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Camfield C, Evans YN, Kumbhakar RG. HIV preexposure prophylaxis in adolescents and young adults: an update. Curr Opin Pediatr 2024; 36:389-399. [PMID: 38655797 DOI: 10.1097/mop.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW This review provides an update of evidence for HIV preexposure prophylaxis (PrEP), including efficacy and safety of newly available medications. It discusses barriers to care that are unique to adolescents and young adults as well as interventions that may help increase uptake, adherence, and retention in care. RECENT FINDINGS Tenofovir alafenamide-emtricitabine and cabotegravir are both newly approved medications for the prevention of HIV and are well tolerated and effective for adolescents. These medications, along with tenofovir disoproxil-emtricitabine, offer a variety of PrEP options to choose from. SUMMARY Adolescents and young adults have many options when it comes to HIV prevention, but barriers persist in terms of uptake and adherence to PrEP and retention in care. Technology-based interventions, provider education, navigation support, and multiple access options are all tools to help increase PrEP use in young people.
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Affiliation(s)
- Caitlin Camfield
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington & Seattle Children's Hospital
| | - Yolanda N Evans
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington & Seattle Children's Hospital, Seattle, Washington, USA
| | - Raaka G Kumbhakar
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington
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Jackson KJ, McCoy SI, White DAE. A Decade of HIV Preexposure Prophylaxis (PrEP): Overcoming Access Barriers in the United States Through Expanded Delivery. Public Health Rep 2024; 139:405-411. [PMID: 38032345 DOI: 10.1177/00333549231208487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Kristopher J Jackson
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sandra I McCoy
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA, USA
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Carmack C, Nganga S, Ahmed E, Coleman T. Concept Mapping STI/HIV Prevention and Condom Use among Young African American Adults. Behav Sci (Basel) 2024; 14:501. [PMID: 38920833 PMCID: PMC11201233 DOI: 10.3390/bs14060501] [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: 03/08/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 06/27/2024] Open
Abstract
Theory-based HIV prevention programs have resulted in increased condom use, which remains the best method for the prevention of sexually transmitted infections (STIs) among sexually active heterosexual individuals. Particularly, the integrative model of behavior prediction theorizes that attitudes, norms, self-efficacy, and socioenvironmental factors influence intention and behavior and has been useful in understanding STI risk among adolescents. However, more research is needed regarding young African American adults. Given the increased freedom and decision-making independence afforded to young adults compared to adolescents, it is important to consider the STI/human immunodeficiency virus (HIV) prevention messages that would resonate with them, particularly regarding condom use. The present study sought to explore how attitudes, subjective norms, self-efficacies, and socioenvironmental factors may influence condom use and STI/HIV prevention, as conceptualized by the participants. We conducted a group-based concept map, a systems-thinking mixed methodology that resulted in a geospatial map reflecting the conceptualizations of the participants. Self-identified young heterosexual African American adults (N = 43) aged 20-26 engaged in an interactive concept mapping procedure in order to "map out" their overarching concepts about STI/HIV risk and condom use. Seven overall conceptual domains emerged: self-efficacy for partner communication, condom use self-efficacy, social media/sociocultural influences, condom use/STI knowledge, condom use cons, condom use pros, and subjective and social norms about condom use. We presented the concept map and discussed the conceptual interpretations and the relationships among the overarching concepts. We also discussed how the social environment, including the social media environment, was conceptualized regarding STI/HIV risk and prevention among young African American adults. Concept mapping can be viewed as a way to determine worthwhile messages for intervention development. The findings may provide information for prevention programs aimed at reducing the incidence of STIs among young adult heterosexual persons within African American communities.
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Affiliation(s)
- Chakema Carmack
- Psychological Health and Learning Sciences Department, University of Houston, Houston, TX 77204, USA; (E.A.); (T.C.)
- Health Research Institute—Research Center in Minority Institution (HRI-RCMI), University of Houston, Houston, TX 77204, USA
- Center for Health Equity and Evaluation Research (CHEER), Texas A&M University, College Station, TX 77843, USA
| | - Sarah Nganga
- Legacy Community Health, Houston, TX 77009, USA;
| | - Eisha Ahmed
- Psychological Health and Learning Sciences Department, University of Houston, Houston, TX 77204, USA; (E.A.); (T.C.)
| | - Taylor Coleman
- Psychological Health and Learning Sciences Department, University of Houston, Houston, TX 77204, USA; (E.A.); (T.C.)
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Meisner A, Xia F, Chan KCG, Mayer K, Wheeler D, Zangeneh S, Donnell D. Estimating the Effect of PrEP in Black Men Who Have Sex with Men: A Framework to Utilize Data from Multiple Non-Randomized Studies to Estimate Causal Effects. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.10.24301113. [PMID: 38260494 PMCID: PMC10802753 DOI: 10.1101/2024.01.10.24301113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Black men who have sex with men (MSM) are disproportionately burdened by the HIV epidemic in the US. The effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection has been demonstrated through randomized placebo-controlled clinical trials in several populations. Importantly, no such trial has been conducted exclusively among Black MSM in the US, and it would be unethical and infeasible to do so now. To estimate the causal effects of PrEP access, initiation, and adherence on HIV risk, we utilized causal inference methods to combine data from two non-randomized studies that exclusively enrolled Black MSM. The estimated relative risks of HIV were: (i) 0.52 (95% confidence interval: 0.21, 1.22) for individuals with versus without PrEP access, (ii) 0.48 (0.12, 0.89) for individuals who initiated PrEP but were not adherent versus those who did not initiate, and (iii) 0.23 (0.02, 0.80) for individuals who were adherent to PrEP versus those who did not initiate. Beyond addressing the knowledge gap around the effect of PrEP in Black MSM in the US, which may have ramifications for public health, we have provided a framework to combine data from multiple non-randomized studies to estimate causal effects, which has broad utility.
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Affiliation(s)
- Allison Meisner
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, US
| | - Fan Xia
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
| | - Kwun C G Chan
- Department of Biostatistics, University of Washington, Seattle, WA, US
| | - Kenneth Mayer
- Harvard Medical School, Boston, MA, US
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, US
- The Fenway Institute, Boston, MA, US
- Infectious Diseases Division, Beth Israel Deaconess Medical Center, Boston, MA, US
| | - Darrell Wheeler
- State University of New York at New Paltz, New Paltz, NY, US
| | - Sahar Zangeneh
- RTI International, Research Triangle Park, NC, US
- School of Public Health, University of Washington, Seattle, WA, US
| | - Deborah Donnell
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA, US
- Department of Global Health, University of Washington, Seattle, WA, US
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Whelchel K, Zuckerman AD, DeClercq J, Choi L, Kelly SG. Optimizing HIV PrEP Persistence: Does Your Pharmacy Matter? AIDS Behav 2023; 27:3735-3744. [PMID: 37266824 DOI: 10.1007/s10461-023-04091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
Persistence to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is integral to preventing new HIV infections. Previous studies have shown real-world PrEP persistence is low and insight is needed into PrEP delivery strategies that improve persistence. This single-center, retrospective, cohort study measured persistence in patients filling PrEP through an integrated health-system specialty pharmacy (HSSP) compared to those filling at external pharmacies. The Kaplan-Meier estimates for persistence probability at 6, 12, and 18 months were 0.87 (95% CI 0.79-0.95), 0.75 (95% CI 0.66-0.86), and 0.64 (95% CI 0.53-0.76) for the HSSP cohort compared to 0.65 (95% CI 0.51-0.83), 0.41 (95% CI 0.28-0.62), and 0.32 (95% CI 0.2-0.53), respectively, for the non-HSSP cohort (log-rank p < 0.001, [Formula: see text] = 11.2). Cox PH modeling showed that patients using a non-HSSP were 2.7 times more likely to be non-persistent than HSSP patients (HR 2.7, 95% CI 1.6-4.7, p < 0.001, [Formula: see text] = 12.61), demonstrating patients were better maintained on PrEP therapy when their prescriptions were filled with the HSSP.
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Affiliation(s)
- Kristen Whelchel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, 726 Melrose Ave, Nashville, TN, 37211, USA.
| | - Autumn D Zuckerman
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, 726 Melrose Ave, Nashville, TN, 37211, USA
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean G Kelly
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Riley T, Anaya G, Gallegos PA, Castaneda R, Khosropour CM. Pre-exposure Prophylaxis Use and Discontinuation in a Federally Qualified Health Center in a Mexico-US Border City. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01807-y. [PMID: 37787944 DOI: 10.1007/s40615-023-01807-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Latino men who have sex with men (MSM) experience disproportionately high rates of HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) use is critical to reduce this inequity, but PrEP awareness, access, and use are low among Latino MSM. This study aims to describe patterns of PrEP persistence and discontinuation among predominately Latino MSM accessing PrEP in a federally qualified health center (FQHC) in El Paso, Texas. METHODS This retrospective cohort comprised individuals who were eligible for PrEP at a FQHC in El Paso, Texas, between January 30, 2019, and August 15, 2021. We defined hierarchical categories of PrEP use and discontinuation, which was defined as more than 120 days between PrEP visits. We used Kaplan-Meier survival plots to estimate median time to first PrEP discontinuation. RESULTS There were 292 patients evaluated for PrEP; 91% were Latino. The majority of PrEP patients (70%, 205/292) experienced any PrEP discontinuation, and the median time to first PrEP discontinuation was 202 days (95% CI: 179-266). The proportion of patients who remained on PrEP at 3 months after initiation was 82% (95% CI: 76%, 87%) and at 6 months after initiation was 55% (95% CI: 46%, 62%). CONCLUSION While 3-month PrEP retention was high in this predominately Latino MSM patient population, PrEP discontinuation was common. Interventions that enhance longer-term persistence and support for restarting PrEP are needed to reduce the persistent ethnoracial disparities in HIV incidence.
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Affiliation(s)
- Taylor Riley
- School of Public Health, Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | | | | | | | - Christine M Khosropour
- School of Public Health, Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
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Khosropour CM, Riley T, Healy E, Backus KV, Gomillia CE, Mena L, Lockwood KR, Gordon FM, Means AR, Ward LM. Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study. BMC Public Health 2023; 23:1130. [PMID: 37312077 PMCID: PMC10262591 DOI: 10.1186/s12889-023-16072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence. METHODS This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior. RESULTS There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals' desire to stay healthy and the support of PrEP clinic staff were facilitators. CONCLUSIONS The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.
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Affiliation(s)
- Christine M Khosropour
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | - Taylor Riley
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Elise Healy
- Department of Medicine, Health Sciences Building, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Kandis V Backus
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Khadijra R Lockwood
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Felicia M Gordon
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Arianna R Means
- Department of Global Health, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Lori M Ward
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
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Chase E, Mena L, Johnson KL, Prather M, Khosropour CM. Patterns of Pre-exposure Prophylaxis (PrEP) Use in a Population Accessing PrEP in Jackson, Mississippi. AIDS Behav 2023; 27:1082-1090. [PMID: 36094635 PMCID: PMC9465129 DOI: 10.1007/s10461-022-03845-9] [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] [Accepted: 08/27/2022] [Indexed: 11/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) persistence is suboptimal in the United States. In the Deep South, a region with high rates of new HIV diagnosis, patterns of PrEP discontinuation remain unexplored. We evaluated data from a clinic-based PrEP program in Jackson, Mississippi and included patients initiating PrEP between August 2018 and April 2021. We considered patients to have a gap in PrEP coverage if they had at least 30 days without an active PrEP prescription; those who restarted PrEP after 30 days were classified as 'stopped and restarted' and those who never obtained a new PrEP prescription were classified as 'stopped and did not restart'. Patients without a gap in coverage were considered 'continuously on PrEP'. We estimated median time to first PrEP discontinuation and examined factors associated with time to first PrEP discontinuation. Of 171 patients who received an initial 90-day PrEP prescription; 75% were assigned male at birth and 74% identified as Black. The median time to first discontinuation was 90 days (95% CI 90-114). Twenty-two percent were continuously on PrEP, 28% stopped and restarted (median time off PrEP = 102 days), and 50% stopped and did not restart. Associations with early PrEP stoppage were notable for patients assigned sex female vs male (adjusted hazard ratio [aHR] = 1.6, 95% CI 1.0-2.5) and those living over 25 miles from clinic vs. 0-10 miles (aHR 1.89, 95% CI 1.2-3.0). Most patients never refilled an initial PrEP prescription though many patients re-started PrEP. Interventions to improve persistence and facilitate re-starts are needed.
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Affiliation(s)
- Erin Chase
- Department of Epidemiology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA
| | - Leandro Mena
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Mariah Prather
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Christine M Khosropour
- Department of Epidemiology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359777, Seattle, WA, 98104, USA.
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Hollcroft MR, Gipson J, Barnes A, Mena L, Dombrowski JC, Ward LM, Khosropour CM. PrEP Acceptance among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi. J Int Assoc Provid AIDS Care 2023; 22:23259582231167959. [PMID: 37032460 PMCID: PMC10088405 DOI: 10.1177/23259582231167959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.
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Affiliation(s)
| | - June Gipson
- Open Arms Healthcare Center, Jackson, MS, USA
| | | | - Leandro Mena
- Open Arms Healthcare Center, Jackson, MS, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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