1
|
Shrader CH, Craker L, Johnson AL, Rodriguez E, Skvoretz J, Self KJ, Kanamori M. Peer Influence on Motivation to Use Pre-Exposure Prophylaxis Among Latino Sexual Minority Men in Miami, Florida: A Network Autocorrelation Model. AIDS Patient Care STDS 2024; 38:370-379. [PMID: 39158979 DOI: 10.1089/apc.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Despite the availability of pre-exposure prophylaxis (PrEP), Latino sexual minority men (LSMM) continue to experience disparities in PrEP uptake and subsequently, HIV vulnerability. Social network norms are an underutilized solution to increase PrEP uptake. We used a peer influence model (network autocorrelation model) to examine the role of social network descriptive norms (i.e., actual behaviors) surrounding PrEP use. A total of 11 sociocentric networks of 13 friends (n = 143 LSMM) were recruited into our study from 2018 to 2019 in South Florida. Most participants were in PrEP pre-contemplation (n = 44), and almost one-third of our sample were using PrEP (n = 38). Three network autocorrelation models were estimated using an empirically informed Bayesian analysis. We found a positive association between participants' Motivational PrEP Cascade (MPC) position and their network members' (friends') cascade position based on three different measures of connection even when accounting for PrEP knowledge: friendship (ρ = 0.22; 95% CIa = 0.01-0.42), emotional closeness (ρ = 0.24; 95% CI = 0.03-0.44), and frequency of interaction (ρ = 0.22; CI = 0.03-0.42). Our findings highlight that an individual's progress in the MPC may be influenced by their network members' progress in the MPC, suggesting that LSMM using PrEP may serve as role models to their peers for PrEP use due to descriptive norms. Our findings further suggest that PrEP interventions for LSMM along the MPC can be implemented at the social network level.
Collapse
Affiliation(s)
- Cho Hee Shrader
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Lacey Craker
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| | - Ariana L Johnson
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| | - Edda Rodriguez
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| | - John Skvoretz
- Department of Sociology, University of South Florida, Tampa, Florida, USA
| | - Kyle J Self
- Department of Educational and Psychological Studies, University of Miami, Miami, Florida, USA
| | - Mariano Kanamori
- Department of Public Health Science, School of Medicine, University of Miami Miller, Miami, Florida, USA
| |
Collapse
|
2
|
Grov C, Guo Y, Westmoreland DA, D'Angelo AB, Mirzayi C, Dearolf M, Carneiro P, Ray M, Pantalone D, Carrico AW, Patel VV, Golub SA, Hirshfield S, Hoover DR, Nash D. Factors associated with PrEP-era HIV seroconversion in a 4-year U.S. national cohort of n = 6059 sexual and gender minority individuals who have sex with men, 2017-2022. J Int AIDS Soc 2024; 27:e26312. [PMID: 38924359 PMCID: PMC11197961 DOI: 10.1002/jia2.26312] [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: 02/01/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Community-based cohort studies of HIV seroconversion can identify important avenues for enhancing HIV prevention efforts in the era of pre-exposure prophylaxis (PrEP). Within individuals, one can assess exposure and outcome variables repeatedly and with increased certainty regarding temporal ordering. This cohort study examined the association of several risk factors with subsequent HIV seroconversion. METHODS We report data from a 4-year study (2017-2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion. RESULTS Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59-1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79-3.28), Hispanic/Latinx (1.53, 1.19-1.96), housing instability (1.58, 1.22-2.05) and past year methamphetamine use (3.82, 2.74-5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51-0.87; 36 months, 0.60, 0.45-0.80; 48 months, 0.48, 0.35-0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17-0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74-6.46) or lack thereof (4.30, 1.85-9.88). However, those who initiated PrEP in the past year (0.14, 0.04-0.39) or persistently used PrEP in the past 2 years (0.33, 0.14-0.74) had a lower risk of seroconversion. Of all HIV seroconversions observed during follow-up assessments (12, 24, 36 and 48 months), methamphetamine was reported in the 12 months prior 128 (42.2%) times (overall). CONCLUSIONS Interventions that acknowledge race and ethnicity, economic variables such as education and housing instability, and methamphetamine use are critically needed. Not only are interventions to engage individuals in PrEP care needed, but those that retain them, and re-engage those who may fall out of care are essential, given the exceptionally high risk of seroconversion in these groups.
Collapse
Affiliation(s)
- Christian Grov
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Yan Guo
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | | | - Alexa B. D'Angelo
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Chloe Mirzayi
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Michelle Dearolf
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Pedro Carneiro
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
| | | | | | | | | | | | | | | | - Denis Nash
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| |
Collapse
|
3
|
Moran A, Javanbakht M, Mimiaga M, Shoptaw S, Gorbach PM. Association of Partnership-Level Methamphetamine Use on Inconsistent PrEP Care Engagement Among GBMSM in Los Angeles County. AIDS Behav 2024; 28:1522-1530. [PMID: 37792232 PMCID: PMC11041383 DOI: 10.1007/s10461-023-04178-x] [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: 09/11/2023] [Indexed: 10/05/2023]
Abstract
There are limited quantitative studies describing the association between meth use in the context of male-male sexual partnerships and PrEP care engagement. We assessed the longitudinal relationship between individual and partnership level meth use with inconsistent PrEP engagement among young gay, bisexual and other men who have sex with men (GBMSM) in Los Angeles. The primary exposure was meth use at the partnership level with a ternary variable (neither partner nor participant used meth, either used meth, or both used meth). Generalized estimating equations were used to assess odds of inconsistent PrEP engagement at different levels of partner-participant meth use, adjusting for age at visit, number of recent male partners and partner intimacy. Among inconsistent PrEP engagement, 61% (n = 84, vs. 79.5%, n = 346 continuous) reported that neither they nor their partner used meth, 22% (n = 31, vs. 18%, n = 56) reported that either partner or participant used meth and 17% (n = 24, vs. 8%, n = 33) reported that both partner and participant used meth (P < 0.01). There were increased odds of inconsistent PrEP engagement when both partner and participant reported meth use (aOR: 3.82; 95%CI: 1.83-7.99) and when either partner or participant reported meth use (aOR: 2.46; 95%CI: 1.28-4.75). Meth use plays an important role in consistent PrEP engagement among GBMSM in mSTUDY. PrEP users who use meth with partners may benefit from integrated interventions addressing both meth use and PrEP engagement.
Collapse
Affiliation(s)
- Alexander Moran
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 615 E Charles Young Drive S, Los Angeles, CA, 90095, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 615 E Charles Young Drive S, Los Angeles, CA, 90095, USA
| | - Matthew Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 615 E Charles Young Drive S, Los Angeles, CA, 90095, USA
| | - Steven Shoptaw
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 615 E Charles Young Drive S, Los Angeles, CA, 90095, USA
| |
Collapse
|
4
|
Lions C, Laroche H, Mora M, Pialoux G, Cotte L, Cua E, Piroth L, Molina JM, Salnikova M, Maradan G, Poizot-Martin I, Spire B. Missed opportunities for HIV pre-exposure prophylaxis among people with recent HIV infection: The French ANRS 95041 OMaPrEP study. HIV Med 2023; 24:191-201. [PMID: 35943165 DOI: 10.1111/hiv.13367] [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: 08/23/2021] [Accepted: 07/06/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Our objective was to identify missed opportunities for the use of pre-exposure prophylaxis (PrEP) in people with recently acquired HIV, factors associated with PrEP knowledge, and reasons for not using PrEP. DESIGN This was a French national cross-sectional multicentre study enrolling people diagnosed with recent HIV (incomplete Western blot or negative HIV test in the previous 6 months) in 28 HIV clinical centres. Data were gathered using a self-administered questionnaire (SAQ). METHOD We analysed missed opportunities for PrEP use via a retrospective prep cascade. Factors associated with prior knowledge of PrEP and reasons for PrEP non-use among those who knew about PrEP were described using univariate and multivariate logistic regression models. RESULTS Of the 224 eligible patients, 185 completed the SAQ and 168 (91%) were eligible for PrEP. Of these, 90% reported seeing at least one physician during the previous year, 26% received information about PrEP, and 5% used PrEP. Factors independently associated with a higher probability of knowing about PrEP were being a man who has sex with men, being aged 25-30 years (vs older), undergoing HIV screening at least once every semester (vs less often; odds ratio [OR] 4.11; 95% confidence interval [CI] 2.00-8.45), and practicing chemsex (OR 3.19; 95% CI 1.12-9.10). Fear of side effects and a low perceived risk of HIV infection were the two most common reasons for not using PrEP (N = 40 [33.33%] and N = 34 [28.3%], respectively). CONCLUSIONS We found two gaps in the retrospective PrEP cascade: insufficient provision of PrEP information by healthcare providers (mainly general practitioners) and low PrEP acceptability by informed, eligible patients. More diverse healthcare providers need to be involved in PrEP prescription, and at-risk people need to be sensitized to the risk of HIV infection.
Collapse
Affiliation(s)
- Caroline Lions
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France
| | - Helene Laroche
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France
| | - Marion Mora
- Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Gilles Pialoux
- Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Maladies Infectieuses, Sorbonne Université, Paris, France
| | - Laurent Cotte
- Maladies Infectieuses, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France
| | - Eric Cua
- Maladies Infectieuses, Hôpital L'Archet, Nice, France
| | - Lionel Piroth
- Département d'infectiologie, CHU Dijon Bourgogne, INSERM CIC1432 Université de Bourgogne, Dijon, France
| | - Jean Michel Molina
- Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM UMR 944, Biologie Cellulaire des Infections Virales, Paris, France.,Université de Paris, Paris, France
| | - Maria Salnikova
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France
| | - Gwenaëlle Maradan
- Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| | - Isabelle Poizot-Martin
- Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France.,Immunohematology Clinical Uni, APHM, INSERM, IRD, SESSTIM, ISSPAM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France
| | - Bruno Spire
- Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France
| |
Collapse
|
5
|
Pyra M, Heffron R, Haberer JE, Kiarie J. HIV prevention metrics: lessons to be learned from contraception. J Int AIDS Soc 2022; 25:e25958. [PMID: 35929343 PMCID: PMC9353407 DOI: 10.1002/jia2.25958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction As the range of effective HIV prevention options, including multiple biomedical tools, increases, there are many challenges to measuring HIV prevention efforts. In part, there is the challenge of varying prevention needs, between individuals as well as within individuals over time. The field of contraception faces many similar challenges, such as the range of prevention methods and changing contraceptive needs, and has developed many metrics for assessing contraceptive use at the program level, using frameworks that move beyond the HIV prevention cascade. We explore these similarities and differences between these two prevention fields and then discuss how each of these contraceptive metrics could be adapted to assessing HIV prevention. Discussion We examined measures of initiation, coverage and persistence. Among measures of initiation, HIV Prevention–Post Testing would be a useful corollary to Contraceptive Use–Post Partum for a subset of the population. As a measure of coverage, both Net Prevention Coverage and HIV Protection Index (modelled off the Contraception Protection Index) may be useful. Finally, as a measure of persistence, Person‐Years of HIV Protection could be adapted from Couple‐Years Protection. As in contraception, most programs will not reach 100% on HIV prevention metrics but these metrics are highly useful for making comparisons. Conclusions While we may not be able to perfectly capture the true population of who would benefit from HIV prevention, by building off the work of the contraceptive field to use and refine these metrics, we can assess and compare HIV prevention over time and across programs. Furthermore, these metrics can help us reach global targets, such as the 2025 UNAIDS Goals, and reduce HIV incidence.
Collapse
Affiliation(s)
- Maria Pyra
- University of Chicago, Chicago, Illinois, USA
| | | | | | | |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Ten years since the first regulatory approval of oral HIV preexposure prophylaxis (PrEP), this review summarizes PrEP uptake, the role of ambitious PrEP targets, emerging evidence of impact on the HIV epidemic and innovative approaches to increasing PrEP uptake. RECENT FINDINGS PrEP uptake among people at risk of HIV has been slow, but has accelerated in recent years, particularly in gay and bisexual men in a limited number of high-income settings and recently in heterosexuals at risk of HIV in sub-Saharan Africa. However, UNAIDS 2020 PrEP targets and HIV prevention targets were missed by large margins. Although UNAIDS testing and treatment targets have galvanised public health action, in contras, PrEP targets have been lower profile and insufficiently ambitious. Parts of the USA, Australia and the UK with high PrEP coverage have demonstrated striking reductions in HIV infection at the population level, as PrEP is introduced at scale. Scaling up PrEP uptake will require innovations in PrEP promotion, simplified models of care, improved adherence interventions, improved choice in the form of longer-acting PrEP and interventions to ensure that all those who can benefit from PrEP can access it. SUMMARY PrEP is a revolutionary HIV prevention tool, which if ambitiously scaled up could drive HIV transmission towards elimination. Highly publicized and ambitious PrEP targets could help drive this.
Collapse
|
7
|
Carneiro PB, Frye V, Mirzayi C, Patel V, Lounsbury D, Huang TTK, Sabounchi N, Grov C. What Predicts a Clinical Discussion About PrEP? Results From Analysis of a U.S. National Cohort of HIV-Vulnerable Sexual and Gender Minorities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:195-208. [PMID: 35647867 PMCID: PMC9212698 DOI: 10.1521/aeap.2022.34.3.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
HIV-outcome inequities remain prevalent in the U.S. Medical providers (MPs) are gatekeepers of PrEP, and understanding the dynamics of PrEP assessments is of major interest for public health. We analyzed data from Together 5000, an internet-based U.S. national cohort of sexual and gender minority (SGM) individuals aged 16-49 years and at risk for HIV. Among those eligible for PrEP uptake (n = 6264), we modeled predictors of discussing PrEP with an MP. A third (31%) of participants had spoken to a MP about PrEP. Among those who spoke to a MP, 45% suggested they would initiate PrEP; this outcome was more common among participants older than 24. With a persistent stagnant uptake nationwide, new opportunities to influence PrEP uptake must be explored. An attractive less targeted space is the medical office, specifically ways to support an initial and continued discussion about PrEP between MPs and their patients.
Collapse
Affiliation(s)
- Pedro B Carneiro
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, New York
| | | | - Chloe Mirzayi
- CUNY Institute for Implementation Science in Population Health
| | - Viraj Patel
- Division of General Internal Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - David Lounsbury
- Department of Epidemiology & Population Health, Montefiore Health System, Albert Einstein College of Medicine
| | - Terry T-K Huang
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy
| | - Nasim Sabounchi
- Department of Health Policy and Management, CUNY Graduate School of Public Health and Health Policy
| | - Christian Grov
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, New York
- CUNY Institute for Implementation Science in Population Health
| |
Collapse
|