 alters (SD = 2.8). Related to PrEP stigma, participants had 0.4 times decreased odds of PrEP disclosure with alters who would disapprove of them taking PrEP (95% CI: 0.1-0.9). Related to support, participants had 2.5 times higher odds of disclosure among peers who could provide PrEP advice (95% CI: 1.0-6.0). Interventions that increase social support and decrease stigma are pivotal for increasing PrEP use disclosure among WWID.
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46
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Broz D, Carnes N, Chapin-Bardales J, Des Jarlais DC, Handanagic S, Jones CM, McClung RP, Asher AK. Syringe Services Programs' Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them. Am J Prev Med 2021; 61:S118-S129. [PMID: 34686281 DOI: 10.1016/j.amepre.2021.05.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
Diagnoses of HIV among people who inject drugs have increased in the U.S. during 2014-2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies-Prevent, Diagnose, Treat, and Respond-and thus are instrumental to its success in preventing disease and saving lives.
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Affiliation(s)
- Dita Broz
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Neal Carnes
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Johanna Chapin-Bardales
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Don C Des Jarlais
- Department of Epidemiology, School of Global Health, New York University, New York, New York
| | - Senad Handanagic
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - R Paul McClung
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia; U.S. Public Health Service Commissioned Corps, Rockville, Maryland
| | - Alice K Asher
- Office of Policy, Planning and Partnerships, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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47
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Grimshaw C, Boyd L, Smith M, Estcourt CS, Metcalfe R. Evaluation of an inner city HIV pre-exposure prophylaxis service tailored to the needs of people who inject drugs. HIV Med 2021; 22:965-970. [PMID: 34585494 DOI: 10.1111/hiv.13181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES HIV prevention strategies including pre-exposure prophylaxis (PrEP) must reach all in need to achieve elimination of transmission by 2030. Mainstream provision may inadvertently exclude key populations. Incidence of HIV in people who inject drugs (PWID) in Glasgow, Scotland's largest city, is increasing, partly due to sexual transmission. Scotland provides publicly funded oral PrEP for individuals at sexual risk of HIV through sexual health services; however, uptake by PWID has been negligible. We developed a tailored outreach PrEP service based in the local homeless health centre. We used active case finding, flexibility of assessment location, supervised community daily dispensing and active follow-up to optimise uptake and adherence. We describe a two-year service evaluation. METHODS We reviewed the case records of all PWID identified by the outreach team as being at higher risk of sexual acquisition for whom PrEP was considered between November 2018 and November 2020. Evaluation focused on PrEP uptake, adherence and monitoring. We conducted a descriptive statistical analysis. RESULTS Of 41 PWID assessed as eligible, 32 (78.0%) commenced PrEP. The proportion of PrEP-covered days was 3320/3400 days (97.6%); 31/32 (96.9%) had regular HIV serology monitoring. The service was feasible to run, but it relied on outreach provision and liaison with other services. DISCUSSION Tailored PrEP services can reach PWID effectively. Uptake and adherence were high but the model was resource-intensive. Appropriately tailored PrEP delivery may be required to meet the needs of this and other key populations who experience barriers to accessing mainstream services.
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Affiliation(s)
- Ceilidh Grimshaw
- Sandyford Initiative, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lynsey Boyd
- Sandyford Initiative, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Matt Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Rebecca Metcalfe
- Sandyford Initiative, NHS Greater Glasgow and Clyde, Glasgow, UK
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48
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Biello KB, Mimiaga MJ, Valente PK, Saxena N, Bazzi AR. The Past, Present, and Future of PrEP implementation Among People Who Use Drugs. Curr HIV/AIDS Rep 2021; 18:328-338. [PMID: 33907971 PMCID: PMC8286349 DOI: 10.1007/s11904-021-00556-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Recent HIV outbreaks among people who use drugs (PWUD) necessitate additional HIV prevention tools. Pre-exposure prophylaxis (PrEP) is highly efficacious yet uptake among PWUD remains exceedingly low. To address multilevel, complex barriers to PrEP use among PWUD, a range of intervention strategies are needed. RECENT FINDINGS The literature on interventions to optimize PrEP use among PWUD is nascent, comprising small pilots and demonstration projects in early phases of intervention development. Initial studies suggest that structural, healthcare, interpersonal, and individual-level interventions can improve PrEP use for PWUD, and a number of efficacy trials are underway. Future studies are needed to optimize the use of new PrEP modalities (e.g., injectable PrEP), simultaneously target multilevel challenges to PrEP use, and evaluate the integration of PrEP into other service settings and substance use treatment modalities.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Center for LGBTQ Advocacy, Research, and Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Nimish Saxena
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
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49
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Felsher M, Ziegler E, Amico KR, Carrico A, Coleman J, Roth AM. "PrEP just isn't my priority": Adherence challenges among women who inject drugs participating in a pre-exposure prophylaxis (PrEP) demonstration project in Philadelphia, PA USA. Soc Sci Med 2021; 275:113809. [PMID: 33735778 DOI: 10.1016/j.socscimed.2021.113809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 12/21/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has the ability to curb HIV transmission among women if they are highly adherent (e.g. 6/7 weekly doses). In a recent PrEP demonstration project with 95 women who inject drugs (WWID) in Philadelphia, PA, USA, PrEP uptake was high but adherence was low. This qualitative study draws upon the Behavioral Model for Vulnerable Populations (BMVP) to describe how the context of 23 WWID's lives challenged PrEP adherence using narrative data from in-depth interviews. Content analysis suggests that women's need to organize their day around predisposing survival needs made it difficult to prioritize PrEP. Adherence was further challenged by dis-enabling structural forces such as entry into institutions that do not provide PrEP (e.g., drug treatment and correctional facilities) and medication diversion to illicit marketplaces. Overtime, women's perceived need for PrEP was dynamic: in periods they characterized as risky, women considered PrEP highly beneficial and described enhanced motivation to adhere. In periods of low perceived risk, women were less committed to continuing daily PrEP in the context of their competing survival needs. In sum, WWID faced challenges to PrEP adherence that correspond to all of the BMVP domains. To optimize PrEP for WWID, multi-level programs are needed that address the determinants that both increase HIV susceptibility and undermine adherence.
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Affiliation(s)
- Marisa Felsher
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, USA.
| | - Eliza Ziegler
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - K Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Jennie Coleman
- Prevention Point Philadelphia, 2913 Kensington Ave, Philadelphia, PA, 19134, USA.
| | - Alexis M Roth
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
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50
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Tran NK, Felsher M, Pol BVD, Bellamy SL, McKnight J, Roth AM. Intention to initiate and uptake of PrEP among women who injects drugs in a demonstration project: an application of the theory of planned behavior. AIDS Care 2021; 33:746-753. [PMID: 33486981 DOI: 10.1080/09540121.2021.1874267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Some women who inject drugs (WWID) would benefit from pre-exposure prophylaxis (PrEP), yet there are few studies of issues related to uptake in real-world settings. In this study, participants (n = 95) were offered PrEP and responded to items measuring PrEP-related attitudes, norms, and perceived behavioral control based on the Theory of Planned Behavior. We tested associations with intention to initiate PrEP and uptake. Most WWID (88%) intended to initiate PrEP and 78% accepted a prescription. Compared to WWID who did not express PrEP intentions, those who did were less concerned about attitudinal and perceived behavioral control constructs such as temporary (75% vs. 36%, p = 0.01) and long-term (63% vs. 27%, p = 0.05) side effects, negative interactions with their birth control (93% vs. 38%, p < 0.01), their ability to take a daily pill (80% vs. 36%, p < 0.01), and the cost of PrEP (87% vs. 36%, p < 0.01). WWID who went on to take PrEP had fewer concerns with subjective norms constructs such as talking to health care providers about sex (91% vs. 65%, p < 0.01) and drug use (88% vs. 55%, p < 0.01) compared to those who did not. Attitudes and perceived behavioral control influenced intention while subjective norms had a greater impact on actual uptake.
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Affiliation(s)
- Nguyen K Tran
- Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Marisa Felsher
- Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Barbara Van Der Pol
- Division of Infectious Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Scarlett L Bellamy
- Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jade McKnight
- Prevention Point Philadelphia, Philadelphia, PA, USA
| | - Alexis M Roth
- Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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