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Shaw SY, Biegun JCS, Leung S, Isac S, Musyoki HK, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Emmanuel F, Blanchard J, Pickles M, Mishra S, Becker ML, Lazarus L, Lorway R, Bhattacharjee P. Describing the effect of COVID-19 on sexual and healthcare-seeking behaviours of men who have sex with men in three counties in Kenya: a cross-sectional study. Sex Transm Infect 2024:sextrans-2024-056105. [PMID: 38964841 DOI: 10.1136/sextrans-2024-056105] [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: 01/03/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND While the COVID-19 pandemic disrupted HIV preventative services in sub-Saharan Africa, little is known about the specific impacts the pandemic has had on men who have sex with men (MSM) in Kenya. METHODS Data were from an HIV self-testing intervention implemented in Kisumu, Mombasa and Kiambu counties in Kenya. Baseline data collection took place from May to July 2019, and endline in August-October 2020, coinciding with the lifting of some COVID-19 mitigation measures. Using endline data, this study characterised the impact the pandemic had on participants' risk behaviours, experience of violence and behaviours related to HIV. Logistic regression was used to understand factors related to changes in risk behaviours and experiences of violence; adjusted AORs (AORs) and 95% CIs are reported. RESULTS Median age was 24 years (IQR: 21-27). Most respondents (93.9%) reported no change or a decrease in the number of sexual partners (median number of male sexual partners: 2, IQR: 2-4). Some participants reported an increase in alcohol (10%) and drug (16%) consumption, while 40% and 28% reported decreases in alcohol and drug consumption, respectively. Approximately 3% and 10% reported an increase in violence from intimate partners and police/authorities, respectively. Compared with those with primary education, those with post-secondary education were 60% less likely to report an increase in the number of male sexual partners per week (AOR: 0.4, 95% CI: 0.2 to 0.9), while those who were HIV positive were at twofold the odds of reporting an increase or sustained levels of violence from intimate partners (AOR: 2.0, 95% CI: 1.1 to 4.0). CONCLUSION The results of this study demonstrate heterogeneity in participants' access to preventative HIV and clinical care services in Kenya after the onset of the COVID-19 epidemic. These results indicate the importance of responding to specific needs of MSM and adapting programmes during times of crisis.
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Affiliation(s)
- Souradet Y Shaw
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Stella Leung
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Helgar K Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Mary Mugambi
- National Syndemic Disease Control Council, Nairobi, Kenya
| | - Japheth Kioko
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Musimbi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | | | | | | | - James Blanchard
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Lisa Lazarus
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Lorway
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Parinita Bhattacharjee
- Partners for Health and Development in Africa, Nairobi, Kenya
- Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Wang L, Slaughter F, Nguyen AT, Smith S, Prabhu S, Beima-Sofie K, Wallace S, Crane HM, Simoni JM, Graham SM. Impact of the COVID-19 pandemic on mental health and viral suppression among persons living with HIV in western Washington. AIDS Care 2024; 36:885-898. [PMID: 38623592 DOI: 10.1080/09540121.2024.2341220] [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: 08/18/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Abstract
The COVID-19 pandemic and social distancing measures elevated stress levels globally, exacerbating mental health challenges for people with HIV (PWH). We examined the effect of COVID-19-related stress on mental health among PWH in western Washington, exploring whether social support and coping self-efficacy were protective. Data on COVID-19-related stress, mental health, social support, and coping self-efficacy were collected using online surveys during the pandemic. Pre-COVID-19 mental health data were available for a subset of participants and were linked with the survey data. In the total sample (N = 373), COVID-19-stress was associated with elevated depression (PHQ-8, β = 0.21, 95%CI [0.10, 0.32]) and anxiety (GAD-7, β = 0.28, 95%CI [0.17, 0.39]). Among the subset of respondents with pre-pandemic mental health data (N = 103), COVID-19-related stress was associated with elevated PHQ-8 scores (β = 0.35, 95%CI [0.15, 0.56]) and GAD-7 scores (β = 0.35, 95%CI [0.16, 0.54]), adjusted for baseline mental health and other confounders. Coping self-efficacy was negatively associated with GAD-7 scores (β = -0.01, 95%CI [-0.01, 0.00]), while social support was negatively associated with PHQ-8 scores (β = -0.06, 95%CI [-0.12, -0.01]). Viral suppression before and during the pandemic did not differ among participants with available data. While COVID-19-related stress predicted elevated depression and anxiety symptoms among PWH, social support and coping self-efficacy were protective.
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Affiliation(s)
- Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Francis Slaughter
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Anh T Nguyen
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah Smith
- Center on Gender Equity and Health (GEH), University of California, San Diego, USA
| | - Sandeep Prabhu
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Stephaun Wallace
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Susan M Graham
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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3
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Alarcón Gutiérrez M, Palma Díaz D, Forns Cantón ML, Fernández-López L, García de Olalla P, Rius Gibert C. Trends in Sexual Health of Gay, Bisexual, and Other Men Who Have Sex with Men, and Transgender Individuals: Apps Driven Testing Program for HIV and Other STIs in Barcelona, Spain (2016-2023). J Community Health 2024; 49:429-438. [PMID: 38063976 PMCID: PMC10981613 DOI: 10.1007/s10900-023-01310-9] [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: 11/08/2023] [Indexed: 04/02/2024]
Abstract
Gay, bisexual and other men who have sex with men (GBMSM) and transgender individuals face heightened risks of HIV and other sexually transmitted infections (STIs). Surveillance within these populations is critical, and community testing services play a pivotal role in preventing and controlling HIV and STIs. This study investigates the trends in HIV, syphilis and hepatitis C (HCV) infections among participants in an apps-driven rapid test program from 2016 to 2023 in Barcelona, Spain, examining associated factors. Trend analysis utilized Wilcoxon-type test and associated factors were determined through multivariate logistic analysis. The prevalence of new HIV diagnosis was 1.81% (CI 1.18-2.64), active syphilis was 3.37% (CI 2.46-4.50) and acute HCV was 0.40% (CI 0.11-1.02). While infection rates showed no significant changes, there was significant increasing in sex work and chemsex and decreasing in condom use. Additionally, a peak in dating apps use for sex and a specific reduction in number of sexual partners were observed in 2020. Factors associated with HIV diagnoses included migrant status (aOR = 11.19; CI 2.58-48.53) and inconsistent condom use during the previous 12 months (aOR = 3.12; CI 1.02-9.51). For syphilis, associated factors were migrant status (aOR = 2.46; CI 1.14-5.29), inconsistent condom use (aOR = 3.38; CI 1.37-8.36), and chemsex practice during the previous 12 months (aOR = 2.80; CI 1.24-6.30). Our findings emphasize the need for tailored interventions, including culturally sensitive outreach for migrants and comprehensive strategies addressing substance use in sexual contexts. Technological innovations and targeted educational initiatives could reduce the burden of HIV and STIs within the GBMSM and transgender communities, providing valuable insights for public health strategies.
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Affiliation(s)
- Miguel Alarcón Gutiérrez
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain.
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain.
| | - David Palma Díaz
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Laura Fernández-López
- Centre of Epidemiological Studies of HIV/AIDS and STI of Catalonia (CEEISCAT), Health Department, Generalitat de Catalunya, Badalona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Patricia García de Olalla
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Barcelona, Spain
| | - Cristina Rius Gibert
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau, Barcelona, Spain
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4
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Hentges M, Kågesten AE, Brandén G, Kosidou K, Michielsen K, Ekström AM, Larsson EC. Effects of COVID-19 measures on access to HIV/STI testing and condoms among adults in Sweden: a cross-sectional online survey. Scand J Public Health 2024; 52:299-308. [PMID: 38166520 PMCID: PMC11067389 DOI: 10.1177/14034948231217020] [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: 11/23/2022] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 01/04/2024]
Abstract
AIMS To investigate the self-reported impact of COVID-19 measures on access to testing for HIV and other sexually transmitted infections (STIs) and condoms and factors associated with reduced access among adults in Sweden. METHODS Cross-sectional data were collected in late 2020 through a web panel with adults (18-49 years) in Sweden as part of the International Sexual Health And REproductive health survey (I-SHARE) (N=1307). The primary outcome was self-reported access to HIV/STI testing and condoms during COVID-19 measures. Logistic regression was used to assess adjusted odds ratios of experiencing reduced access to HIV/STI testing and condoms in relation to sociodemographic characteristics, changes in sexual behaviours and COVID-19-related factors. RESULTS Of the 1138 sexually active respondents, 17% wanted an HIV/STI test, and of those over half (57%) reported reduced access during the COVID-19 measures in 2020. Compared with cis-women, transgender or non-binary respondents were more likely to experience lower access to testing. Among those who usually used condoms (n=568), 23% reported hampered condom access due to COVID-19 restrictions. Reduced condom access was associated with identifying as non-cis gender and a cis-man compared with cis-woman, non-heterosexual orientation, being foreign-born and financially worried. CONCLUSIONS Findings indicate that access to HIV/STI testing and condoms among sexually active adults of reproductive age in Sweden was disrupted during the COVID-19 pandemic in 2020 with varied impact depending on sexual orientation, gender identity or socioeconomic situation. This signals the importance of ensuring equitable access to sexual and reproductive health services and commodities in future crises response.
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Affiliation(s)
- Maike Hentges
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Anna E. Kågesten
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Gunnar Brandén
- Department of Global Public Health, Karolinska Institutet, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
| | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Sweden
- Department of Infectious Diseases, South General Hospital, Sweden
| | - Elin C. Larsson
- Department of Global Public Health, Karolinska Institutet, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Sweden
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5
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Cuadros DF, Huang Q, Mathenjwa T, Gareta D, Devi C, Musuka G. Unlocking the potential of telehealth in Africa for HIV: opportunities, challenges, and pathways to equitable healthcare delivery. Front Digit Health 2024; 6:1278223. [PMID: 38500968 PMCID: PMC10944905 DOI: 10.3389/fdgth.2024.1278223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Affiliation(s)
- Diego F. Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Thulile Mathenjwa
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
| | - Chayanika Devi
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Cincinnati, OH, United States
| | - Godfrey Musuka
- International Initiative for Impact Evaluation, Harare, Zimbabwe
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6
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O'Cleirigh C, Foley JD, Stanton AM, McKetchnie SM, Gulbicki LR, Muten J, Chai P, Fitch C, Onofrey S, Klevens RM, Psaros C. Sexual Networking and HIV/STI Prevention Among Men who have Sex with Men and Identify as Persons of Color in the Era of COVID-19 in Boston, MA: Qualitative Findings from the National HIV Behavioral Surveillance Project. AIDS Behav 2024; 28:473-487. [PMID: 38165597 DOI: 10.1007/s10461-023-04238-2] [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] [Accepted: 11/28/2023] [Indexed: 01/04/2024]
Abstract
Men who have sex with men and identify as persons of color (MSM of color) are significantly impacted by HIV in the United States. The COVID-19 pandemic may have disproportionately exacerbated HIV-related disparities among MSM of color by affecting sexual networking behaviors and disrupting access to sexual health care. The current study explored the impact of COVID-19 on sexual networking and HIV/sexually transmitted infection (STI) prevention behaviors among MSM of color in Boston, MA. Eighteen semi-structured interviews were conducted via the 2020-2021 Boston sample of the National HIV Behavioral Surveillance (NHBS) project. Eligible participants were at least 18 years old, identified as a man or non-binary person assigned male at birth and as a person of color, and endorsed ever having sex with men. Interviews were coded using inductive and deductive approaches, and themes were extracted using thematic analysis. When participants were asked about the impact of COVID-19 on sexual networking and HIV/STI prevention, the following themes emerged: (1) differing interpretations of COVID-19 public health guidance, (2) behavior change to meet social and sexual needs, (3) limited or changed access to HIV/STI prevention services; and (4) avoidance of healthcare appointments. Overall, the pandemic affected sexual networking and HIV/STI prevention behaviors among MSM of color. Though changes in sexual networking varied, most participants decreased in-person networking, increased dating app use, and prioritized longer-term relationships. Despite loosening of restrictions, these impacts may persist and should inform the adaptation of sexual networking guidance and interventions to mitigate HIV-related disparities in communities of color.
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Affiliation(s)
- Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jacklyn D Foley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Samantha M McKetchnie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Lauren R Gulbicki
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Muten
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Peter Chai
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA
| | - Calvin Fitch
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shauna Onofrey
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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7
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Forero-Peña DA, Carrión-Nessi FS, Forero-Peña JL, Camejo-Ávila NA, Mendoza-Millán DL, Omaña-Ávila ÓD, Maricuto AL, Velásquez VL, Mejía-Bernard MD, Rodriguez-Saavedra CM, Marcano-Rojas MV, Contreras Y, Guerra LJ, Alvarado MF, Carballo M, Caldera J, Guevara RN, Redondo MC, Landaeta ME. The impact of the COVID-19 pandemic on people living with HIV: a cross-sectional study in Caracas, Venezuela. BMC Infect Dis 2024; 24:87. [PMID: 38225550 PMCID: PMC10789023 DOI: 10.1186/s12879-023-08967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/29/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. METHODS We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. RESULTS A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31-55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. CONCLUSION This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela.
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Affiliation(s)
- David A Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela.
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
| | - Fhabián S Carrión-Nessi
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela.
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela.
| | - José L Forero-Peña
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | | | - Daniela L Mendoza-Millán
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Óscar D Omaña-Ávila
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Andrea L Maricuto
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Viledy L Velásquez
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Mario D Mejía-Bernard
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
- "Luis Razetti" School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | | | | | - Yoesmir Contreras
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Luis J Guerra
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - María F Alvarado
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Martín Carballo
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Jocays Caldera
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - Rafael N Guevara
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - María C Redondo
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
| | - María E Landaeta
- Infectious Diseases Department, University Hospital of Caracas, Caracas, Venezuela
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8
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Dearolf MH, D’Angelo AB, Grov C. 'You have to trust their word': transmasculine experiences with sex partners and safety during the early COVID-19 outbreak. CULTURE, HEALTH & SEXUALITY 2024; 26:77-92. [PMID: 36929822 PMCID: PMC10505243 DOI: 10.1080/13691058.2023.2187093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The early months of the SARS-CoV2 pandemic exacerbated health disparities for vulnerable populations, including transgender (trans) communities, creating unique challenges for navigating sex and dating. This paper aims to expand upon the current literature regarding transmasculine populations by capturing their lived experiences during this critical time. We interviewed 20 assigned female sex at birth (AFAB) adults of the transmasculine spectrum - men, nonbinary, and transmasculine individuals - about their social and sexual experiences in the USA in May and June 2020. Transcripts were analysed using an inductive thematic approach. We found that sex drive decreased and uncertainty about health risks increased. Some participants found alternate ways to date and hook-up that reduced their COVID-19 risk, such as engaging in online sex (e.g. sexting, dating apps). Others expressed discomfort using virtual platforms for both personal/work and sexual lives, along with nuanced feelings around being objectified, compared to pornography, and fetishised as trans bodies. COVID-related shutdowns of queer spaces also amplified pre-existing concerns about interpersonal safety and rejection. When seeking new partners, participants sought behavioural characteristics that instilled trust. Future public health communications can take advantage of safety and sexual health strategies already present in trans communities to bolster wellbeing in trans lives.
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Affiliation(s)
- Michelle H. Dearolf
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - Alexis B. D’Angelo
- Department of Community Health and Social Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, USA
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
| | - 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, NY, USA
- CUNY Institute for Implementation Science in Population Health (ISPH), New York, NY, USA
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9
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McNulty MC, Stanford KA, Eller D, Sha BE, Purim-Shem-Tov Y, Kishen E, Glick N, Hunt B, Lin JY, Maheswaran A, Galvin S, Turelli R, Schmitt J, Pitrak D. Concurrent Testing for COVID-19 and HIV Infection at 6 High-Volume Emergency Departments in a Priority Jurisdiction for Ending the HIV Epidemic in the United States. J Acquir Immune Defic Syndr 2023; 94:364-370. [PMID: 37884056 PMCID: PMC10609715 DOI: 10.1097/qai.0000000000003287] [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: 11/22/2022] [Accepted: 08/01/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused disruptions in access to routine HIV screening. SETTING We assess HIV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing across 6 emergency departments (EDs) in Cook County, Illinois. METHODS We retrospectively analyzed the number of SARS-CoV-2 tests, HIV screens, and the proportion of concurrent tests (encounters with both SARS-CoV-2 and HIV testing), correlating with diagnoses of new and acute HIV infection. RESULTS Five sites reported data from March 1, 2020, to February 28, 2021, and 1 site from September 1, 2020, to February 28, 2021. A total of 1,13,645 SARS-CoV-2 and 36,094 HIV tests were performed; 17,469 of these were concurrent tests. There were 102 new HIV diagnoses, including 25 acute infections. Concurrent testing proportions ranged from 6.7% to 37% across sites (P < 0.001). HIV testing volume correlated with the number of new diagnoses (r = 0.66, P < 0.01). HIV testing with symptomatic SARS-CoV-2 testing was strongly correlated with diagnosis of acute infections (r = 0.87, P < 0.001); this was not statistically significant when controlling for HIV testing volumes (r = 0.59, P = 0.056). Acute patients were more likely to undergo concurrent testing (21/25) versus other new diagnoses (29/77; odds ratio = 8.69, 95% CI: 2.7 to 27.8, P < 0.001). CONCLUSIONS Incorporating HIV screening into SARS-CoV-2 testing in the ED can help maintain HIV screening volumes. Although all patients presenting to the ED should be offered opt-out HIV screening, testing individuals with symptoms of COVID-19 or other viral illness affords the opportunity to diagnose symptomatic acute and early HIV infection, rapidly link to care, and initiate treatment.
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Affiliation(s)
- Moira C. McNulty
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| | | | - Dylan Eller
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| | - Beverly E. Sha
- Division of Infectious Diseases, Rush University Medical Center, Chicago, IL
| | | | - Ekta Kishen
- Clinical Data Analytics, Research Core, Rush University Medical Center, Chicago, IL
| | - Nancy Glick
- Sinai Infectious Disease Center, Chicago, IL
| | - Bijou Hunt
- Sinai Infectious Disease Center, Chicago, IL
| | - Janet Y. Lin
- Department of Emergency Medicine, The University of Illinois Chicago, Chicago, IL
| | - Anjana Maheswaran
- Department of Emergency Medicine, The University of Illinois Chicago, Chicago, IL
| | - Shannon Galvin
- Division of Infectious Disease, Northwestern University, Chicago, IL; and
| | - Robert Turelli
- Department of Emergency Medicine, Northwestern University, Chicago, IL
| | - Jessica Schmitt
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
| | - David Pitrak
- Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, IL
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Li Z, Qiao S, Ning H, Sun X, Zhang J, Olatosi B, Li X. Place Visitation Data Reveals the Geographic and Racial Disparities of COVID-19 Impact on HIV Service Utilization in the Deep South. AIDS Behav 2023:10.1007/s10461-023-04163-4. [PMID: 37792234 DOI: 10.1007/s10461-023-04163-4] [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] [Accepted: 09/03/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic has posed unprecedented pressure to health care systems, and interrupted health care delivery and access including HIV care in the United States' Deep South, which endures a double epidemic of HIV and COVID-19. Ryan White programs cover HIV care services for over half of PLWH in the Deep South. Given the important role of Ryan White programs, examining the visitation changes to Ryan White facilities during the pandemic offers insights into the impact of the pandemic on HIV healthcare utilization. OBJECTIVES Analyze the geographic distribution of HIV facility visitors at the county level before and during the pandemic in the nine US states of Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) to reveal the geographic and racial disparity in visitation disruption caused by the pandemic. METHODS We first extracted mobile device-based visitation data for Ryan White HIV facilities in the Deep South during 2019 and 2020. To quantify the disruption in visitations during 2020, we calculated the visitation reduction rate (VRR) for each county, using 2019 data as the baseline. Next, we conducted a spatial analysis of the VRR values to uncover geographical disparities in visitation interruptions. To investigate racial disparities, we performed spatial regression analyses with VRR as the dependent variable, and the percentages of Black, Hispanic, and Asian populations as the independent variables. In this analysis, we controlled for potential confounders. RESULTS Geographic disparities in visitation reduction were observed, with all nine Deep South states experiencing significant drops. Georgia experienced the highest visitation loss (VRR = -0.58), followed by Texas (-0.47), Alabama (0.47), and Tennessee (-0.46), while South Carolina had the smallest reductions (-0.11). All the regression models consistently revealed racial disparities in visitation interruption. That is, counties with a higher proportion of Black population tended to have higher RW facility visitation reductions. CONCLUSIONS Our analysis revealed distinct geographic disparities in visitation interruptions at Ryan White HIV facilities in the Deep South during the COVID-19 pandemic in 2020. Furthermore, we found that the Black/African American population experienced a greater disruption at the county level in the Deep South during this period.
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Affiliation(s)
- Zhenlong Li
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA.
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA.
| | - Shan Qiao
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Huan Ning
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Geography, The Pennsylvania State University, University Park, PA, 16801, USA
| | - Xiaowen Sun
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Jiajia Zhang
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Bankole Olatosi
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
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11
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Billioti de Gage S, Jourdain H, Desplas D, Dray-Spira R. Roll-out and effectiveness of HIV pre-exposure prophylaxis in France: An overview. Therapie 2023; 78:585-591. [PMID: 36894453 DOI: 10.1016/j.therap.2023.02.010] [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: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Oral HIV pre-exposure prophylaxis (PrEP) has been available and fully reimbursed for people at high risk of sexually acquired HIV infection in France since January 2016. OBJECTIVE To evaluate the roll-out of PrEP use in France and its real-life effectiveness. The main results of two previously published studies were presented at the second e-congress of the EPI-PHARE scientific interest group on pharmacoepidemiology and public decision support held in June 2022, and are reported in this article. METHODS Two studies were carried out using the French National Health Data System (SNDS) covering 99% of the French population. A first study aimed to evaluate the roll-out of PrEP use in France from its implementation until June 2021, globally over the entire study period, including an assessment of the impact of the coronavirus disease 2019 (COVID-19) pandemic that started in February 2020 in France. A second study using a nested case-control design was conducted in a cohort of men at high risk of HIV acquisition included between January 2016 and June 2020 to assess the effectiveness of PrEP in the real world. RESULTS As of 30 June 2021, a total of 42 159 people had initiated PrEP in France. Initiations increased steadily until February 2020, then slowed down sharply from the start of the COVID-19 pandemic and resumed from the first half of 2021. PrEP users were overwhelmingly men (98%), with an average age of 36 years, living in a large urban area (74%), and of whom a minority (7%) were socioeconomically disadvantaged. Throughout the study period, the level of PrEP maintenance from one semester to the next was high (80-90%). However, for 20% of PrEP initiators, no prescription renewals were recorded during the first six months, suggesting a substantial proportion of early treatment discontinuation. A minority (21%) of PrEP renewal prescriptions were made by private practitioners. Among 46 706 men at high risk of HIV infection, 256 patients identified with HIV infection were matched with 1213 controls. PrEP was used by 29% of cases and 49% of controls. Overall, PrEP effectiveness reached 60% (95% confidence interval 46% to 71%), and was increased in people with high PrEP use (93% (84% to 97%)), or after excluding periods of treatment discontinuation (86% (79% to 92%)). PrEP effectiveness was significantly reduced in people under 30 years of age (26% (-21% to 54%)) and in socioeconomically disadvantaged people (-64% (-392% to 45%)), for whom low PrEP uptake rates or high PrEP discontinuation rates were frequently observed. CONCLUSION PrEP roll-out has been strongly impacted by the COVID-19 pandemic in France. Although it has been substantial among men who have sex with men, additional measures are needed to expand access to PrEP to all other population groups that could benefit from it. Promoting adherence to PrEP (especially among young people and the socioeconomically disadvantaged) will be essential to ensure a higher level of PrEP effectiveness, which has been shown to be lower in real-life settings than in clinical trials.
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Affiliation(s)
- Sophie Billioti de Gage
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France.
| | - Hugo Jourdain
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - David Desplas
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE, epidemiology of health products (French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM)), Saint-Denis, France
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12
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Hong C, Holloway IW, Bednarczyk R, Javanbakht M, Shoptaw S, Gorbach PM. High Vaccine Confidence Is Associated with COVID-19 Vaccine Uptake in Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Substances. LGBT Health 2023; 10:480-485. [PMID: 36976808 PMCID: PMC10468549 DOI: 10.1089/lgbt.2022.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Purpose: We examined associations between vaccine confidence and COVID-19 vaccine uptake among gay, bisexual, and other men who have sex with men (GBMSM). Methods: Computer-assisted self-interviews were conducted among 249 GBMSM participating in mSTUDY from May to October 2021-a cohort of GBMSM with a history of substance use in Los Angeles. Data were collected using a vaccine confidence index. The association between vaccine confidence and COVID-19 vaccine uptake was assessed using multivariable log-binomial regression. Results: Two-thirds (64.7%) of GBMSM reported receiving at least one dose of COVID-19 vaccine. Vaccine confidence was positively associated with COVID-19 vaccine uptake. Participants expressed neutral attitudes on government trust and vaccine safety. Perceived health benefit and vaccine effectiveness were statistically significantly associated with vaccine uptake (adjusted prevalence ratio [APR] = 1.59, 95% confidence interval [CI]: 1.20-2.16; APR = 1.51, 95% CI: 1.07-2.15). Conclusions: Public health programs should prioritize public benefit and vaccine effectiveness messaging to advance vaccination among GBMSM who use substances.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Ian W. Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Robert Bednarczyk
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
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13
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Bell S, Ranuschio B, Waldron JM, Barnes L, Sheik-Yosef N, Villalobos E, Wackens J, Liboro RM. Pandemic upon Pandemic: Middle-Aged and Older Men Who Have Sex with Men Living with HIV Coping and Thriving during the Peak of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5979. [PMID: 37297583 PMCID: PMC10252860 DOI: 10.3390/ijerph20115979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
When the COVID-19 pandemic emerged in early 2020, not only did it abruptly impede the progress that was being made toward achieving global targets to end the HIV pandemic, but it also created significant impacts on the physical and mental health of middle-aged and older men who have sex with men living with HIV. Utilizing a qualitative, community-based participatory research approach, we conducted semi-structured, one-on-one interviews with 16 ethnoracially diverse, middle-aged and older men who have sex with men living with HIV residing in Southern Nevada, to examine the different ways the COVID-19 pandemic directly impacted their physical and mental health, and explore how they eventually coped and thrived during the peak of the crisis. Using thematic analysis to analyze our interview data, we identified three prominent themes: (1) challenges to obtaining credible health information, (2) the physical and mental health impacts of the COVID-19-pandemic-imposed social isolation, and (3) digital technologies and online connections for medical and social purposes. In this article, we extensively discuss these themes, the current discourse on these themes in academic literature, and how the perspectives, input, and lived experiences of our participants during the peak of the COVID-19 pandemic could be critical to addressing issues they had already been experiencing prior to the emergence of the pandemic in 2020, and just as importantly, helping us best prepare in stark anticipation of the next potentially devastating pandemic.
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Affiliation(s)
- Sherry Bell
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Brandon Ranuschio
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - John M. Waldron
- LGBTQIA+ Community Center of Southern Nevada (The Center), Las Vegas, NV 89101, USA;
| | - Lianne Barnes
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Nadia Sheik-Yosef
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Esmeralda Villalobos
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Janelle Wackens
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Renato M. Liboro
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA; (S.B.); (B.R.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
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Abstract
PURPOSE OF REVIEW We review the intersection between the HIV and COVID-19 pandemics, particularly the impact of HIV infection on the development of severe COVID-19. RECENT FINDINGS Studies early in the COVID-19 pandemic did not find a clear link between HIV infection and increased COVID-19 severity or mortality. People with HIV (PWH) were more likely to have severe COVID-19, but much of the risk for worse outcomes was related to high rates of comorbidities and social determinants of health. Although comorbidities and social determinants of health are certainly critically important reasons for severe COVID-19 among PWH, recent large studies have found HIV infection - particularly when the CD4 cell count is low or HIV RNA is not suppressed - is an independent risk factor for COVID-19 severity. The link between HIV and severe COVID-19 highlights the need to diagnose and treat HIV as well as the importance of COVID-19 vaccination and treatment among PWH. SUMMARY People with HIV have faced increased challenges during the COVID-19 pandemic because of high rates of comorbidities and social determinants of health as well as the impact of HIV on COVID-19 severity. Information on the intersection of the two pandemics has been crucial to improving care for people with HIV.
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Affiliation(s)
- Kathleen W Miller
- Department of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Hamilton DT, Hoover KW, Smith DK, Delaney KP, Wang LY, Li J, Hoyte T, Jenness SM, Goodreau SM. Achieving the "Ending the HIV Epidemic in the U.S." incidence reduction goals among at-risk populations in the South. BMC Public Health 2023; 23:716. [PMID: 37081482 PMCID: PMC10116101 DOI: 10.1186/s12889-023-15563-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION Antiretroviral medication coverage remains sub-optimal in much of the United States, particularly the Sothern region, and Non-Hispanic Black or African American persons (NHB) continue to be disproportionately impacted by the HIV epidemic. The "Ending the HIV Epidemic in the U.S." (EHE) initiative seeks to reduce HIV incidence nationally by focusing resources towards the most highly impacted localities and populations. This study evaluates the impact of hypothetical improvements in ART and PrEP coverage to estimate the levels of coverage needed to achieve EHE goals in the South. METHODS We developed a stochastic, agent-based network model of 500,000 individuals to simulate the HIV epidemic and hypothetical improvements in ART and PrEP coverage. RESULTS New infections declined by 78.6% at 90%/40% ART/PrEP and 94.3% at 100%/50% ART/PrEP. Declines in annual incidence rates surpassed 75% by 2025 with 90%/40% ART/PrEP and 90% by 2030 with 100%/50% ART/PrEP coverage. Increased ART coverage among NHB MSM was associated with a linear decline in incidence among all MSM. Declines in incidence among Hispanic/Latino and White/Other MSM were similar regardless of which MSM race group increased their ART coverage, while the benefit to NHB MSM was greatest when their own ART coverage increased. The incidence rate among NHB women declined by over a third when either NHB heterosexual men or NHB MSM increased their ART use respectively. Increased use of PrEP was associated with a decline in incidence for the groups using PrEP. MSM experienced the largest absolute declines in incidence with increasing PrEP coverage, followed by NHB women. CONCLUSIONS Our analysis indicates that it is possible to reach EHE goals. The largest reductions in HIV incidence can be achieved by increasing ART coverage among MSM and all race groups benefit regardless of differences in ART initiation by race. Improving ART coverage to > 90% should be prioritized with a particular emphasis on reaching NHB MSM. Such a focus will reduce the largest number of incident cases, reduce racial HIV incidence disparities among both MSM and women, and reduce racial health disparities among persons with HIV. NHB women should also be prioritized for PrEP outreach.
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Affiliation(s)
- Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, 206 Raitt Hall, UW, Box 353412, Seattle, WA, 98195-3412, USA.
| | - Karen W Hoover
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Dawn K Smith
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kevin P Delaney
- Division of HIV Prevention (DHP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jingjing Li
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamika Hoyte
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Steven M Goodreau
- Center for Studies in Demography and Ecology, University of Washington, 206 Raitt Hall, UW, Box 353412, Seattle, WA, 98195-3412, USA
- Department of Anthropology, University of Washington, Seattle, WA, USA
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16
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Rosen JG, Stone EM, Mbizvo MT. Age-of-consent requirements and adolescent HIV testing in low-and middle-income countries: multinational insights from 51 population-based surveys. Int J STD AIDS 2023; 34:168-174. [PMID: 36524432 PMCID: PMC9928845 DOI: 10.1177/09564624221142372] [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: 12/23/2022]
Abstract
BACKGROUND Pervasive social and structural barriers-including national policies-inhibit HIV testing uptake among priority populations, including adolescents. We assessed the relationship between age-of-consent policies for HIV testing and adolescent HIV testing coverage in 51 low- and middle-income countries. METHODS We pooled data from household surveys (2010-2020) and calculated the weighted country-level prevalence of lifetime HIV testing separately for adolescent girls and boys (ages 15-19). We then abstracted age-of-consent requirements for HIV testing across countries. Using multivariable linear regression, we estimated the average difference in national HIV testing coverage estimates for adolescent girls and boys by age-of-consent restrictions for HIV testing. RESULTS National HIV testing coverage estimates ranged from 0.7% to 72.5% among girls (median: 18.0%) and 0% to 73.2% among boys (median: 7.5%) in Pakistan and Lesotho, respectively. In adjusted models, HIV testing coverage in countries requiring parental consent for individuals <18 years was, on average, 9.4 percentage-points (pp) lower (95% confidence interval [95%CI] -17.9pp to -0.9pp) among girls and 9.3pp lower (95%CI: -17.3pp to -1.2pp) among boys, relative to countries with less restrictive policies (age-of-consent: ≤16 years). Compared to countries with less restrictive (age-of-consent: ≤14 years) policies, HIV testing prevalence was significantly lower among girls (β -10.5pp, 95%CI: -19.7pp to -1.3pp) and boys (β -10.5pp, 95%CI -19.2pp to -1.8pp) in countries with more restrictive (age-of-consent: 18 years) parental consent requirements. CONCLUSIONS Age-of-consent policies are persistent obstacles to adolescent HIV testing. Repealing parental consent requirements for HIV testing is needed to expand coverage and accelerate progress towards global HIV treatment and prevention targets.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ward MK, Aleite S, Sheehan DM, Li T, Gbadamosi SO, Jean-Gilles M, Ladner RA, Trepka MJ. Self-reported Nonadherence to Antiretroviral Therapy Among Miami-Dade Ryan White Program Clients During the COVID-19 Pandemic: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:198-206. [PMID: 36607312 PMCID: PMC10062022 DOI: 10.1097/jnc.0000000000000382] [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: 06/28/2022] [Indexed: 01/07/2023]
Abstract
This study examined factors associated with self-reported ART nonadherence during the COVID-19 pandemic among Miami-Dade County Ryan White HIV/AIDS Program (RWHAP) clients. A cross-sectional survey was conducted from October 2020-January 2021 in English, Spanish, and Haitian Creole. The survey included questions on self-reported ART adherence, HIV care access (compared to before the pandemic), social and economic pandemic impacts, and demographics. We carried out descriptive bivariate analyses and weighted logistic regression to estimate unadjusted and adjusted odds ratios (aORs) for self-reported nonadherence. 12.7% of participants reported ART nonadherence. Adjusting for age, sex, race/ethnicity, and nativity, factors associated with nonadherence included greater difficulty accessing an HIV doctor compared with before the COVID-19 pandemic (aOR=3.6, 95% CI: 1.4–9.2) and experiencing financial impacts due to the pandemic (aOR=4.2, 95% CI: 1.5–12.2). Ensuring RWHAP clients maintain access to HIV medical care providers and receive support for financial shocks are critical to sustaining ART adherence.
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Affiliation(s)
- Melissa K Ward
- Melissa K. Ward, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and Research Center in Minority Institutions, Florida International University, Miami, Florida, USA. Stephanie Aleite, BA, is an MSW Student, School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Diana M. Sheehan, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Research Center in Minority Institutions, and Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, Florida, USA. Tan Li, PhD, is an Associate Professor, Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Semiu O. Gbadamosi, PhD, MBBS, MPH, was a PhD Candidate, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Michèle Jean-Gilles, PhD, is a Research Associate Professor, Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA. Robert A. Ladner, PhD, is President, Behavioral Science Research Corporation, Miami, Florida, USA. Mary Jo Trepka, MD, MSPH, is a Professor, Department of Epidemiology, Robert Stempel College of Public Health and Social Work, and Research Center in Minority Institutions, Florida International University, Miami, Florida, USA
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Magno L, Soares F, Zucchi EM, Eustórgio M, Grangeiro A, Ferraz D, Greco D, Escuder MM, Dourado I. Reaching Out to Adolescents at High Risk of HIV Infection in Brazil: Demand Creation Strategies for PrEP and Other HIV Combination Prevention Methods. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:703-719. [PMID: 35876978 PMCID: PMC9310684 DOI: 10.1007/s10508-022-02371-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
Using baseline data from the PrEP1519 cohort, in this article we aimed to analyze: (i) the effectiveness of demand creation strategies (DCS) to enroll adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) into an HIV combination prevention study in Brazil; (ii) the predictors of DCS for adolescents' enrollment; and (iii) the factors associated with DCS by comparing online and face-to-face strategies for enrollment. The DCS included peer recruitment (i.e., online and face-to-face) and referrals from health services and non-governmental organizations (NGOs). AMSM and ATGW who agreed to participate in the study could opt to enroll in either PrEP (PrEP arm) or to use other prevention methods (non-PrEP arm). Bivariate and multivariate analyses were conducted and logistic regression odds ratios were estimated. The DCS reached 4529 AMSM and ATGW, the majority of which were derived online (73.8%). Of this total, 935 (20.6%) enrolled to participate (76.6% in PrEP arm and 23.4% in non-PrEP arm). The effectiveness of enrolling adolescents into both arms was greater via direct referrals (235/382 and 84/382, respectively) and face-to-face peer recruitment (139/670 and 35/670, respectively) than online (328/3342). We found that a combination under DCS was required for successful enrollment in PrEP, with online strategies majorly tending to enroll adolescents of a higher socioeconomic status. Our findings reinforce the need for DCS that actively reaches out to all adolescents at the greatest risk for HIV infection, irrespective of their socioeconomic status.
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Affiliation(s)
- Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula41.150-000, Salvador, Bahia, Brazil.
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Mestrado Profissional em Psicologia e Políticas Públicas, Universidade Católica de Santos, São Paulo, Santos, Brazil
| | - Marcos Eustórgio
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Dulce Ferraz
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Distrito Federal, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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19
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Magno L, Medeiros DSD, Soares F, Grangeiro A, Caires P, Fonseca T, Westin MR, Dourado I. Factors associated to HIV prevalence among adolescent men who have sex with men in Salvador, Bahia State, Brazil: baseline data from the PrEP1519 cohort. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00154021. [PMID: 36995866 DOI: 10.1590/0102-311xen154021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/11/2021] [Indexed: 03/29/2023] Open
Abstract
Adolescent men who have sex with men (AMSM) are at a heightened vulnerability for human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HIV and associated individual, social, and programmatic factors among AMSM in Salvador, Bahia State, Brazil. This is a cross-sectional study which analyzed baseline data from the PrEP1519 cohort in Salvador. Descriptive, bivariate, and multivariate analyses were conducted using the dimensions of vulnerability to HIV as hierarchical levels of analysis. Logistic regression models were used to estimate the odds ratios (OR) of the association between predictor variables and HIV infection. The prevalence of HIV infection among the 288 AMSM recruited to the project was 5.9% (95%CI: 3.7-9.3). Adjusted analysis showed a statistically significant association between self-identifying as a sex worker (OR = 3.74, 95%CI: 1.03-13.60) and HIV infection. Other associations with borderline statistical significance were the use of application programs to find sexual partners (OR = 3.30, 95%CI: 0.98-11.04), low schooling level (OR = 3.59, 95%CI: 0.96-13.41), failing to be hired or being dismissed from a job because of sexual orientation (OR = 2.88, 95%CI: 0.89-9.28), and not using health services as a usual source of care (OR = 3.14, 95%CI: 0.97-10.17). We found a high HIV prevalence among AMSM in Salvador. Furthermore, our study found that individual, social, and programmatic factors were associated with HIV infection among these AMSM. We recommend intensifying HIV combined-prevention activities for AMSM.
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20
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Goodreau SM, Delaney KP, Zhu W, Smith DK, Mann LM, Sanchez TH, Hamilton DT, Hoover KW. Impacts of COVID-19 on sexual behaviors, HIV prevention and care among men who have sex with men: A comparison of New York City and Metropolitan Atlanta. PLoS One 2023; 18:e0282503. [PMID: 36943832 PMCID: PMC10030006 DOI: 10.1371/journal.pone.0282503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 03/23/2023] Open
Abstract
The COVID-19 pandemic has disrupted HIV prevention, care, and transmission opportunities. This likely varies by geography, given differences in COVID-19 burden and mandates over time, and by age, given different likelihoods of severe COVID-19 consequences. We consider changes in sexual behavior, HIV testing, pre-exposure prophylaxis (PrEP) use and antiretroviral therapy (ART) use among men who have sex with men (MSM) over the first year of the COVID-19 epidemic, comparing the Atlanta metropolitan area and New York City (NYC). We use two continuous time-series datasets and one panel dataset, assessing changes over time within city and comparing across cities, and disaggregate major findings by age. For clinical results, ART use showed by far the smallest reductions, and testing the largest. Disruptions occurred concurrently between cities, despite the major wave of COVID-19, and government mandates, occurring later in Atlanta. Test positivity increased in NYC only. In both cities, younger MSM saw the greatest reductions in testing and PrEP use, but the smallest in sexual behavior. Reduced clinical service usage would be unconcerning if stemming solely from reductions in exposure; however, the patterns for young MSM suggest that the COVID-19 epidemic likely generated new conditions for increased HIV transmission, especially in this cohort.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington, United States of America
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - Kevin P Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Weiming Zhu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dawn K Smith
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura M Mann
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - Karen W Hoover
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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21
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Holt M, Chan C, Broady TR, Mao L, MacGibbon J, Rule J, Wilcock B, Prestage G, Bavinton BR. Adjusting Behavioural Surveillance and Assessing Disparities in the Impact of COVID-19 on Gay and Bisexual Men's HIV-Related Behaviour in Australia. AIDS Behav 2023; 27:518-534. [PMID: 35895148 PMCID: PMC9326145 DOI: 10.1007/s10461-022-03788-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
COVID-19 has disrupted sexual behaviour and access to health systems. We adapted regular HIV behavioural surveillance of gay and bisexual men (GBM) in Australia in response to COVID-19, assessed the impact on the profile of the sample, the participants' HIV-related behaviour, and whether COVID-19 may have accentuated existing disparities in the Australian HIV epidemic. Data collected from five states during July 2017-June 2021 were included (N = 31,460). The emphasis on online recruitment after COVID-19 led to smaller sample sizes, greater geographic reach, and a higher proportion of bisexual-identifying participants. Most participants (88.1%) reported physical distancing and 52.1% had fewer sex partners due to COVID-19. In the COVID-19-affected rounds (July 2020-June 2021), the number of male partners, recent HIV testing and pre-exposure prophylaxis (PrEP) use all fell, and HIV risk among the smaller group of participants who reported casual sex increased. COVID-related changes were generally more pronounced among GBM aged under 25 years, participants from suburbs with fewer gay residents, and bisexual men. These groups should be prioritised when encouraging GBM to reengage with HIV testing services and effective prevention methods, like condoms and PrEP.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australian Federation of AIDS Organisations, Sydney, Australia
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22
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Impact of COVID-19 on the Belgian HIV epidemic: slowdown of HIV transmission and testing and adaptation of care. BMC Infect Dis 2022; 22:901. [PMID: 36463126 PMCID: PMC9719146 DOI: 10.1186/s12879-022-07879-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To gain insight into the impact of the COVID-19 pandemic and containment measures on the HIV epidemic and services, this study aims to describe HIV trends in 2020 and compare them with previous years. METHODS Belgian national HIV surveillance data 2017-2020 were analysed for trends in HIV testing, HIV diagnoses, VL measurements, ART uptake and PrEP purchase. Descriptive statistics from 2020 are compared to annual averages from 2017 to 2019 (proportional difference, %). RESULTS In 2020, 725 HIV infections were diagnosed in Belgium (- 21.5% compared to 2019). The decline was most pronounced during the first lockdown in April-May but also present in July-December. The number of HIV tests performed decreased by 17.6% in 2020, particularly in March-May and October-December (- 57.5% in April and -25.4% in November 2020 compared to monthly 2017-19 numbers). Diagnosis of acute HIV infections decreased by 47.1% in 2020 (n = 27) compared to 2019 (n = 51). Late HIV diagnoses decreased by 24.7% (95% CI [- 40.7%; -9.7%]) in 2020 compared to 2019. Of patients in care in 2019, 11.8% interrupted HIV care in 2020 compared to 9.1% yearly in the 3 previous years. The number of HIV patients with VL monitoring per month dropped in March-May 2020, whilst proportions of VL suppression and ART coverage remained above 86% and 98.5% respectively in 2020. PrEP purchases, number of purchasers and starters dropped during April-May 2020 (respectively - 45.7%, - 47.4%, - 77.9% in April compared to February 2020). CONCLUSIONS The significant decrease in HIV diagnoses in Belgium in 2020 coincided with the COVID-19 pandemic and following containment measures, particularly in April-May during the first lockdown. A slowdown of HIV transmission due to reduced HIV risk exposure is suggested by the halving in diagnosis of acute HIV infections in March-December 2020 compared to the previous year, and the adaptive decrease in PrEP use and PrEP initiation from April onwards. Despite a slight increase in HIV care interruptions, the indicators of quality of HIV care remained stable. Access to prevention, testing and care for all people living with HIV and at risk of acquiring HIV is a priority during and after times of pandemic.
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23
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Characterizing the Impact of the COVID-19 Pandemic on HIV PrEP care: A Review and Synthesis of the Literature. AIDS Behav 2022; 27:2089-2102. [DOI: 10.1007/s10461-022-03941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
AbstractThe global COVID-19 pandemic and associated lockdown measures have caused disruptions to sexual health services and created additional barriers to the continuity of HIV pre-exposure prophylaxis (PrEP) among key populations. This review provides an examination of the influences of the pandemic on engagement in the PrEP care continuum. Using the PRISMA guideline, 46 studies were included in this review and the synthesis. Most of the studies were conducted in high-income settings through quantitative analysis. A majority of studies examining the changes in PrEP use suggested a decline or discontinuation in PrEP uptake during the pandemic. The most common reasons for stopping using PrEP were perceived barriers to PrEP-related care, having reduced sexual behaviors and fewer sexual partners, and reduced perceived risk of HIV infection. Limited studies documenting an increase in PrEP uptake were all in specific PrEP optimizing programs. During the pandemic, there is also an emerging trend of switching to on-demand PrEP from daily oral PrEP. Future studies should understand the mechanism of strategies that facilitated the improvements during the pandemic. PrEP implementation programs should consider alternative PrEP modalities and provide consistent and comprehensive knowledge about correct information.
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24
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Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
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Gökengin D. HIV Pre-Exposure Prophylaxis in Central and Eastern Europe-Gains and Challenges in An Ever-Changing World. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:223-228. [PMID: 38633717 PMCID: PMC10986726 DOI: 10.36519/idcm.2022.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 04/19/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective prevention tool for controlling the HIV epidemic. Since its approval in the United States in 2012 and Europe in 2016, it has become available on a global scale offered as a registered strategy in clinical studies or demonstration projects with a slow and steady increase. In the second quarter of 2022, PrEP became available in 78 countries globally, with around 3 million people having started using PrEP. Europe has been much slower than the rest of the world to roll out PrEP; nevertheless, currently, PrEP is nationally available and reimbursed in 21 countries; generics are available but not reimbursed in 14 countries. PrEP is not formally implemented in 20 countries, which are mostly Central and Eastern European countries. There are significant disparities between countries in terms of PrEP availability, accessibility, and usage, most likely due to social, cultural, and political differences. The major barriers to PrEP use are reported to be lack of knowledge of people in need, not being reimbursed, and low perception of HIV. PrEP uptake globally and regionally still lacks the power to have an impact on controlling the epidemic. High prioritization of PrEP targets will offer us a realistic chance of reaching the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal of a 90% reduction in HIV infections by 2030 compared to 2010.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, İzmir, Turkey
- Ege University HIV/AIDS Research and Practice Center, İzmir, Turkey
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26
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Roll-out of HIV pre-exposure prophylaxis use in France: A nationwide observational study from 2016 to 2021. Lancet Reg Health Eur 2022; 22:100486. [PMID: 35990255 PMCID: PMC9386455 DOI: 10.1016/j.lanepe.2022.100486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Oral HIV pre-exposure prophylaxis (PrEP) has been available and fully reimbursed for people at high risk of sexually acquired HIV infection in France since January 2016. Its dissemination has been widely promoted to reduce HIV incidence in high-risk populations. This study aimed to assess the roll-out of PrEP use in France from its implementation until mid-2021. Methods Using the French National Health Data System (SNDS) covering 99% of people residing in France, all PrEP users defined as individuals aged 15 years or older who received at least one dispensing of PrEP between 1 January 2016 and 30 June 2021 were identified. PrEP users number and their socio-demographic and PrEP use characteristics were assessed over time. Findings As of 30 June 2021, a total of 42 159 individuals had initiated PrEP in France. Monthly PrEP initiations increased steadily up to 1027 in February 2020, and then slowed down sharply from the onset of the COVID-19 epidemic until a recovery in the first half of 2021. PrEP users were overwhelmingly men (97·5%, 41 126/42 159), aged 36 years on average, living in a large metropolitan area (73·8%, 31 096/42 159), and among whom a minority (7·0%, 2966/42 159) were socio-economically disadvantaged. Throughout the study period, 80-90% of users renewed PrEP from one semester to another, suggesting a good level of maintenance among those engaged in treatment. Nevertheless, for 20·1% (7148/35 549) of new PrEP users no prescription renewal was recorded in the first six months after initiation, suggesting a substantial proportion of early treatment discontinuation. Private practitioners accounted for a minority (21·3%, 77 885/366 399) of PrEP renewal prescriptions. Interpretation PrEP roll-out has been markedly impacted by the COVID-19 pandemic in France. Although PrEP deployment has been substantial among men who have sex with men, further action is needed to expand access to PrEP to all other population groups who could benefit from it and to promote adherence to treatment. Funding This research was carried out within EPI-PHARE without external funding.
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27
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Nyitray AG, Quinn KG, John SA, Walsh JL, Schim van der Loeff MF, Wu R, Eastwood D, McAuliffe TL. Sexually Transmitted Infections Diagnosed Among Sexual and Gender Minority Communities During the First 11 Months of the COVID-19 Pandemic in Midwest and Southern Cities in the United States. Sex Transm Dis 2022; 49:687-694. [PMID: 35858473 PMCID: PMC9477706 DOI: 10.1097/olq.0000000000001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected sexual health services. Given the burden of sexually transmitted infections (STIs) on sexual and gender minorities (SGMs), we estimated incidence of self-reported STI diagnoses and factors associated with STI diagnoses among SGMs during the pandemic's first year. METHODS A cohort of 426 SGM persons, 25 years or older, recruited in Chicago, Milwaukee, Detroit, Minneapolis, and Houston completed 5 online surveys from April 2020 to February 2021. Persons self-reported on each survey all health care provider STI diagnoses. Kaplan-Meier was used to estimate the cumulative risk of STI diagnoses, stratified by human immunodeficiency virus (HIV) status. Factors associated with STI diagnoses were assessed with a longitudinal negative binomial regression. RESULTS Median age was 37 years, and 27.0% were persons living with HIV (PLH). Participants reported 63 STIs for a cumulative incidence for PLH and HIV-negative persons of 0.19 (95% confidence interval [CI], 0.13-0.29) and 0.12 (95% CI, 0.09-0.17), respectively. Regardless of HIV, a younger age and changes in health care use were associated with STI diagnoses. Among HIV-negative persons, the rate of STI diagnoses was higher in Houston than the Midwest cities (adjusted relative risk, 2.37; 95% CI, 1.08-5.20). Among PLH, a decrease in health care use was also associated with STI diagnoses (adjusted relative risk, 3.53; 95% CI, 1.01-12.32 vs no change in health care services), as was Hispanic ethnicity and using a dating app to meet a sex partner. CONCLUSIONS Factors associated with STI diagnoses during the COVID-19 pandemic generally reflected factors associated with STI incidence before the pandemic like geography, HIV, age, and ethnicity.
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Affiliation(s)
- Alan G. Nyitray
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, WI
| | - Katherine G. Quinn
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Steven A. John
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Jennifer L. Walsh
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
| | - Maarten F. Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam Institute for Infection and Immunity
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ruizhe Wu
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Eastwood
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Timothy L. McAuliffe
- From the Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine
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28
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Baral S, Rao A, Rwema JOT, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya RN, Kamarulzaman A, Millett G, Marcus JL, Mishra S. Competing health risks associated with the COVID-19 pandemic and early response: A scoping review. PLoS One 2022; 17:e0273389. [PMID: 36037216 PMCID: PMC9423636 DOI: 10.1371/journal.pone.0273389] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. OBJECTIVES We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. METHODS A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from November 1st, 2019 to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. RESULTS A total of 1604 published papers and 205 preprints were retrieved in the search. Overall, 8.0% (129/1604) of published studies and 10.2% (21/205) of preprints met the inclusion criteria and were included in this review: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (19/183) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. DISCUSSION COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, St. Andrews, Scotland
| | - Anna E. Kågesten
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | | | - Annette H. Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Refilwe Nancy Phaswana-Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Adeeba Kamarulzaman
- Department of Medicine and Infectious Diseases, University of Malaya, Kuala Lumpur, Malaysia
| | - Gregorio Millett
- Public Policy Office, amfAR, Washington, District of Columbia, United States of America
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Canada
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Toller Erausquin J, Tan RKJ, Uhlich M, Francis JM, Kumar N, Campbell L, Zhang WH, Hlatshwako TG, Kosana P, Shah S, Brenner EM, Remmerie L, Mussa A, Klapilova K, Mark K, Perotta G, Gabster A, Wouters E, Burns S, Hendriks J, Hensel DJ, Shamu S, Marie Strizzi J, Esho T, Morroni C, Eleuteri S, Sahril N, Yun Low W, Plasilova L, Lazdane G, Marks M, Olumide A, Abdelhamed A, López Gómez A, Michielsen K, Moreau C, Tucker JD. The International Sexual Health And REproductive Health during COVID-19 (I-SHARE) Study: A Multicountry Analysis of Adults from 30 Countries Prior to and During the Initial Coronavirus Disease 2019 Wave. Clin Infect Dis 2022; 75:e991-e999. [PMID: 35136960 PMCID: PMC9383436 DOI: 10.1093/cid/ciac102] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. METHODS Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. RESULTS Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSIONS Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.
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Affiliation(s)
- Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina–Greensboro, Greensboro, North Carolina, USA
| | - Rayner K J Tan
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project–China, Guangzhou, China
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Joel M Francis
- Department of Family Medicine, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Navin Kumar
- Department of Sociology, Yale University, New Haven, Connecticut, USA
| | - Linda Campbell
- Center for Population, Family, and Health, University of Antwerp, Antwerp, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Wei Hong Zhang
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Takhona G Hlatshwako
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Priya Kosana
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonam Shah
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erica M Brenner
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lore Remmerie
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Katerina Klapilova
- Faculty of Humanities, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - Kristen Mark
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Gabriela Perotta
- Faculty of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | - Amanda Gabster
- Gorgas Memorial Institute for Health Studies, Panama City, Panama
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Edwin Wouters
- Center for Population, Family, and Health, University of Antwerp, Antwerp, Belgium
| | - Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, Australia
| | - Jacqueline Hendriks
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, Australia
| | - Devon J Hensel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Sociology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Simukai Shamu
- Health Systems Strengthening, Foundation for Professional Development, Pretoria, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Tammary Esho
- End FGM/C Centre of Excellence, Amref Health Africa, Nairobi, Kenya
| | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Initiative, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Wah Yun Low
- Asia–Europe Institute, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Leona Plasilova
- Faculty of Humanities, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - Gunta Lazdane
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Amr Abdelhamed
- Department of Dermatology, Venereology & Andrology, Sohag University, Sohag, Egypt
| | | | - Kristien Michielsen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAand
- Primary Care and Prevention, Center for Research in Epidemiology and Public Health, National Institute of Health and Medical Research 1018, Villejuif, France
| | - Joseph D Tucker
- University of North Carolina Project–China, Guangzhou, China
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mohamed R, White TM, Lazarus JV, Salem A, Kaki R, Marrakchi W, Kheir SGM, Amer I, Ahmed FM, Khayat MA, Al-Abdullah N, Ali B, Sultan R, Alamri B, Abdulmajid A, Kooli I, Chakroun M, Madani TA, Esmat G, Cordie A. COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region. South Afr J HIV Med 2022; 23:1391. [PMID: 36101660 PMCID: PMC9452923 DOI: 10.4102/sajhivmed.v23i1.1391] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Identifying coronavirus disease 2019 (COVID-19) vaccine acceptance and associated factors among people living with HIV (PLHIV) in the Middle East and North Africa region is important to meet the need for broad-scale vaccination against COVID-19. Objectives To investigate the COVID-19 vaccine acceptance rate and factors among PLHIV in the Middle East and North Africa region. Method An online cross-sectional survey was conducted among PLHIV currently living in Egypt, Tunisia and Saudi Arabia between March 2021 and August 2021. Results Of the 540 respondents, 19.3% reported already being vaccinated against COVID-19 (n = 104), 32.0% responded ‘definitely yes’ (n = 173), and 13.3% responded ‘probably yes’ (n = 72) for intention to receive a COVID-19 vaccine, with an overall COVID-19 vaccine acceptance rate of 64.6% among PLHIV in the region. The most significant predictors of COVID-19 vaccine acceptance included feeling less worried about COVID-19 transmission post-vaccination (221.0% higher odds), and believing the disease is vaccine-preventable (160.0% higher odds). Reported barriers to COVID-19 vaccine acceptance include concerns about vaccine effectiveness and belief that HIV medications protect against COVID-19 transmission, living in a rural area and reporting less-frequent engagement with HIV care. Nine out of 10 participants reported that the chances of them getting COVID-19 vaccine would increase if given adequate information and if their doctor recommended it. Conclusion Findings of the study can help researchers, health officials, and other health system actors understand the predictors and barriers to COVID-19 vaccine acceptance reported by PLHIV. This understanding could inform the future planning of interventions tailored to PLHIV.
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Affiliation(s)
- Rahma Mohamed
- Endemic Medicine Department, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Trenton M. White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Amany Salem
- Department of Public Health, Kasr Alaini School of Medicine, Cairo University, Cairo, Egypt
| | - Reham Kaki
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wafa Marrakchi
- Infectious Diseases Department, Faculty of Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Sara G. M Kheir
- Disease Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Ibrahim Amer
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
| | - Fida M Ahmed
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maie A Khayat
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Batool Ali
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Roaa Sultan
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Bandar Alamri
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Anouf Abdulmajid
- Department of Infectious Diseases, East Jeddah General Hospital, Jeddah, Saudi Arabia
| | - Ikbal Kooli
- Infectious Diseases Department, Faculty of Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Mohamed Chakroun
- Infectious Diseases Department, Faculty of Medicine, University Hospital of Monastir, Monastir, Tunisia
| | - Tariq A. Madani
- Department of Infectious Disease, Infection Control and Environmental Health, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Gamal Esmat
- Endemic Medicine Department, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Ahmed Cordie
- Endemic Medicine Department, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
- Kasr Al-Aini HIV and Viral Hepatitis Fighting Group, Kasr Alaini School of Medicine, Cairo University Hospitals, Cairo, Egypt
- Infectious Diseases Department, Armed Forces College of Medicine, Cairo, Egypt
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Rosen JG, Zhang L, Pelaez D, Coleman JS, To C, Cooper L, Olatunde PF, Toomre T, Glick JL, Park JN. Provider Perspectives on HIV Pre-Exposure Prophylaxis Service Disruptions and Adaptations During the COVID-19 Pandemic in Baltimore, Maryland: A Qualitative Study. AIDS Patient Care STDS 2022; 36:313-320. [PMID: 35951445 PMCID: PMC9419971 DOI: 10.1089/apc.2022.0058] [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: 11/12/2022] Open
Abstract
The COVID-19 pandemic continues driving unprecedented disruptions to health care provision, including HIV pre-exposure prophylaxis (PrEP) services. We explored service provider experiences promoting and prescribing PrEP to marginalized populations during the COVID-19 pandemic in Baltimore, Maryland. In February to April 2021, we facilitated four virtual focus group discussions with 20 PrEP providers, representing various professional cadres and practice settings. Employing an iterative, team-based thematic analysis, we identified salient enablers and constraints to PrEP promotion, initiation, and maintenance in the COVID-19 era, along with innovative adaptations to PrEP service delivery. Discussants described attenuated demands for PrEP early in the pandemic, exemplified by high PrEP discontinuation rates. This was attributed to changes in clients' sexual behaviors and shifting priorities, including caregiving responsibilities, during the pandemic. Substantial systems-level disruptions impacting PrEP provision were identified, including outreach service suspension, personnel shortages, and facility restrictions on face-to-face visits. Providers emphasized that these disruptions, though occurring early in the pandemic, had protracted impacts on PrEP accessibility. The transition to telemedicine rendered health care services, including PrEP, more accessible/convenient to some clients and expeditious to providers. However, structural barriers to telehealth engagement (telephone/internet access), coupled with limitations of the virtual care environment (difficulty establishing rapport), impeded efforts to equitably promote and prescribe PrEP. Expanding the PrEP outreach workforce and availing alternatives to telemedicine (e.g., community-based PrEP provision, specimen self-collection) could facilitate PrEP care continuity, especially as COVID-19 transitions from an acute to a protracted health crisis.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - C To
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Praise F Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Teagan Toomre
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, Rhode Island, USA
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Juan Carlos MP, Julio VC, Héctor Alexis LB, Ignacio LV, Shelley L. C. Differences in Sexual Health of Mexican Gay and Bisexual Youth and Adults During the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:614-626. [PMID: 38596397 PMCID: PMC10903613 DOI: 10.1080/19317611.2022.2097357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 04/11/2024]
Abstract
Objective: compare and analyze the implications of COVID-19 on the sexual health of Mexican gay and bisexual young and adult men (GBM). Method: an online survey with 1001 GBM participants. Information was collected on sexual desire, use of mobile applications, sexual practices during the pandemic, and prevention of sexually transmitted infections (STIs) from August to October 2020. Young participants were compared with adults. Results: Young GBM reported more challenges to their sexual health in the pandemic. There was an increase in sexual desire, mobile applications, and a decrease in access to STIs prevention supplies. Discussion: Implications for sexual health policies for these groups during health contingencies are discussed.
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Affiliation(s)
- Mendoza-Pérez Juan Carlos
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Vega-Cauich Julio
- Facultad de Educación, Universidad Autónoma de Yucatán, Merida, Mexico
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Drabo EF, Moucheraud C, Nguyen A, Garland WH, Holloway IW, Leibowitz A, Suen SC. Using Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles County. J Acquir Immune Defic Syndr 2022; 90:S167-S176. [PMID: 35703769 PMCID: PMC9216245 DOI: 10.1097/qai.0000000000002977] [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: 02/03/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is essential to ending HIV. Yet, uptake remains uneven across racial and ethnic groups. We aimed to estimate the impacts of alternative PrEP implementation strategies in Los Angeles County. SETTING Men who have sex with men, residing in Los Angeles County. METHODS We developed a microsimulation model of HIV transmission, with inputs from key local stakeholders. With this model, we estimated the 15-year (2021-2035) health and racial and ethnic equity impacts of 3 PrEP implementation strategies involving coverage with 9000 additional PrEP units annually, above the Status-quo coverage level. Strategies included PrEP allocation equally (strategy 1), proportionally to HIV prevalence (strategy 2), and proportionally to HIV diagnosis rates (strategy 3), across racial and ethnic groups. We measured the degree of relative equalities in the distribution of the health impacts using the Gini index (G) which ranges from 0 (perfect equality, with all individuals across all groups receiving equal health benefits) to 1 (total inequality). RESULTS HIV prevalence was 21.3% in 2021 [Black (BMSM), 31.1%; Latino (LMSM), 18.3%, and White (WMSM), 20.7%] with relatively equal to reasonable distribution across groups (G, 0.28; 95% confidence interval [CI], 0.26 to 0.34). During 2021-2035, cumulative incident infections were highest under Status-quo (n = 24,584) and lowest under strategy 3 (n = 22,080). Status-quo infection risk declined over time among all groups but remained higher in 2035 for BMSM (incidence rate ratio, 4.76; 95% CI: 4.58 to 4.95), and LMSM (incidence rate ratio, 1.74; 95% CI: 1.69 to 1.80), with the health benefits equally to reasonably distributed across groups (G, 0.32; 95% CI: 0.28 to 0.35). Relative to Status-quo, all other strategies reduced BMSM-WMSM and BMSM-LMSM disparities, but none reduced LMSM-WMSM disparities by 2035. Compared to Status-quo, strategy 3 reduced the most both incident infections (% infections averted: overall, 10.2%; BMSM, 32.4%; LMSM, 3.8%; WMSM, 3.5%) and HIV racial inequalities (G reduction, 0.08; 95% CI: 0.02 to 0.14). CONCLUSIONS Microsimulation models developed with early, continuous stakeholder engagement and inputs yield powerful tools to guide policy implementation.
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Affiliation(s)
- Emmanuel F. Drabo
- Department of Health Policy and Management, John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Corrina Moucheraud
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
| | - Anthony Nguyen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
| | - Wendy H. Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA
| | - Ian W. Holloway
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Arleen Leibowitz
- UCLA Center for HIV Identification, Prevention and Treatment Services, University of Los Angeles, CA
- Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Sze-chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA
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McFall AM, Menezes NP, Srikrishnan AK, Solomon SS, Anand S, Baishya JJ, Lucas GM, Celentano DD, Mehta SH. Impact of the COVID-19 pandemic on HIV prevention and care services among key populations across 15 cities in India: a longitudinal assessment of clinic-based data. J Int AIDS Soc 2022; 25:e25960. [PMID: 35818314 PMCID: PMC9273869 DOI: 10.1002/jia2.25960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/14/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has threatened to diminish gains in HIV epidemic control and impacts are likely most profound among key populations in resource-limited settings. We aimed to understand the pandemic's impact on HIV-related service utilization among men who have sex with men (MSM) and people who inject drugs (PWID) across India. METHODS Beginning in 2013, we established integrated care centres (ICCs) which provide HIV preventive and treatment services to MSM and PWID across 15 Indian sites. We examined utilization patterns for an 18-month period covering 2 months preceding the pandemic (January-February 2020) and over the first and second COVID-19 waves in India (March 2020-June 2021). We assessed: (1) unique clients accessing any ICC service, (2) ICC services provided, (3) unique clients tested for HIV and (4) HIV diagnoses and test positivity. Among an established cohort of PWID/MSM living with HIV (PLHIV), we administered a survey on the pandemic's impact on HIV care and treatment (June-August 2020). RESULTS Overall, 13,854 unique clients visited an ICC from January 2020 to June 2021. In January/February 2020, the average monthly number of clients was 3761. Compared to pre-pandemic levels, the number of clients receiving services declined sharply in March 2020, dropping to 25% of pre-pandemic levels in April/May 2020 (first wave), followed by a slow rebound until April/May 2021 (second wave), when there was a 57% decline. HIV testing followed a similar trajectory. HIV test positivity changed over time, declining in the first wave and reaching its nadir around July 2020 at ∼50% of pre-pandemic levels. Positivity then increased steadily, eventually becoming higher than pre-pandemic periods. The second wave was associated with a decline in positivity for MSM but was relatively unchanged for PWID. Among 1650 PLHIV surveyed, 52% of PWID and 45% of MSM reported the pandemic impacted their ability to see an HIV provider. MSM had barriers accessing sexually transmitted infection testing and partner HIV testing. CONCLUSIONS The COVID-19 pandemic led to significant decreases in HIV-related service utilization among key populations in India. This presents an opportunity for increased transmission and patients presenting with advanced disease among groups already disproportionately impacted by HIV.
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Affiliation(s)
- Allison M. McFall
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Neia Prata Menezes
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Sunil S. Solomon
- Department of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and EducationChennaiIndia
| | - Jiban J. Baishya
- Department of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Gregory M. Lucas
- Department of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - David D. Celentano
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Shruti H. Mehta
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Protecting HIV service delivery for key populations in southern Africa in the context of the COVID-19 pandemic. IJID REGIONS 2022; 3:114-116. [PMID: 35720139 PMCID: PMC8924033 DOI: 10.1016/j.ijregi.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
The 2025 UNAIDS targets prioritize reaching all subpopulations living with HIV The COVID-19 pandemic has resulted in a setback in terms of confronting HIV National HIV control programs must focus on key populations Strategies for addressing fundamental structural barriers are proposed
The 2025 UNAIDS targets prioritize reaching all subpopulations living with HIV and those at risk for HIV as the only pathway to achieving control of the HIV epidemic. This has brought to the fore the importance of addressing the needs of key marginalized groups and placing such communities at the center of HIV response strategies. However, the COVID-19 pandemic has resulted in a setback in terms of confronting HIV. With this in mind, it is important not only to protect services within HIV responses among key populations, but also to expand such services to meet the UNAIDS 2025 targets. Without this, gains in controlling COVID-19 may be achieved at the expense of losses in controlling the spread of HIV, which had been achieved after sustained and resource-intensive actions.
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Santos GM, Hong C, Wilson N, Nutor JJ, Harris O, Garner A, Holloway I, Ayala G, Howell S. Persistent disparities in COVID-19-associated impacts on HIV prevention and care among a global sample of sexual and gender minority individuals. Glob Public Health 2022; 17:827-842. [PMID: 35435149 PMCID: PMC10953730 DOI: 10.1080/17441692.2022.2063362] [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: 11/02/2021] [Accepted: 03/24/2022] [Indexed: 02/06/2023]
Abstract
As COVID-19 continues to persist, there is a need to examine its impact among sexual and gender minority individuals, especially those with intersecting vulnerabilities. We conducted a cross-sectional survey with a global sample of sexual and gender minority individuals (n = 21,795) from October 25, 2020 to November 19, 2020, through a social networking app. We characterised the HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 mitigation response and examined whether subgroups of our study population are disproportionately impacted by COVID-19. Many sexual and gender minority individuals reported interruptions to HIV prevention and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, individuals with a history of sex work, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among sexual and gender minority individuals.
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Affiliation(s)
- Glenn-Milo Santos
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Chenglin Hong
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Natalie Wilson
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Ian Holloway
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, USA
| | - George Ayala
- Alameda County Public Health Department, San Leandro, CA, USA
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Jordão T, Magno L, Pereira M, Rossi TRA, de Almeida Silva P, Figueiredo MAA, de Brito Lima Prado NM, Dos Santos AM, Cangussu MC, Dourado I. Willingness of health care providers to offer HIV self-testing from specialized HIV care services in the northeast of Brazil. BMC Health Serv Res 2022; 22:713. [PMID: 35637470 PMCID: PMC9149328 DOI: 10.1186/s12913-022-08091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background The insufficient knowledge regarding the serological status of people affected with human immunodeficiency virus (HIV) is a concern in Brazil. HIV self-testing (HIVST) has been proved to have great potential for increasing testing, especially among vulnerable populations. The large-scale distribution of HIVST by the Brazilian public health system has increased in recent years. We aimed to investigate the awareness of HIVST among health care providers (HCP) from specialized HIV/AIDS care services in the state of Bahia, Northeast Brazil. Further we investigated HCP acceptability and willingness to offer its use. Methods A cross-sectional study on HCP from 29 specialized care services (SCS) located in 21 cities in the state of Bahia. HCP working in the service for at least 6 months were included. Sociodemographic, occupational, and behavioral data were collected using a questionnaire. Descriptive statistics were carried out. Bivariate, and multivariate analyses estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) using logistic regression were conducted. Results The awareness and acceptability of HIVST and the willingness to provide it were 79.8, 55.2, and 47.1%, respectively. Few HCP reported that the SCS where they worked dispensed HIVST (3.6%), and 13.5% received some information or training on HIVST. Factors associated with willingness to offer HIVST were: HIVST acceptability (aOR = 9.45; 95% CI: 4.53–19.71), willingness to use HIVST on themselves (aOR = 4.45; 95% CI: 1.62–12.24), confidence in offering HIVST to clients (aOR = 5.73; 95% CI: 2.26–12.72), and considering everyone eligible for HIVST (aOR = 2.88; 95% CI: 1.25–6.59). Conclusions Although most HCP were aware of HIVST, acceptability and willingness to provide it to the clients was moderate. The scale up of HIVST as a mean for the HIV prevention and control policy in Brazil, requires further training of HCP and better implementation of this program. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08091-2.
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Affiliation(s)
- Tiago Jordão
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Diretoria de Vigilância Epidemiológica da Bahia, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil. .,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
| | - Marcos Pereira
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Thais Regis Aranha Rossi
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | - Pedro de Almeida Silva
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Rua Silveira Martins, 2555, Cabula, Salvador, 41.150-000, Brazil
| | | | | | - Adriano Maia Dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
| | | | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Kawichai S, Songtaweesin WN, Wongharn P, Phanuphak N, Cressey TR, Moonwong J, Vasinonta A, Saisaengjan C, Chinbunchorn T, Puthanakit T. A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e25561. [PMID: 35451976 PMCID: PMC9073624 DOI: 10.2196/25561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/11/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Widespread smartphone use provides opportunities for mobile health HIV prevention strategies among at-risk populations. Objective This study aims to investigate engagement in a theory-based (information–motivation–behavioral skills model) mobile phone app developed to support HIV pre-exposure prophylaxis (PrEP) adherence among Thai young men who have sex with men (YMSM) and young transgender women (YTGW) in Bangkok, Thailand. Methods A randomized controlled trial was conducted among HIV-negative YMSM and YTGW aged 15-19 years initiating daily oral PrEP. Participants were randomized to receive either youth-friendly PrEP services (YFS) for 6 months, including monthly contact with site staff (clinic visits or telephone follow-up) and staff consultation access, or YFS plus use of a PrEP adherence support app (YFS+APP). The target population focus group discussion findings and the information–motivation–behavioral skills model informed app development. App features were based on the 3Rs—risk assessment of self-HIV acquisition risk, reminders to take PrEP, and rewards as redeemable points. Dried blood spots quantifying of tenofovir diphosphate were collected at months 3 and 6 to assess PrEP adherence. Tenofovir diphosphate ≥350-699 fmol/punch was classified as fair adherence and ≥700 fmol/punch as good adherence. Data analysis on app use paradata and exit interviews were conducted on the YFS+APP arm after 6 months of follow-up. Results Between March 2018 and June 2019, 200 participants with a median age of 18 (IQR 17-19) years were enrolled. Overall, 74% (148/200) were YMSM; 87% (87/100) of participants who received YFS+APP logged in to the app and performed weekly HIV acquisition risk assessments (log-in and risk assessment [LRA]). The median duration between the first and last log-in was 3.5 (IQR 1.6-5.6) months, with a median frequency of 6 LRAs (IQR 2-10). Moreover, 22% (22/100) of the participants in the YFS+APP arm were frequent users (LRA≥10) during the 6-month follow-up period. YMSM were 9.3 (95% CI 1.2-74.3) times more likely to be frequent app users than YTGW (P=.04). Frequent app users had higher proportions (12%-16%) of PrEP adherence at both months 3 and 6 compared with infrequent users (LRA<10) and the YFS arm, although this did not reach statistical significance. Of the 100 participants in the YFS+APP arm, 23 (23%) were interviewed. The risk assessment function is perceived as the most useful app feature. Further aesthetic adaptations and a more comprehensive rewards system were suggested by the interviewees. Conclusions Higher rates of PrEP adherence among frequent app users were observed; however, this was not statistically significant. A short app use duration of 3 months suggests that they may be useful in establishing habits in taking daily PrEP, but not long-term adherence. Further studies on the specific mechanisms of mobile phone apps that influence health behaviors are needed. Trial Registration ClinicalTrials.gov NCT03778892; https://clinicaltrials.gov/ct2/show/NCT03778892
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Affiliation(s)
- Surinda Kawichai
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | | | - Prissana Wongharn
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | | | - Tim R Cressey
- The Program for HIV Prevention and Treatment/ Unité Mixte de recherches Internationale 174, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Juthamanee Moonwong
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | | | - Chutima Saisaengjan
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | | | - Thanyawee Puthanakit
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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The impact of COVID-19 restrictions on online sales of HIV self-test kits and implications for HIV prevention: analysis of transaction data from a leading e-commerce platform in China. J Acquir Immune Defic Syndr 2022; 90:408-417. [PMID: 35394989 DOI: 10.1097/qai.0000000000002997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of the COVID-19 epidemic on HIV self-testing (HIVST) remains unclear. We aimed to quantify the impact of COVID-restrictions on HIVST kit purchasing behaviors in mainland China. METHODS De-identified transaction data were retrieved from a large online shopping platform. An interrupted time series model was constructed to examine the impact of COVID-restrictions on the weekly number of anonymous customers purchasing HIVST kits, online orders, and purchased kits. RESULTS A total of 2.32 million individuals submitted 4.46 million orders for 4.84 million HIVST kits between 7 January 2016 and 22 April 2020. Compared to expected levels assuming COVID-19 epidemic and related restrictions had not happened, the number of purchasers, orders, and kits decreased by an estimated 10,500 (51.7%), 18,000 (55.3%) and 18,500 (54.9%) in the first week (23 January 2020 to 29 January 2020) after COVID-restrictions were implemented, respectively. As restrictions eased, the number of purchasers, orders, and kits increased by an average of 7.4%, 4.8%, and 4.9% per week, respectively. In the first week after COVID-restrictions were lifted (9 April 2020 to 15 April 2020), the number of purchasers returned to expected levels, whereas the number of orders and kits were still lower than expected levels. The impact of COVID-restrictions on outcomes at the beginning of COVID-restrictions and the increasing trends of outcomes were larger among those living in regions with higher COVID-19 incidence (e.g., Wuhan city and Hubei province). CONCLUSIONS Online sales of HIVST kits were significantly impacted by COVID-restrictions, and HIVST kit purchasing patterns returned to expected levels after restrictions were lifted.
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Corneli A, Perry B, Taylor J, Beckford J, Molokwu N, Reif S, Wilson J, Gulden C, Bickham J, Siren J, Thompson W, Clement ME. HIV Prevention During the COVID-19 Pandemic: Sexual Activity and PrEP Use Among Black Same-Gender-Loving Men and Black Cisgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:142-157. [PMID: 35438538 PMCID: PMC9534043 DOI: 10.1521/aeap.2022.34.2.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Black populations in the U.S. South are disproportionally affected by HIV and COVID-19 due to longstanding inequalities. We conducted 20 in-depth interviews-12 with Black same-gender-loving men and 8 with Black cisgender women-to explore the impact of the initial phase of the COVID-19 pandemic on sexual activities and PrEP use. Almost all participants reduced the frequency of sex and number of partners. Women described little interest in sex, whereas men began to connect with some sexual partners after stay-at-home orders were lifted. Both populations were concerned about contracting COVID-19 through sexual partners, and men described selecting partners based on perceived COVID-19 risk. Participants valued PrEP and could access it, although several men who were not having sex stopped taking it. Risk of acquiring HIV during this time was likely limited. Future qualitative research is needed to understand how sexual behaviors and PrEP use changed as the pandemic continued.
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Affiliation(s)
- Amy Corneli
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Brian Perry
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Jamilah Taylor
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Jeremy Beckford
- Louisiana State University Health Sciences Center, Section of Infectious Diseases, New Orleans, LA
| | - Nneka Molokwu
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Susan Reif
- Center for Health Policy and Inequities Research, Duke University, Durham, NC
| | | | | | - Jacquelyn Bickham
- Louisiana Department of Health STD/HIV/Hepatitis Program, New Orleans, LA
| | - Julia Siren
- CrescentCare Federally Qualified Health Center, New Orleans, LA
| | | | - Meredith E. Clement
- Louisiana State University Health Sciences Center, Section of Infectious Diseases, New Orleans, LA
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Karaosmanoglu HK, Mete B, Gunduz A, Sevgi DY, Aydin OA, Dokmetas I, Tabak F. Changing Characteristics of Patients Living with HIV/AIDS after COVID-19 Pandemics in Turkey. Curr HIV Res 2022; 20:236-241. [PMID: 35240974 DOI: 10.2174/1570162x20666220303103805] [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: 08/25/2021] [Revised: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
AIMS COVID-19 pandemic has substantially changed the life and presented several barriers to health services. HIV care continuum needs a high rate of diagnosis, an effective treatment and a sustained suppression of viral replication. COVID-19 pandemic has affected these three steps of HIV care. In this study, we investigated the characteristics of newly diagnosed patients living with HIV/AIDS (PLWH) during the COVID pandemic and compared them with those before the pandemic. METHODS All newly diagnosed patients in three HIV healthcare center, in Istanbul, Turkey were included into the study. Pandemic period included April 1, 2020 to April 1, 2021 and pre-pandemic period included March 1, 2019 to March 1, 2020. RESULTS During pre-pandemic period, 756 patients were diagnosed HIV/AIDS. In pandemic period, this figure was 58% less: 315. Patients in pre-pandemic and pandemic period had comparable age and gender distributions. PLWH diagnosed in pandemic period had higher rates of low CD4 cells: low CD4 (<350 cells /mm3) was measured in 243 (36.4%) patients in pre-pandemic, while it was done in 126 (47.9%) in pandemic period (p<0.01). Also the distribution of CD4 cells was significantly different between periods: In pandemic period, CD4 cell distribution skewed to lower CD4 categories significantly. Symptomatic patient rate and AIDS-defining disorder rate among symptomatic patients were comparable. Viral loads were not significantly different in two periods. CONCLUSION Less number of newly diagnosed PLWH can be explained by less HIV testing, less admission to the health care or actual decrease of HIV prevalence during pandemic. Sexual behaviors may have changed during COVID-19 pandemic which could lead to HIV transmission restriction. Lower CD4 counts among the newly diagnosed PLWH suggest that admittance to health care is late and a significant portion of PLWH remain undiagnosed.
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Affiliation(s)
- Hayat Kumbasar Karaosmanoglu
- Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Birgul Mete
- Cerrahpasa University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Alper Gunduz
- Sisli Hamidiye Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Dilek Yildiz Sevgi
- Sisli Hamidiye Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Ozlem Altuntas Aydin
- Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Ilyas Dokmetas
- Sisli Hamidiye Training and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Fehmi Tabak
- Cerrahpasa University Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Di Ciaccio M, Villes V, Michels D, Morel S, Delabre RM, Rojas Castro D, Velter A. Impact of the early 2020 COVID-19 crisis and lockdown on PrEP use among men who have sex with men (MSM) in France. Sex Transm Infect 2022; 98:510-517. [PMID: 35149580 DOI: 10.1136/sextrans-2021-055189] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe changes in pre-exposure prophylaxis (PrEP) use during and following the COVID-19 lockdown in France (March-May 2020) and identify the factors associated with PrEP discontinuation among men who have sex with men (MSM) after the lockdown. METHODS Data from the, an anonymous, cross-sectional internet survey among MSM in July 2020, were analysed. Among respondents who were using PrEP prior to the lockdown, a binary logistic regression model was used to compare participants who were still taking PrEP (current PrEP users) with those who were not taking PrEP at the time of the survey (former PrEP users). RESULTS Among 8345 respondents, 946 were PrEP users before the lockdown, of whom 58.8% (n=556) reported stopping PrEP during the lockdown and 15.4% (n=146) were not using PrEP at the time of the survey. Among the 556 who stopped PrEP during lockdown, 86.5% (n=481) reported no sexual activity; 76.8% (n=427) restarted PrEP after lockdown. Former PrEP users were more likely to be younger, not living with a stable male sexual partner, report moderate anxiety, report increased psychoactive drug use during the lockdown, and report not having tested for HIV or STI since the end of the lockdown because they did not know where to go, preferred to wait or for another reason. Reporting fewer male sexual partners in the last 6 months was also significantly associated with being a former PrEP user. CONCLUSIONS MSM adapted PrEP use to their sexual activity during and after the French lockdown. After the lockdown, discontinued PrEP occurred more often among MSM who had fewer sexual partners and had mental health vulnerabilities. These factors could also be predictive of PrEP discontinuation in a more general context. PrEP users should be informed on how to safely stop/start PrEP and on the use of other prevention tools to reduce potential risk exposure during PrEP discontinuation.
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Affiliation(s)
- Marion Di Ciaccio
- Community-based Research Laboratory, Coalition PLUS, Pantin, France .,Groupe de Recherche en Psychologie Sociale (GRePS), Université Lyon 2, Lyon, France
| | - Virginie Villes
- Community-based Research Laboratory, Coalition PLUS, Pantin, France
| | - David Michels
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | - Stéphane Morel
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,AIDES, Pantin, France
| | | | - Daniela Rojas Castro
- Community-based Research Laboratory, Coalition PLUS, Pantin, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Grov C, Zohra F, Westmoreland DA, Mirzayi C, D'Angelo A, Stief M, Kulkarni S, Nash D, Carrico AW. Sex in the Era of COVID-19 in a U.S. National Cohort of Cisgender Men, Transgender Women, and Transgender Men Who Have Sex with Men: April-May 2020. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:343-354. [PMID: 34845579 PMCID: PMC8628839 DOI: 10.1007/s10508-021-02121-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/05/2021] [Accepted: 08/01/2021] [Indexed: 05/28/2023]
Abstract
Since the emergence of the COVID-19 pandemic, there has been an increasing body of research focused on the effects that measures like stay-at-home orders and social distancing are having on other aspects of health, including mental health and sexual health. Currently, there are limited extant data on the effects of the pandemic on sexual and gender minorities. Between April 15, 2020, and May 15, 2020, we invited participants in an ongoing U.S. national cohort study (Together 5000) to complete a cross-sectional online survey about the pandemic, and its effects on mental and sexual health and well-being (n = 3991). Nearly all (97.7%) were living in an area where they were told they should only leave their homes for essentials. Most (70.1%) reported reducing their number of sex partners as a result of the pandemic. Among the 789 participants prescribed HIV pre-exposure prophylaxis (PrEP), 29.9% said they stopped taking their PrEP entirely, and 14.2% started selectively skipping doses. For those who had been taking PrEP, discontinuing PrEP was associated with having no new sex partners (β = 0.90, 95% CI 0.40-1.40). Among the 152 HIV-positive participants, 30.9% said they were unable to maintain an HIV-related medical appointment because of the pandemic and 13.8% said they had been unable to retrieve HIV medications. Additionally, 35.3% of participants were experiencing moderate to severe anxiety because of the pandemic and 36.7% reported symptoms of depression. In a multivariable logistic regression, reporting a new sex partner in the prior 30 days was significantly associated with being aged 30 or older (vs. not, AOR = 1.21), being Black (AOR = 1.79) or Latinx (AOR = 1.40, vs. white), and being unsure if they had been in close contact with someone diagnosed with COVID-19 (AOR = 1.32, vs. no contact). It was unassociated with COVID-19-induced anxiety, depression, or knowing someone hospitalized with COVID-19. The pandemic has caused disruptions in sexual behavior (partner reduction) as well as difficulties navigating PrEP and HIV care continua. Findings will guide more comprehensive public health responses to optimize HIV prevention and treatment in the era of COVID-19.
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Affiliation(s)
- Christian Grov
- CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 55 W. 125th St., New York, NY, 10027, USA.
- CUNY Institute for Implementation Science in Population Health, New York, USA.
| | - Fatima Zohra
- CUNY Institute for Implementation Science in Population Health, New York, USA
| | - Drew A Westmoreland
- CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 55 W. 125th St., New York, NY, 10027, USA
- CUNY Institute for Implementation Science in Population Health, New York, USA
| | - Chloe Mirzayi
- CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 55 W. 125th St., New York, NY, 10027, USA
- CUNY Institute for Implementation Science in Population Health, New York, USA
| | - Alexa D'Angelo
- CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 55 W. 125th St., New York, NY, 10027, USA
- CUNY Institute for Implementation Science in Population Health, New York, USA
| | - Matthew Stief
- CUNY Institute for Implementation Science in Population Health, New York, USA
| | - Sarah Kulkarni
- CUNY Institute for Implementation Science in Population Health, New York, USA
| | - Denis Nash
- CUNY Graduate School of Public Health and Health Policy, 7th Floor Mailroom, 55 W. 125th St., New York, NY, 10027, USA
- CUNY Institute for Implementation Science in Population Health, New York, USA
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Walters SM, Li WP, Saifi R, Azwa I, Syed Omar SF, Collier ZK, Amir Hassan AB, Haddad MS, Altice FL, Kamarulzaman A, Earnshaw VA. Barriers and Facilitators to Implementing Project ECHO in Malaysia During the COVID-19 Pandemic. J Int Assoc Provid AIDS Care 2022; 21:23259582221128512. [PMID: 36177542 PMCID: PMC9528038 DOI: 10.1177/23259582221128512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: In Malaysia, HIV is concentrated among key populations who experience barriers to care due to stigma and healthcare discrimination. The COVID-19 pandemic has increased barriers to healthcare. Project ECHO (Extension for Community Healthcare Outcomes) is a transformative tele-education strategy that could improve HIV prevention and treatment. Methods: Practicing physicians who were aged 18 years or older and had internet access participated in asynchronous online focus groups. Results: Barriers to Project ECHO were conflicting priorities, time constraints, and technology. Facilitators included content and format, dedicated time, asynchronized flexible programming, incentives, and ensuring technology was available. Conclusion: Project ECHO is a promising intervention that can increase physicians' knowledge and skill set in specialty medicine during the COVID-19 pandemic. Interventionists in Malaysia in particular, but also in general, should consider these barriers and facilitators when developing Project ECHO as they may aid in developing a more robust program and increase participation.
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Affiliation(s)
- Suzan M Walters
- Department of Epidemiology, 5894New York University School of Global Public Health, New York, NY, USA.,Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Wong Pui Li
- Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Rumana Saifi
- Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Marwan S Haddad
- Center for Key Populations, 219813Community Health Center, Inc., New Britain, CT, USA
| | - Frederick L Altice
- Centre of Excellence for Research in AIDS, 37447University of Malaya, Kuala Lumpur, Malaysia.,Department of Internal Medicine, 12228Yale School of Medicine, Yale University, New Haven, CT, USA.,Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Adeeba Kamarulzaman
- Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, 5972University of Delaware, Newark, DE, USA
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Trepka MJ, Ward MK, Ladner RA, Sheehan DM, Li T, Ibarra C, Gbadamosi SO, Ibañez GE, Jean-Gilles M. HIV Care Access During the COVID-19 Pandemic as Perceived by Racial/Ethnic Minority Groups Served by the Ryan White Program, Miami-Dade County, Florida. J Int Assoc Provid AIDS Care 2022; 21:23259582221084536. [PMID: 35243926 PMCID: PMC8899832 DOI: 10.1177/23259582221084536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Ryan White Program (RWP) in Miami-Dade County, Florida made several modifications to keep HIV care accessible during the COVID-19 Pandemic, including expanding telehealth services, increasing access to HIV medications, and waiving required lab tests for service recertification. We assessed ease of access to medical providers, medical case managers, and antiretroviral medications during the COVID-19 Pandemic among 298 Non-Hispanic Black, Hispanic, and Haitian people with HIV (PWH) served by the RWP Part A, Miami-Dade County, Florida using a telephone-administered survey between October 2020 and January 2021. Overall, most clients reported similar or better access compared to before the Pandemic. Use of videocalls to communicate with HIV medical providers varied by race/ethnicity: Hispanics (49.6%), Non-Hispanic Blacks (37.7%), and Haitian clients (16.0%). Results suggest the modifications helped maintain access to care during an unprecedented health crisis. Permanently adopting many of these modifications should be considered to continue to facilitate access to care.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Melissa K Ward
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | | | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA.,Research Center in Minority Institutions (RCMI), 5450Florida International University, Miami, FL, USA
| | - Tan Li
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
| | - Cynthia Ibarra
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Gladys E Ibañez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL USA
| | - Michele Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, 5450Florida International University, Miami, FL, USA
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46
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Baral S, Rao A, Twahirwa Rwema JO, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya N, Kamarulzaman A, Millett G, Marcus JL, Mishra S. Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.07.21249419. [PMID: 33442703 PMCID: PMC7805463 DOI: 10.1101/2021.01.07.21249419] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. OBJECTIVES We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. METHODS A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. RESULTS A total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. DISCUSSION COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.
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Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, Scotland
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Sweden
| | | | - Annette H Sohn
- TREAT Asia, amfAR, the Foundation for AIDS Research, Bangkok, Thailand
| | - Nancy Phaswana-Mafuya
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg
| | | | | | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Access to HIV Antiretroviral Therapy among People Living with HIV in Melbourne during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312765. [PMID: 34886496 PMCID: PMC8657228 DOI: 10.3390/ijerph182312765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
The social measures taken to control the COVID-19 pandemic can potentially disrupt the management of HIV. The objective of this study was to examine the impact of the Australian COVID-19 lockdown restrictions on access to antiretroviral therapy (ART) for people living with HIV in Melbourne. Using data from the Melbourne Sexual Health Centre (MSHC), we assessed the changes in rates of ART postal delivery, controlled viral load, and ART dispensing from 2018 to 2020. The percentage of ART delivered by postage from the MSHC pharmacy was calculated weekly. The percentage of people living with HIV with a controlled viral load (≤200 copies/mL) was calculated monthly. We calculated a yearly Medication Possession Ratio (MPR). The average percentage of HIV ART dispensed through postage for the years 2018, 2019, and 2020 was 3.7% (371/10,023), 3.6% (380/10,685), and 14% (1478/10,765), respectively (Ptrend < 0.0001). Of the 3115 people living with HIV, the average MPR for 2018, 2019, and 2020 was 1.05, 1.06, and 1.14, respectively (Ptrend = 0.28). The average percentage of people with an HIV viral load of <200 copies/mL for the years 2018, 2019, and 2020 was 97.6% (2271/2327), 98.0% (2390/2438), and 99.2% (2048/2064), respectively (Ptrend < 0.0001). This study found that the proportion of controlled viral load and access to ART of people living with HIV in Melbourne was largely unaffected by the COVID-19 lockdown restrictions. This suggests that some of the services provided by the MSHC during the pandemic, such as HIV ART postal delivery, may assist long-term HIV management.
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48
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Winwood JJ, Fitzgerald L, Gardiner B, Hannan K, Howard C, Mutch A. Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review. AIDS Behav 2021; 25:4125-4140. [PMID: 34019203 PMCID: PMC8137806 DOI: 10.1007/s10461-021-03300-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 01/05/2023]
Abstract
Understanding the clinical impact of COVID-19 has been central to emerging research in the HIV field, but in focusing on the biomedical, researchers must not overlook the socially embedded nature of HIV and the potential social impacts of this new pandemic on PLHIV. We conducted a scoping review to explore emerging research examining the social impacts of COVID-19 on PLHIV in OECD countries over the first 12 months of the pandemic. Twenty articles were identified and included for review. Key themes included: impacts on HIV care access/telehealth; stress and mental health; social isolation and loneliness; food insecurity; changes to sexual behaviour; changes to substance use; impacts on income, education and employment; and racial and social inequality. Results from this review can help guide research into areas where it is needed to help minimise the negative social impacts of the COVID-19 pandemic.
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Affiliation(s)
- Jordan J Winwood
- School of Public Health, University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia.
| | - Lisa Fitzgerald
- School of Public Health, University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Bernard Gardiner
- School of Public Health, University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Kate Hannan
- School of Public Health, University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Chris Howard
- Queensland Positive People (QPP), 21 Manilla St, East Brisbane, QLD, 4169, Australia
| | - Allyson Mutch
- School of Public Health, University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
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49
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Social and Behavioral Impacts of COVID-19 on People Living with HIV: Review of the First Year of Research. Curr HIV/AIDS Rep 2021; 19:54-75. [PMID: 34826067 PMCID: PMC8617547 DOI: 10.1007/s11904-021-00593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
Purpose of the Review The SARS-CoV-2 (COVID-19) pandemic brought unprecedented social change with the most severe impacts on the most vulnerable populations, including people living with HIV (PLWH). This review examined findings from empirical studies of social and behavioral impacts of COVID-19 on PLWH in the first year of the pandemic. Recent Findings Impacts of COVID-19 on PLWH fit within an HIV syndemics framework, with overlapping COVID-19 and HIV comorbid conditions concerning mental health and structural inequality. Early impacts of COVID-19 on social isolation, emotional distress, stigma, and substance use varied across studies with few consistent patterns. Structural inequalities, particularly impacts on food security and housing stability, were observed more consistently and globally. Summary COVID-19 intersects with HIV infection along with multiple interlocking comorbidities that are best characterized and understood within a syndemics framework.
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50
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Eisinger RW, Lerner AM, Fauci AS. Human Immunodeficiency Virus/AIDS in the Era of Coronavirus Disease 2019: A Juxtaposition of 2 Pandemics. J Infect Dis 2021; 224:1455-1461. [PMID: 33825905 PMCID: PMC8083774 DOI: 10.1093/infdis/jiab114] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted persons with human immunodeficiency virus (HIV), interfering with critical health services for HIV prevention, treatment, and care. While there are multiple profiles of persons living with HIV and the impact of COVID-19 may differ for each, the severity of COVID-19 in persons with HIV is related strongly to the presence of comorbidities that increase the risk of severe disease in COVID-19 patients in the absence of HIV. An effective response to the juxtaposition of the HIV and COVID-19 pandemics requires a novel coordinated and collaborative global effort of scientists, industry, and community partners to accelerate basic and clinical research, as well as implementation science to operationalize evidence-based interventions expeditiously in real-world settings. Accelerated development and clinical evaluation of prevention and treatment countermeasures are urgently needed to mitigate the juxtaposition of the HIV and COVID-19 pandemics.
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Affiliation(s)
- Robert W Eisinger
- Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea M Lerner
- Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony S Fauci
- Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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