1
|
Hong C. Intimate Partner Violence and HIV Pre-Exposure Prophylaxis Care Engagement Among Sexual Minority Men: A Systematic Review. AIDS Patient Care STDS 2024. [PMID: 39047006 DOI: 10.1089/apc.2024.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Sexual minority men (SMM) who experience intimate partner violence (IPV) may also be at increased risk for HIV; however, little is known about the relationship between these experiences and the utilization of pre-exposure prophylaxis (PrEP) for HIV prevention. This systematic review aimed to synthesize available literature to examine the complex interplay between IPV experiences and engagement in the PrEP care continuum among SMM. A comprehensive search following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in Embase, PubMed, PsycINFO, Web of Science, Medline, and CINAHL identified only 13 relevant articles, most of which were conducted in the United States (n = 9) and only two in low- and middle-income countries (LMICs). Nearly all studies (n = 12, 92.3%) were quantitative in design and used cross-sectional data. The findings of this review identified critical gaps in measuring IPV and PrEP outcomes and revealed mixed findings regarding the complex interplay between IPV and PrEP care engagement in the context of syndemics experienced by SMM. The results highlight the critical need for future research to understand the impact of IPV on PrEP uptake and adherence and its underlying mechanisms. This includes investigating the effects of different types of IPV (e.g., emotional, physical, sexual) on PrEP utilization and how these experiences influence PrEP preferences, such as daily PrEP versus on-demand PrEP or long-acting injectable PrEP. The implications of this review call for comprehensive public health policies and integrated health care practices that provide tailored interventions for IPV screening in PrEP care settings to deliver IPV services and promote engagement in the PrEP care continuum among SMM, as well as further investigation in LMICs.
Collapse
Affiliation(s)
- Chenglin Hong
- School of Social Work, University of Connecticut, Hartford, Connecticut, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Bhuptani PH, Hunter J, Goodwin C, Millman C, Orchowski LM. Characterizing Intimate Partner Violence in the United States During the COVID-19 Pandemic: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:3220-3235. [PMID: 36321779 DOI: 10.1177/15248380221126187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intimate partner violence (IPV) is a significant global health concern. Numerous research studies document increases in IPV since the onset of the COVID-19 pandemic in March 2020. Despite this widespread recognition, research around the nature of this violence is still growing. This systematic review summarizes the existing literature documenting the prevalence and characteristics of IPV during the COVID-19 pandemic. Inclusion criteria are as follows: reported original data empirical study, assessed for IPV among adult population in the United States, and was published in English between December 2019 and March 2022. A total of 53 articles were then independently reviewed and sorted into four thematic subcategories: victimization, perpetration, articles addressing victimization and perpetration, and provider perspectives. Studies document consistent increases in the prevalence of IPV victimization and perpetration. Providers within agencies providing support to individuals impacted by IPV also documented increased strain on the agencies.
Collapse
Affiliation(s)
- Prachi H Bhuptani
- Rhode Island Hospital, Providence, USA
- Brown University, Providence, RI, USA
| | | | | | | | | |
Collapse
|
4
|
Knox JR, Dolotina B, Moline T, Matthews I, Durrell M, Hanson H, Almirol E, Hotton A, Pagkas-Bather J, Chen YT, English D, Manuzak J, Rower JE, Miles C, Millar B, Jean-Louis G, Rendina HJ, Martins SS, Grov C, Hasin DS, Carrico AW, Shoptaw S, Schneider JA, Duncan DT. HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status-Neutral Cohort Study Using an Observational-Implementation Hybrid Approach. JMIR Res Protoc 2023; 12:e48548. [PMID: 38039075 PMCID: PMC10724817 DOI: 10.2196/48548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. OBJECTIVE This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. METHODS Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). RESULTS The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. CONCLUSIONS The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48548.
Collapse
Affiliation(s)
- Justin R Knox
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Dolotina
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tyrone Moline
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Isabella Matthews
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Yen-Tyng Chen
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Devin English
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Jennifer Manuzak
- Division of Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Joseph E Rower
- Center for Human Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Caleb Miles
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Millar
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - H Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Silvia S Martins
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Grov
- Einstein-CUNY-Rockefeller Center for AIDS Research, School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Deborah S Hasin
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Adam W Carrico
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, United States
| |
Collapse
|
5
|
Kerman J, Brewer R, Hotton A, Flores R, Devlin SA, Friedman EE, Schneider JA, McNulty MC. Multi-Level and Intersectional Stigma Experienced by Black Transgender Women in Chicago: a Qualitative Study to Inform Sociostructural Interventions for Reducing Stigma and Improving Health Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01853-6. [PMID: 37957538 PMCID: PMC11089070 DOI: 10.1007/s40615-023-01853-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Stigma contributes to health disparities including increased HIV vulnerability among minority communities. Black transgender women experience multiple forms of stigma (e.g., anticipated, experienced), which can result in poor HIV-related outcomes. We utilized an adapted social ecological model (ASEM) to better understand the levels at which stigma is encountered and its impact on lived experience, particularly related to making healthcare decisions. METHODS Semi-structured interviews and two focus groups (n = 38) were conducted with Black transgender women and Black transfeminine individuals in Chicago from 2016 to 2017. Participants were asked about discrimination in the community, healthcare experiences, and their thoughts and decision-making process with their healthcare provider regarding HIV pre-exposure prophylaxis. We conducted thematic analysis and organized our findings based on the levels of the ASEM: individual, interpersonal, organizational, community, and structural. RESULTS Participants experienced and anticipated stigma at each ASEM level. Stigma was not experienced in isolation: stigma experienced at one level caused anticipated stigma at other levels and internalized stigma leading to negative self-image. In each case, stigma adversely impacted health outcomes (e.g., medication nonadherence, disengagement from care). Stigma within healthcare settings, medication-related stigma, and stigma directed at appearance and identity are particularly detrimental to shared decision-making with a healthcare provider. CONCLUSIONS Recognizing and valuing Black transgender women's experience with stigma are essential for developing social and structural interventions that may work collaboratively across multiple levels of lived experience to reduce stigma and healthcare disparities faced by Black transgender women.
Collapse
Affiliation(s)
- Jared Kerman
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Rey Flores
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Samantha A Devlin
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Eleanor E Friedman
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Chicago Center for HIV Elimination, Chicago, IL, USA.
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Yeager S, Serrano VB, Paltin D, Fisher A, Karris M, Aarons GA, Rangel A, Flynn R, Bolan R, Moore DJ, Montoya JL. Qualitative Examination of the Impact of the COVID-19 Pandemic on Access and Adherence to Pre-exposure Prophylaxis (PrEP) Among Sexual and Gender Minorities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:255-267. [PMID: 37535324 PMCID: PMC10849009 DOI: 10.1521/aeap.2023.35.4.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
During the COVID-19 pandemic, pre-exposure prophylaxis (PrEP) access and adherence decreased nationwide. This study examined pandemic-related disruptions to PrEP access and adherence among clients of a health center (Center) in Los Angeles, California. Clients (n = 25) and Center personnel (n = 11) completed qualitative interviews from March to July 2021. Although the Center provided options for remote PrEP care (i.e., telehealth, STI self-testing kits, and prescription delivery), clients experienced difficulty navigating services or lacked equipment for telehealth. More than half (n = 13) of clients discontinued PrEP during COVID-19 due to decreased sexual partners, relocation, or insurance status changes. Among those who continued PrEP, the majority reported no change in adherence, while a minority reported worsening adherence due to distractions/forgetting, prescription refill issues, lack of insurance coverage, and fear of completing in-person visits. Findings highlight the challenges of navigating PrEP services during COVID-19 and suggest PrEP services enhancement to adapt to crisis events.
Collapse
Affiliation(s)
- Samantha Yeager
- Department of Medicine, University of California San Diego (UCSD), San Diego, California
| | - Vanessa B Serrano
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
- Department of Psychiatry, UCSD
| | - Dafna Paltin
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
- Department of Psychiatry, UCSD
| | - Arin Fisher
- Department of Psychiatry, UCSD
- Pacific Institute for Research and Evaluation-Southwest Center, Albuquerque, New Mexico
| | - Maile Karris
- Department of Medicine, University of California San Diego (UCSD), San Diego, California
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
| | - Gregory A Aarons
- Department of Psychiatry, UCSD
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
- Child and Adolescent Services Research Center, UCSD
| | - Alvy Rangel
- Los Angeles LGBT Center, Los Angeles, California
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, California
| | - Robert Bolan
- Los Angeles LGBT Center, Los Angeles, California
| | - David J Moore
- Department of Psychiatry, UCSD
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
| | - Jessica L Montoya
- Department of Psychiatry, UCSD
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
| |
Collapse
|
8
|
Bocage AE, Coelho LE, Lake JE, Clark JL, Torres TS, Jalil EM, Cardoso SW, Moreira RI, Veloso VG, Grinsztejn B, Luz PM. The Impact of COVID-19 on HIV Care in Rio de Janeiro, Brazil 2019-2021: Disparities by Age and Gender. AIDS Behav 2023; 27:2629-2641. [PMID: 36715887 PMCID: PMC9885404 DOI: 10.1007/s10461-023-03988-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
We evaluated COVID-19's impact on HIV care indicators among INI/FIOCRUZ's HIV Clinical Cohort in Rio de Janeiro, Brazil: (1) Adequate care visits: two visits ≥ 90 days apart; (2) Adequate viral load monitoring: ≥ 2 viral load results ≥ 90 days apart; (3) Consistent viral suppression: all viral loads < 40 copies/mL; and (4) ART medication possession ratio (MPR) ≥ 95%. Chi-square tests compared the fraction of participants meeting each indicator per period: pre-pandemic (3/1/2019-2/29/2020) and post-pandemic (3/1/2020-2/28/2021). Logistic regression models were used to assess disparities in adequate care visits. Among 906 participants, care visits and viral load monitoring decreased pre-pandemic to post-pandemic: 77.0-55.1% and 36.6-11.6% (both p < 0.001), respectively. The optimal MPR rate improved from 25.5 to 40.0% (p < 0.001). Post-pandemic period (aOR 0.33, CI 0.28-0.40), transgender women (aOR 0.34, CI 0.22-0.53), and those aged 18-24 years (aOR 0.67, CI 0.45-0.97) had lower odds of adequate care visits. COVID-19 disrupted care access disproportionately for transgender women and younger participants.
Collapse
Affiliation(s)
- Anne E Bocage
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- The Warren Alpert Medical School of Brown University, 222 Richmond St, Box G-M117, Providence, RI, 02912, USA.
| | - Lara E Coelho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jordan E Lake
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UTHealth Houston, Houston, TX, USA
| | - Jesse L Clark
- South American Program in HIV Prevention Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for HIV Identification, Prevention, and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Thiago S Torres
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Emília M Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paula M Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Kim JYH, Barth SK, Monroe AK, Ahsan S, Kovacic J, Senn S, Castel AD. The impact of COVID-19 on the HIV continuum of care: challenges, innovations, and opportunities. Expert Rev Anti Infect Ther 2023; 21:831-846. [PMID: 37470436 DOI: 10.1080/14787210.2023.2239503] [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: 04/05/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION In February 2019, the United States (US) launched the Ending the HIV Epidemic (EHE) initiative with emphasis on improving the various steps of the Human Immunodeficiency Virus (HIV) prevention and care continuum. However, in March 2020, the Coronavirus Disease 2019 (COVID-19) pandemic was declared, curtailing efforts to end the epidemic in the US. AREAS COVERED To describe the impact of the pandemic on EHE in the US, the authors performed a comprehensive literature review focusing on outcomes at each step of the HIV care continuum. Simultaneously, they identified examples of pandemic-era innovations that may help EHE. EXPERT OPINION Numerous studies demonstrated pandemic-related disruptions across the care continuum as well as the impact on preexisting barriers to care among People with HIV (PWH) at higher risk for poor outcomes. As the pandemic progressed, innovative approaches to delivering healthcare and providing essential services emerged, including widespread use of telemedicine, expansion of home-based care, self-collected sexually transmitted infection (STI) and HIV testing, and co-located testing for COVID-19 and HIV/STIs. While the COVID-19 pandemic initially hindered achieving EHE in the US, the ability to be agile, flexible, and creative led to innovation in HIV care delivery that may ultimately assist in meeting EHE goals as we transition into the post-pandemic era.
Collapse
Affiliation(s)
- Jenny Yeon Hee Kim
- Department of Global Health, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 4th Floor, Washington, DC, 20052, USA
| | - Shannon K Barth
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Anne K Monroe
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Sarah Ahsan
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Janja Kovacic
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Siena Senn
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| | - Amanda D Castel
- Department of Epidemiology, The George Washington University Milken School of Public Health, 950 New Hampshire Ave NW, 5th Floor, Washington DC, 20052, USA
| |
Collapse
|
10
|
Poteat TC, Wirtz AL, Adams D, Linton SL, Gutierrez C, Brown C, Miller M, Rich AJ, Williams J, Nguyen TQ, Reisner SL. Brief Report: Interruptions in HIV Prevention and Treatment During the COVID-19 Pandemic: A Cross-Sectional Study of Transgender and Gender Nonbinary Adults in the United States. J Acquir Immune Defic Syndr 2023; 93:181-186. [PMID: 36881811 PMCID: PMC10272025 DOI: 10.1097/qai.0000000000003185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Transgender and gender nonbinary (TNB) people have been disproportionately affected by HIV and the COVID-19 pandemic. This study explored the prevalence of HIV prevention and treatment (HPT) interruptions during the pandemic and identified factors associated with these interruptions. SETTING Data were drawn from LITE Connect, a US-based, nationwide, online, self-administered survey designed to examine the experiences of TNB adults during the COVID-19 pandemic. A convenience sample of 2134 participants were recruited between June 14, 2021, and May 1, 2022. METHODS The analytic sample was restricted to participants taking antiretroviral medications to prevent or treat HIV before the onset of the pandemic (n = 153). We calculated descriptive statistics as well as Pearson χ 2 bivariate tests and multivariable models to identify factors associated with HPT interruptions during the pandemic. RESULTS Thirty-nine percent of participants experienced an HPT interruption. We found a lower odds of HPT interruptions among participants living with HIV [adjusted odds ratios (aOR) 0.45; 95% Confidence Intervals (CI): 0.22, 0.92; P = 0.02] and essential workers [aOR 0.49; 95% CI: 0.23, 1.0; P = 0.06] and higher odds among people with chronic mental health conditions [aOR 2.6; 95% CI: 1.1, 6.2; P = 0.03]. When sex and education were included, we found a lower odds of interruptions among people with higher education. CI widened, but the magnitude and direction of effects did not change for the other variables. CONCLUSIONS Focused strategies to address longstanding psychosocial and structural inequities are needed to mitigate HPT treatment interruptions in TNB people and prevent similar challenges during future pandemics.
Collapse
Affiliation(s)
- Tonia C Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Sabriya L Linton
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Carmen Gutierrez
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carter Brown
- Black Transgender Advocacy Coalition, Dallas, TX
| | - Marissa Miller
- Trans Solutions Research and Resource Center, Indianapolis, IN
| | - Ashleigh J Rich
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jennifer Williams
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trang Q Nguyen
- Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA; and
- Department of Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Meyer D, Slone SE, Ogungbe O, Duroseau B, Farley JE. Impact of the COVID-19 Pandemic on HIV Healthcare Service Engagement, Treatment Adherence, and Viral Suppression in the United States: A Systematic Literature Review. AIDS Behav 2023; 27:344-357. [PMID: 35916951 PMCID: PMC9344234 DOI: 10.1007/s10461-022-03771-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 01/24/2023]
Abstract
The COVID-19 pandemic has necessitated adaptations in how healthcare services are rendered. However, it is unclear how these adaptations have impacted HIV healthcare services across the United States. We conducted a systematic review to assess the impacts of the pandemic on service engagement, treatment adherence, and viral suppression. We identified 26 total studies spanning the beginning of the pandemic (March 11, 2020) up until November 5, 2021. Studies were conducted at the national, state, and city levels and included representation from all four CDC HIV surveillance regions. Studies revealed varying impacts of the pandemic on HIV healthcare retention/engagement, medication adherence, and viral suppression rates, including decreases in HIV healthcare visits, provider cancellations, and inability to get prescription refills. Telehealth was critical to ensuring continued access to care and contributed to improved retention and engagement in some studies. Disparities existed in who had access to the resources needed for telehealth, as well as among populations living with HIV whose care was impacted by the pandemic.
Collapse
Affiliation(s)
- Diane Meyer
- Center for Health Security, Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA 621 East Pratt Street, Suite 210, 21202 ,Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Sarah E. Slone
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Oluwabunmi Ogungbe
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Brenice Duroseau
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University School of Nursing, 525 North Wolfe Street, Suite 511, 21205 Baltimore, MD USA
| |
Collapse
|
13
|
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.
Collapse
|
14
|
Zhou L, Assanangkornchai S. Current Perspectives on the Determinants of Acceptability of Pre-Exposure Prophylaxis and Nonoccupational Post-Exposure Prophylaxis among People at Risk for HIV: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12605. [PMID: 36231904 PMCID: PMC9565962 DOI: 10.3390/ijerph191912605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Pre-exposure prophylaxis (PrEP) and nonoccupational post-exposure prophylaxis (nPEP) were found to be effective HIV biomedical interventions. However, several barriers to acceptance of these interventions were discovered among populations at risk for HIV, and the Coronavirus Disease 2019 (COVID-19) pandemic may also exacerbate these. The current scoping review aims to update information in regards to facilitators and barriers for PrEP and nPEP acceptability among key populations collected in the past two years and to identify any existing knowledge gaps during the time of the COVID-19 pandemic. Of 1453 studies retrieved, 16 met the final inclusion criteria. The review synthesized a range of individual, PrEP-specific, psychosocial, and health system factors that may affect the acceptability of PrEP or nPEP. The conclusion from this scoping review is that more research is needed to enable a comprehensive understanding of the determinants of acceptability of PrEP and nPEP in the context of COVID-19, particularly among PWID and FSWs.
Collapse
Affiliation(s)
- Lingmi Zhou
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China
| | - Sawitri Assanangkornchai
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| |
Collapse
|
15
|
Duncan DT, Park SH, Chen YT, Mountcastle H, Pagkas-Bather J, Timmins L, Kim B, Hanson H, Koli K, Durrell M, Makarem N, Eavou R, Bharadwaj K, Schneider JA. Sleep characteristics among black cisgender sexual minority men and black transgender women during the COVID-19 pandemic: The role of multi-level COVID-19-related stressors. Sleep Health 2022; 8:440-450. [PMID: 36075791 PMCID: PMC9444827 DOI: 10.1016/j.sleh.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine the association between individual, network, and structural COVID-19-related stressors and changes in sleep duration and quality among Black cisgender sexual minority men (SMM) and Black transgender women during the COVID-19 peak infectivity rate in Chicago. METHODS From April 20, 2020 to July 31, 2020, we conducted the N2 COVID Study in Chicago (n = 226). The survey included questions regarding multi-level COVID-19-related stressors (eg, food unavailability, partner violence, housing instability, concern about neighborhood COVID-19), sleep duration, and sleep quality. RESULTS About 19.5% of our sample reported a shorter duration of sleep during the initial peak COVID-19 infectivity, while 41.2% reported more sleep and 38.9% reported about the same. Compared to the prepandemic period, 16.8% reported that their sleep quality worsened in the COVID-19 pandemic, while 27.9% reported their sleep quality had improved and 55.3% reported it was about the same. In multivariable models, we found that ≥1 day of physical stress reaction, worrying about being infected with COVID-19, traveling during COVID-19 being a financial burden, not having enough medication, knowing someone who was diagnosed with COVID-19, partner violence and housing instability were associated with poor sleep health in the COVID-19 pandemic (adjusted risk ratio: 1.82-3.90, p < .05). CONCLUSIONS These data suggest that COVID-19-related stressors impacted poor sleep duration and quality during the pandemic among this cohort. Multi-level interventions to reduce COVID-19-related stressors (eg, meditation, intimate partner violence prevention and housing programs) may be useful for improving sleep health among Black cisgender sexual minority men and Black transgender women.
Collapse
Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
| | - Su Hyun Park
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yen-Tyng Chen
- Department of Public Health, William Paterson University of New Jersey, Wayne, New Jersey, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA; Department of Medicine, University of Chicago, Chicago, Illinois, USA; Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey, USA
| | - Hayden Mountcastle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA; Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Byoungjun Kim
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, Illinois, USA
| | - Kangkana Koli
- Survey Lab, University of Chicago, Chicago, Illinois, USA
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA; Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nour Makarem
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Kevalyn Bharadwaj
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA; Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA; Department of Medicine, University of Chicago, Chicago, Illinois, USA; Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA; Crown School of Social Work, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
16
|
Goedel WC, Rogers BG, Li Y, Nunn AS, Patel RR, Marshall BD, Mena LA, Ward LM, Brock JB, Napoleon S, Zanowicki-Marr A, Curoe K, Underwood A, Johnson CJ, Lockwood KR, Chan PA. Pre-exposure Prophylaxis Discontinuation During the COVID-19 Pandemic Among Men Who Have Sex With Men in a Multisite Clinical Cohort in the United States. J Acquir Immune Defic Syndr 2022; 91:151-156. [PMID: 36094480 PMCID: PMC9472808 DOI: 10.1097/qai.0000000000003042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic continues to put strain on health systems in the United States, leading to significant shifts in the delivery of routine clinical services, including those offering HIV pre-exposure prophylaxis (PrEP). We aimed to assess whether individuals discontinued PrEP use at higher rates during the COVID-19 pandemic and the extent to which disruptions to usual clinical care were mitigated through telehealth. METHODS Using data from an ongoing prospective cohort of men who have sex with men (MSM) newly initiating PrEP in 3 mid-sized cities (n = 195), we calculated the rate of first-time discontinuation of PrEP use in the period before the COVID-19 pandemic and during the COVID-19 pandemic and compared these rates using incidence rate ratios (IRRs). Furthermore, we compared the characteristics of patients who discontinued PrEP use during these periods with those who continued to use PrEP during both periods. RESULTS Rates of PrEP discontinuation before the COVID pandemic and during the COVID-19 pandemic were comparable [4.29 vs. 5.20 discontinuations per 100 person-months; IRR: 1.95; 95% confidence interval (CI): 0.83 to 1.77]. Although no significant differences in the PrEP discontinuation rate were observed in the overall population, the rate of PrEP discontinuation increased by almost 3-fold among participants aged 18-24 year old (IRR: 2.78; 95% CI: 1.48 to 5.23) and by 29% among participants covered by public insurance plans at enrollment (IRR: 1.29; 95% CI: 1.03 to 5.09). Those who continued to use PrEP were more likely to have had a follow-up clinical visit by telehealth in the early months of the pandemic (45% vs. 17%). CONCLUSIONS In this study, rates of PrEP discontinuation were largely unchanged with the onset of the COVID-19 pandemic. The use of telehealth likely helped retain patients in PrEP care and should continue to be offered in the future.
Collapse
Affiliation(s)
- William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Brooke G. Rogers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Yu Li
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Rupa R. Patel
- Department of Internal Medicine, School of Medicine, Washington University in Saint Louis, Saint Louis, MO
| | - Brandon D.L. Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Leandro A. Mena
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Lori M. Ward
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS
| | - J. Benjamin Brock
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Siena Napoleon
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | | | - Kate Curoe
- Department of Internal Medicine, School of Medicine, Washington University in Saint Louis, Saint Louis, MO
| | - Ashley Underwood
- Department of Internal Medicine, School of Medicine, Washington University in Saint Louis, Saint Louis, MO
| | - Catrell J. Johnson
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Khadijra R. Lockwood
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Philip A. Chan
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| |
Collapse
|
17
|
Chen YT, Duncan DT, Del Vecchio N, Timmins L, Pagkas-Bather J, Knox J, Lacap S, Hanson H, Schneider JA. COVID-19 Conspiracy Beliefs are not Barriers to HIV Status Neutral Care Among Black Cisgender Sexual Minority Men and Black Transgender Women at the Initial Peak of the COVID-19 Pandemic in Chicago, USA. AIDS Behav 2022; 26:3939-3949. [PMID: 35731308 PMCID: PMC9214465 DOI: 10.1007/s10461-022-03720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/24/2022]
Abstract
We examined associations between COVID-19 conspiracy beliefs and HIV status neutral care engagement among Black cisgender sexual minority men (BCSMM) and Black transgender women (BTW). Throughout April–July 2020, a total of 226 (222 in the current analysis: 196 BCSMM, 20 BTW, and 6 other) participants in Chicago’s Neighborhoods and Networks (N2) cohort study completed virtual assessments. Participants reported their HIV status, changes in the frequency of PrEP/ART use, and COVID-19 conspiracy beliefs. Three-quarters of the sample believed at least one conspiracy theory that COVID-19 was either government-created or lab-created accidentally or purposefully. Believing one or more COVID-19 conspiracy theories was significantly associated with better PrEP or ART engagement (using PrEP more frequently or continuously using PrEP/Missing ART less or continuously using ART) (aPR = 0.75 [95% CI 0.56–0.99], p < 0.05). Believing COVID-19 came about naturally was strongly associated with worse PrEP engagement (i.e., use PrEP less or not on PrEP) or worse ART engagement (i.e., missed ART more or not on ART) (aPR = 1.56 [95% CI 1.23, 1.98], p < 0.001). Findings suggested substantial COVID-19 conspiracies among BCSMM and BTW, and this was associated with HIV care engagement.
Collapse
Affiliation(s)
- Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA. .,Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA. .,Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natascha Del Vecchio
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.,School of Psychology, Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, Wales, UK
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Shaina Lacap
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ, USA
| | | | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA.,Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.,Crown School of Social Work, University of Chicago, Chicago, IL, USA
| |
Collapse
|
18
|
Moody RL, Chen YT, Schneider JA, Knox J, Timmins L, Hanson H, Koli K, Durrell M, Dehlin J, Eavou R, Martins SS, Duncan DT. Polysubstance use in a community sample of Black cisgender sexual minority men and transgender women in Chicago during initial COVID-19 pandemic peak. Subst Abuse Treat Prev Policy 2022; 17:4. [PMID: 35090507 PMCID: PMC8796750 DOI: 10.1186/s13011-022-00433-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In response to COVID-19, the city of Chicago issued stay-at-home orders, which began on March 20, 2020, and restrictions meant to "flatten the curve" remained in effect until June 2, 2020. On June 3, 2020, Chicago entered the reopening phase. This study compares rates of polysubstance use by COVID-19 lockdown phase and across sociodemographic characteristics in a Chicago-based sample of Black cisgender sexual minority men (SMM) and transgender women. METHOD Data come from the Neighborhood and Networks (N2) cohort, an ongoing study of Black cisgender SMM and transgender women living in Chicago. Participants (N = 226) completed a survey between April 20, 2020, and July 30, 2020, during the initial peak of the COVID-19 pandemic in Chicago. We conducted chi-square tests of independence and modified Poisson regression models with robust error variance and estimated adjusted prevalence ratios. RESULTS Alcohol and marijuana were the most used substances, with 73.5% reporting at least one drinking day and 71.2% of the sample reporting marijuana use in the past 14 days. Tobacco was used by 41.6% of the sample, and illegal drug use, which does not include marijuana, was reported by 17.7% of the sample. Substance use was consistently associated with the use of other substances. As such, polysubstance use (i.e., using two or more substances) was common in this sample (63.7%). Few sociodemographic differences emerged, and substance use was not associated with lockdown phase. CONCLUSION Substance use, including polysubstance use, was high in our sample of Black SMM and transgender women during the initial peak of the COVID-19 pandemic. Continued monitoring is needed given the duration of the COVID-19 pandemic and the negative health consequences associated with substance use in this population.
Collapse
Affiliation(s)
- Raymond L Moody
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA.
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Yen-Tyng Chen
- Department of Public Health, William Paterson University of New Jersey, 300 Pompton Road, Wayne, New Jersey, 07470, USA
- Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue, Chicago, IL, 60637, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue, Chicago, IL, 60637, USA
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6092, Chicago, IL, 60637, USA
| | - Justin Knox
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Hillary Hanson
- Survey Lab, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Kangkana Koli
- Survey Lab, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, 60637, USA
| | - Mainza Durrell
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6092, Chicago, IL, 60637, USA
| | - Jessica Dehlin
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
| | - Rebecca Eavou
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Avenue, MC2000, Chicago, IL, 60637, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, 772 West 168th Street, New York, NY, 10032, USA
| |
Collapse
|
19
|
COVID-19 stressors and symptoms of depression and anxiety among Black cisgender sexual minority men and Black transgender women during the initial peak of the COVID-19 pandemic. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1999-2011. [PMID: 35460059 PMCID: PMC9030680 DOI: 10.1007/s00127-022-02282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/31/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To examine associations between COVID-19-related stressors and symptoms of depression and anxiety in Black cisgender sexual minority men (SMM) and transgender women during the initial peak of the COVID-19 pandemic. METHODS Participants from the N2 Cohort Study comprised Black cisgender SMM and Black transgender women in Chicago, IL, completed a face-to-face video or phone interview between April 20 and July 31, 2020. The survey included 18 measures of individual, network, and structural COVID-19 stressors such as income loss, network COVID-19 diagnoses, and housing loss, as well as 5 outcome measures: anxiety, depression, loneliness, worry and hope. RESULTS Of 226 participants, 56.6% experienced anxiety on at least 1 of the last 14 days, 48.7% experienced depression, 48.7% experienced loneliness, 42.0% experienced worry, and 51.8% did not experience hope. Completing the study during a later phase of reopening was associated with hopefulness, RR = 1.37 95% CI [1.02, 1.85]. Fifteen of the 18 multi-level COVID-19 stressors were associated with 1 or more symptoms of depression and anxiety, for example, physical stress reactions, income loss, food loss, medication loss, network COVID-19 diagnoses, partner violence, housing loss, and neighborhood pandemic concerns (aRRs = 0.61-2.78, ps < 0.05). CONCLUSION COVID-19-related stressors were associated with depression and anxiety symptoms in Black cisgender SMM and transgender women. Mitigation strategies to reduce virus transmission should be supplemented with measures to prevent depression and anxiety among marginalized populations, such as targeted economic relief and eHealth/mHealth interventions.
Collapse
|