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Cordova D, Bauermeister JA, Warner S, Wells P, MacLeod J, Neilands TB, Mendoza Lua F, Delva J, Fessler KB, Smith V, Khreizat S, Boyer C. Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e47216. [PMID: 38373025 PMCID: PMC10912993 DOI: 10.2196/47216] [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: 03/16/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. OBJECTIVE To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. METHODS In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. RESULTS This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. CONCLUSIONS This study has the potential to improve public health by preventing HIV/STI and substance use disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47216.
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Affiliation(s)
- David Cordova
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - José A Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sydni Warner
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Jennifer MacLeod
- Livingston Physician Organization, Livingston, MI, United States
| | - Torsten B Neilands
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Frania Mendoza Lua
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, United States
| | - Jorge Delva
- School of Social Work, Boston University, Boston, MA, United States
| | | | | | - Sarah Khreizat
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Cherrie Boyer
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
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Kreniske P, Namuyaba OI, Kasumba R, Namatovu P, Ssewamala F, Wingood G, Wei Y, Ybarra ML, Oloya C, Tindyebwa C, Ntulo C, Mujune V, Chang LW, Mellins CA, Santelli JS. Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49352. [PMID: 38113102 PMCID: PMC10762611 DOI: 10.2196/49352] [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: 06/01/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. OBJECTIVE This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo's effectiveness in increasing HIV testing and linking users to mental health counselors. METHODS We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message-based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention's impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. RESULTS Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. CONCLUSIONS Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. TRIAL REGISTRATION ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49352.
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Affiliation(s)
- Philip Kreniske
- Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | | | - Robert Kasumba
- Washington University in St Louis, St Louis, MO, United States
| | - Phionah Namatovu
- International Center for Child Development, Masaka, Uganda
- Washington University in St Louis, St Louis, MO, United States
| | - Fred Ssewamala
- International Center for Child Development, Masaka, Uganda
- Washington University in St Louis, St Louis, MO, United States
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Michele L Ybarra
- Center for Innovative Public Health Research, San Clemente, CA, United States
| | | | | | | | | | - Larry W Chang
- Department of Epidemiology, School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - John S Santelli
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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3
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Jitmun W, Palee P, Choosri N, Surapunt T. The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review. JMIR Serious Games 2023; 11:e39915. [PMID: 37669098 PMCID: PMC10509732 DOI: 10.2196/39915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/21/2022] [Accepted: 07/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AIDS, which is caused by HIV, has long been one of the most significant global public health issues. Since the beginning of the HIV epidemic, various types of nonelectronic communication tools have been commonly used in HIV/AIDS prevention and care, but studies that apply the potential of electronic games are still limited. OBJECTIVE We aimed to identify, compare, and describe serious games and gamified systems currently used in HIV/AIDS prevention and care that were studied over a specific period of time. METHODS A scoping review was conducted into serious games and gamified systems used in HIV prevention and care in various well-known digital libraries from January 2010 to July 2021. RESULTS After identifying research papers and completing the article selection process, 49 of the 496 publications met the inclusion criteria and were examined. A total of 32 articles described 22 different serious games, while 17 articles described 13 gamified systems for HIV prevention and care. CONCLUSIONS Most of the studies described in the publications were conducted in the United States, while only a few studies were performed in sub-Saharan African countries, which have the highest global HIV/AIDS infection rates. Regarding the development platform, the vast majority of HIV/AIDS gaming systems were typically deployed on mobile devices. This study demonstrates the effectiveness of using serious games and gamified systems. Both can improve the efficacy of HIV/AIDS prevention strategies, particularly those that encourage behavior change.
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Affiliation(s)
- Waritsara Jitmun
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Patison Palee
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Noppon Choosri
- Data Analytics and Knowledge Synthesis for Healthcare (DAKSH) Research Group, College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Tisinee Surapunt
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
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Fee C, Fuller J, Guss CE, Woods ER, Cooper ER, Bhaumik U, Graham D, Burchett S, Dumont O, Marty E, Narvaez M, Haberer JE, Swendeman D, Mulvaney SA, Kumar VS, Jackson JL, Ho YX. A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study (Preprint). JMIR Form Res 2022; 6:e39357. [DOI: 10.2196/39357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/24/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
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Shin J, Konlan KD, Mensah E. Health promotion interventions for the control of hypertension in Africa, a systematic scoping review from 2011 to 2021. PLoS One 2021; 16:e0260411. [PMID: 34843567 PMCID: PMC8629234 DOI: 10.1371/journal.pone.0260411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/09/2021] [Indexed: 01/29/2023] Open
Abstract
Background A proportion of hypertension patients live in developing countries with low awareness, poor control capabilities, and limited health resources. Prevention and control of hypertension can be achieved by applying both targeted and population-based health promotion interventions. This study synthesised the health promotion interventions for the control of hypertension in Africa. Methods An in-depth search of PubMed, CINAHL, EMBASE, Cochrane library, web of science, google scholar yielded 646 titles and 615 after duplicates were removed. Full text (112) was screened, and ten articles were selected. The data analysis method was thematic analysis through the incorporation of convergent synthesis. The major sub-themes that were identified were reduction in the prevalence of hypertension, increase in knowledge, impact and feasibility, role in the reduction of risk factors, and the cost associated with health promotion interventions. Results Health promotion interventions led to a remarkable decrease in the prevalence of hypertension, increased knowledge and awareness in the intervention compared to the control groups. Community-based interventions were noted to have a positive impact on people’s adoption of measures to reduce risk or identify early symptoms of hypertension. There was a significant relationship for the reduction in salt consumption, smoking, alcohol use, and increased physical activity after the administration of an intervention. Interventions using community health workers were cost-effective. Conclusion To sustain health promotion interventions and achieve control of hypertension especially in the long term, interventions must be culturally friendly and incorporate locally available resources in Africa.
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Affiliation(s)
- Jinhee Shin
- Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Kennedy Diema Konlan
- Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
- * E-mail:
| | - Eugenia Mensah
- War Memorial Hospital, Navrongo, Upper East Region, Ghana
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Ishimaru T, Yoshida T, Fujino Y. Correlation Between Voluntary HIV Testing and Public Awareness of HIV Using Google Trends in Japan. Asia Pac J Public Health 2021; 34:113-117. [PMID: 34668410 DOI: 10.1177/10105395211051251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article was to evaluate the correlation between the number of voluntary human immunodeficiency virus (HIV) tests conducted and public awareness according to Internet search volumes from Google Trends. We used bivariate correlations to assess the relationship between the Internet search frequency for each term of HIV and acquired immunodeficiency syndrome (AIDS) and the number of HIV tests, by time series and prefecture. We observed positive correlations between search frequencies of the terms HIV and AIDS and the number of HIV tests in both time-series analysis (HIV: r = 0.65, P < .001; AIDS: r = 0.73, P < .001) and analysis by prefecture (HIV: r = 0.71, P < .001; AIDS: r = 0.40, P = .001). The findings of this study indicate that the current stagnant number of HIV tests conducted in Japan reflects declining public awareness regarding HIV.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tatsuya Yoshida
- Faculty of Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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7
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Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A Review of Interventions to Enhance HIV Medication Adherence. Curr HIV/AIDS Rep 2021; 18:443-457. [PMID: 34152554 DOI: 10.1007/s11904-021-00568-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. RECENT FINDINGS There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
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Affiliation(s)
- Laura B Whiteley
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Elizabeth M Olsen
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla K Haubrick
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Enyonam Odoom
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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8
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Nelson KM, Perry NS, Horvath KJ, Smith LR. A systematic review of mHealth interventions for HIV prevention and treatment among gay, bisexual, and other men who have sex with men. Transl Behav Med 2021; 10:1211-1220. [PMID: 33044531 DOI: 10.1093/tbm/ibaa007] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The use of mobile health (mHealth) technologies addressing HIV disparities among gay, bisexual, and other men who have sex with men (GBMSM) has increased. A systematic review of mHealth interventions for HIV prevention and treatment among GBMSM was conducted to summarize the current evidence and provide recommendations for future research. PRISMA guidelines were followed (PROSPERO ID: 148452). Studies identified via PubMed, PsychInfo, or Embase were included that (i) were in English, (ii) were published in a peer-reviewed journal prior to July 1, 2019, (iii) presented primary results, (iv) included only GBMSM, and (v) reported the results of an mHealth intervention (e.g., text message, phone/mobile application [app]) to improve HIV prevention or treatment outcomes. Of 1,636 identified abstracts, 16 published studies met inclusion criteria. Eleven studies were conducted in the United States. One study was a fully powered randomized controlled trial (RCT), seven were single-arm pilots with pre-post assessments, four were pilot RCTs, and four tested public health campaigns with post-assessments. Seven developed study-specific apps, five used text messaging, and four used existing social networking apps. Most (81%) targeted prevention outcomes. Nine cited a specific behavioral theory. All studies found that a mHealth approach was feasible and acceptable. All interventions provided evidence of preliminary efficacy or promising trends on primary outcomes. Although mHealth interventions for HIV prevention and treatment appear feasible and acceptable, most published studies are small pilot trials. Additional research assessing the efficacy and mechanisms of mHealth interventions is needed.
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Affiliation(s)
- Kimberly M Nelson
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Nicholas S Perry
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Laramie R Smith
- Division of Infectious Diseases and Global Public Health, UC San Diego School of Medicine, La Jolla, CA, USA
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9
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Fernandez MI, Harper GW, Hightow-Weidman LB, Kapogiannis BG, Mayer KH, Parsons JT, Rotheram-Borus MJ, Seña AC, Sullivan PS. Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint. JMIR Res Protoc 2021; 10:e22279. [PMID: 33393918 PMCID: PMC7813632 DOI: 10.2196/22279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Youth represent 21% of new HIV diagnoses in the United States. Gay, bisexual, and transgender (GBT) youth, particularly those from communities of color, and youth who are homeless, incarcerated, in institutional settings, or engaging in transactional sex are most greatly impacted. Compared with adults, youth have lower levels of HIV serostatus awareness, uptake of antiretroviral therapy (ART), and adherence. Widespread availability of ART has revolutionized prevention and treatment for both youth at high risk for HIV acquisition and youth living with HIV, increasing the need to integrate behavioral interventions with biomedical strategies. The investigators of the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) completed a research prioritization process in 2019, focusing on research gaps to be addressed to effectively control HIV spread among American youth. The investigators prioritized research in the following areas: (1) innovative interventions for youth to increase screening, uptake, engagement, and retention in HIV prevention (eg, pre-exposure prophylaxis) and treatment services; (2) structural changes in health systems to facilitate routine delivery of HIV services; (3) biomedical strategies to increase ART impact, prevent HIV transmission, and cure HIV; (4) mobile technologies to reduce implementation costs and increase acceptability of HIV interventions; and (5) data-informed policies to reduce HIV-related disparities and increase support and services for GBT youth and youth living with HIV. ATN’s research priorities provide a roadmap for addressing the HIV epidemic among youth. To reach this goal, researchers, policy makers, and health care providers must work together to develop, test, and disseminate novel biobehavioral interventions for youth.
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Affiliation(s)
- M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Gary W Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | | | | | - Arlene C Seña
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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10
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Mitchell KR, Purcell C, Forsyth R, Barry S, Hunter R, Simpson SA, McDaid L, Elliot L, McCann M, Wetherall K, Broccatelli C, Bailey JV, Moore L. A peer-led intervention to promote sexual health in secondary schools: the STASH feasibility study. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Young people report higher levels of unsafe sex and have higher rates of sexually transmitted infections than any other age group. Schools are well placed to facilitate early intervention, but more effective approaches are required. Peer-led approaches can augment school-based education, but often fail to capitalise on mechanisms of social influence. The potential of using social media in sexual health has not been tested in school settings.
Objectives
Finalise the design of the Sexually Transmitted infections And Sexual Health (STASH) intervention; assess the recruitment and retention of peer supporters, and acceptability to participants and stakeholders; assess the fidelity and reach, in addition to the barriers to and facilitators of, implementation; refine programme theory; understand the potential of social media; determine design parameters for a future randomised controlled trial, including economic evaluation; and establish whether or not progression criteria were met.
Design
This was a feasibility study comprising intervention development and refinement of the STASH pilot and non-randomised feasibility trial in six schools. Control data were provided by students in the year above the intervention group.
Setting
Secondary schools in Scotland.
Participants
Students aged 14–16 years, teachers and intervention delivery partners.
Interventions
The STASH intervention was adapted from A Stop Smoking In Schools Trial (ASSIST) (an effective peer-led smoking intervention). Based on diffusion of innovation theory, the STASH study involves peer nomination to identify the most influential students, with the aim of recruiting and training 15% of the year group as peer supporters. The peer supporters deliver sexual health messages to friends in their year group via conversations and use of Facebook (www.facebook.com; Facebook, Inc., Menlo Park, CA, USA) to share varied content from a curated set of web-based resources. Peer supporters are given support themselves via follow-up sessions and via trainer membership of Facebook groups.
Main outcome measures
The primary outcome was whether or not progression criteria were met in relation to intervention acceptability and feasibility. The study also piloted indicative primary outcomes for a full-scale evaluation.
Data sources
Peer supporter questionnaire; observations of activities; interviews with trainers, teachers, peer supporters and students; monitoring log of peer supporter activities (including on Facebook and meeting attendance); questionnaire to control year group (baseline characteristics, social networks, mediators and sexual health outcomes); baseline and follow-up questionnaire (approximately 6 months later) for intervention year group.
Results
A total of 104 students were trained as peer supporters (just over half of those nominated for the role by their peers). Role retention was very high (97%). Of 611 students completing the follow-up questionnaire, 58% reported exposure to STASH study activities. Intervention acceptability was high among students and stakeholders. Activities were delivered with good fidelity. The peer supporters were active, representative of their year group and well connected within their social network. Carefully managed social media use by peer supporters augmented conversations. A primary outcome of ‘always safer sex’ was identified, measured as no sex or always condom use for vaginal or anal sex in the last 6 months. The intervention cost £42 per student. Six progression criteria were met. A seventh criterion (regarding uptake of role by peer supporters) was not.
Limitations
Small feasibility study that cannot comment on effectiveness.
Conclusions
The STASH intervention is feasible and acceptable within the context of Scottish secondary schools. The results support continuation to a full-scale evaluation.
Future work
Small-scale improvements to the intervention, refinement to programme theory and funding sought for full-scale evaluation.
Trial registration
Current Controlled Trials ISRCTN97369178.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kirstin R Mitchell
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Carrie Purcell
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ross Forsyth
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sarah Barry
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sharon A Simpson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lawrie Elliot
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Mark McCann
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Chiara Broccatelli
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Laurence Moore
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Laskar P, Yallapu MM, Chauhan SC. "Tomorrow Never Dies": Recent Advances in Diagnosis, Treatment, and Prevention Modalities against Coronavirus (COVID-19) amid Controversies. Diseases 2020; 8:E30. [PMID: 32781617 PMCID: PMC7563589 DOI: 10.3390/diseases8030030] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of novel coronavirus disease (2019-nCoV or COVID-19) is responsible for severe health emergency throughout the world. The attack of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found to be responsible for COVID-19. The World Health Organization has declared the ongoing global public health emergency as a pandemic. The whole world fights against this invincible enemy in various capacities to restore economy, lifestyle, and safe life. Enormous amount of scientific research work(s), administrative strategies, and economic measurements are in place to create a successful step against COVID-19. Furthermore, differences in opinion, facts, and implementation methods laid additional layers of complexities in this battle against survival. Thus, a timely overview of the recent, important, and overall inclusive developments against this pandemic is a pressing need for better understanding and dealing with COVID-19. In this review, we have systematically summarized the epidemiological studies, clinical features, biological properties, diagnostic methods, treatment modalities, and preventive measurements related to COVID-19.
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Affiliation(s)
- Partha Laskar
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, UK;
| | - Murali M. Yallapu
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
| | - Subhash C. Chauhan
- Department of Immunology and Microbiology, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
- South Texas Center of Excellence in Cancer Research, School of Medicine, University of Texas Rio Grande Valley, McAllen, TX 78504, USA
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12
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Cell Phones, Sexual Behaviors and HIV Prevalence in Rakai, Uganda: A Cross Sectional Analysis of Longitudinal Data. AIDS Behav 2020; 24:1574-1584. [PMID: 31520238 DOI: 10.1007/s10461-019-02665-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cell phones have increased communication and connection across the globe and particularly in sub-Saharan Africa-with potential consequences for the HIV epidemic. We examined the association among ownership of cell phones, sexual behaviors (number of sexual partners, alcohol use before sex, inconsistent condom use), and HIV prevalence. Data were from four rounds (2010-2016) of the Rakai Community Cohort Study (N = 58,275). Sexual behaviors and HIV prevalence were compared between people who owned a cell phone to people who did not own a cell phone. We stratified analysis by younger (15-24 years) and older (25+ years) age groups and by gender. Using logistic regression and after adjusting for sociodemographic characteristics, we found cell phone ownership was independently associated with increased odds of having two or more sexual partners in the past 12 months across age and gender groups (young men AOR 1.67, 95% CI 1.47-1.90; young women AOR 1.28 95% CI 1.08-1.53; older men AOR 1.54 95% CI 1.41-1.69; older women AOR 1.44 95% CI 1.26-1.65). Interestingly, young men who owned cell phones had decreased odds of using condoms inconsistently (AOR 0.66, 95% CI 0.57-0.75). For young women, cell phone ownership was associated with increased odds of using alcohol before sex (AOR 1.38 95% CI 1.17-1.63) and increased odds of inconsistent condom use (AOR 1.40, 95% 1.17-1.67). After adjusting for sociodemographic characteristics, only young women who owned cell phones had increased odds of being HIV positive (AOR 1.27 95% CI 1.07-1.50). This association was not mediated by sexual behaviors (Adjusted for sociodemographic characteristics and sexual behaviors AOR 1.24, 95% CI 1.05-1.46). While cell phone ownership appears to be associated with increased HIV risk for young women, we also see a potential opportunity for future cell phone-based health interventions.
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Li DH, Brown CH, Gallo C, Morgan E, Sullivan PS, Young SD, Mustanski B. Design Considerations for Implementing eHealth Behavioral Interventions for HIV Prevention in Evolving Sociotechnical Landscapes. Curr HIV/AIDS Rep 2020; 16:335-348. [PMID: 31250195 DOI: 10.1007/s11904-019-00455-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Despite tremendous potential for public health impact and continued investments in development and evaluation, it is rare for eHealth behavioral interventions to be implemented broadly in practice. Intervention developers may not be planning for implementation when designing technology-enabled interventions, thus creating greater challenges for real-world deployment following a research trial. To facilitate faster translation to practice, we aimed to provide researchers and developers with an implementation-focused approach and set of design considerations as they develop new eHealth programs. RECENT FINDINGS Using the Accelerated Creation-to-Sustainment model as a lens, we examined challenges and successes experienced during the development and evaluation of four diverse eHealth HIV prevention programs for young men who have sex with men: Keep It Up!, Harnessing Online Peer Education, Guy2Guy, and HealthMindr. HIV is useful for studying eHealth implementation because of the substantial proliferation of diverse eHealth interventions with strong evidence of reach and efficacy and the responsiveness to rapid and radical disruptions in the field. Rather than locked-down products to be disseminated, eHealth interventions are complex sociotechnical systems that require continual optimization, vigilance to monitor and troubleshoot technological issues, and decision rules to refresh content and functionality while maintaining fidelity to core intervention principles. Platform choice and sociotechnical relationships (among end users, implementers, and the technology) heavily influence implementation needs and challenges. We present a checklist of critical implementation questions to address during intervention development. In the absence of a clear path forward for eHealth implementation, deliberate design of an eHealth intervention's service and technological components in tandem with their implementation plans is critical to mitigating barriers to widespread use. The design considerations presented can be used by developers, evaluators, reviewers, and funders to prioritize the pragmatic scalability of eHealth interventions in research.
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Affiliation(s)
- Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA. .,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - C Hendricks Brown
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Carlos Gallo
- Center for Prevention Implementation Methodology for Drug Abuse and HIV, Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ethan Morgan
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sean D Young
- Institute for Prediction Technology, Department of Informatics, Bren School of Information and Computer Science, University of California, Irvine, Irvine, CA, USA.,Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Rouffiac AE, Whiteley L, Brown L, Mena L, Craker L, Healy M, Haubrick K. A Mobile Intervention to Improve Uptake of Pre-Exposure Prophylaxis for Southern Black Men Who Have Sex With Men: Protocol for Intervention Development and Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15781. [PMID: 32130196 PMCID: PMC7059079 DOI: 10.2196/15781] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The uptake of pre-exposure prophylaxis (PrEP) has been slow for young black men who have sex with men (BMSM) living in the southern United States. This is a significant issue because 8 of the 10 states with the highest rates of new HIV infections are in the South. Jackson, Mississippi (MS), the site of this project, has the second highest AIDS diagnosis rate in the nation and the highest rate of HIV infection for young, urban BMSM. This study will develop and test an engaging, interactive, and cost-effective mobile messaging intervention to improve engagement in PrEP care for BMSM aged 18 to 35 years living in Jackson, MS. OBJECTIVE The goals of this mixed methods study are to (1) conduct qualitative interviews with young BMSM in Jackson, MS, to understand individual, community, and structural barriers affecting engagement in PrEP-related care, (2) assemble a PrEP mobile messaging intervention that includes text messages with publicly available internet content (websites and YouTube videos) that provide factual information, motivational materials, and behavioral skills related to PrEP and HIV prevention, and (3) evaluate the preliminary efficacy of the intervention in a randomized controlled study with PrEP-eligible BMSM receiving care in STI/HIV testing clinics in Jackson, MS. METHODS This research protocol will be conducted in 2 phases. A development phase will involve in-depth interviews (n=30) with PrEP-eligible BMSM who receive care in STI/HIV testing clinics in MS. These interviews will allow researchers to select the texted material that will be sent out during the intervention. The second phase will consist of an unblinded, small, randomized controlled trial among 66 new participants to examine the preliminary efficacy of the intervention compared with enhanced standard of care (ESC) on attendance at a PrEP services appointment (the first step in initiating PrEP care) and receipt of a PrEP prescription, based on self-report and electronic medical records. The free, publicly available material will be sent to PrEP-eligible BMSM in 8 to 16 interactive text messages over 4 weeks. Study assessments will occur at enrollment and at 4- and 16-weeks postenrollment and can be completed online or in person. All participants will be recruited from a local clinic. RESULTS Institutional review board approval was received on January 16, 2017, and research activities, subsequently, began in February 2018. Recruitment for the study concluded in November 2019. In total, 65 participants were randomized with 33 being assigned to the intervention and 32 to ESC. Collection of follow-up data is ongoing. CONCLUSIONS This PrEP mobile messaging intervention aims to increase uptake of PrEP by BMSM in the southern United States. This intervention uses interactive, tailored text messaging and appealing free Web content (publicly accessible educational websites and YouTube videos) to promote linkage to PrEP care and increase HIV preventative behaviors. A cost-effective PrEP mobile messaging intervention has great potential to improve information about PrEP, improve motivation to use PrEP, and decrease stigma and structural barriers that often prevent engagement in PrEP-related medical care. TRIAL REGISTRATION ClinicalTrials.gov NCT03308097; https://clinicaltrials.gov/ct2/show/NCT03308097. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15781.
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Affiliation(s)
- Anne-Emilie Rouffiac
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Larry Brown
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, United States
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lacey Craker
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Healy
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
| | - Kayla Haubrick
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
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15
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Villegas N, Cianelli R, de Tantillo L, Warheit M, Montano NP, Ferrer L, Patel S. Assessment of Technology Use and Technology Preferences for HIV Prevention Among Hispanic Women. HISPANIC HEALTH CARE INTERNATIONAL 2019; 16:197-203. [PMID: 31185747 DOI: 10.1177/1540415318808828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION HIV transmission presents an ongoing risk to Hispanic women, and prevention efforts remain a priority. The use of technology to prevent HIV transmission among Hispanic women and those of lower socioeconomic status underscore the need for effective implementation of technology. The purpose of this study is to describe technology preferences and predictors of the use of the internet for HIV prevention among low-income Hispanic women. METHOD A secondary analysis was conducted using baseline data from an intervention to prevent HIV among 320 Hispanic women. The parent study was SEPA, Salud (health), Educación (education), Promoción (promotion), y [and] Autocuidado (self-care). RESULTS Most participants reported using personal technology, such as smartphones (90.6%), the internet (78.1%), and personal email (67.5%), every day. Most (71.3%) participants were open to learning about HIV education via the internet. In the logistic regression analysis, education and time since the last visit to the health care provider were significant predictors of the use of the internet to learn about HIV prevention, after controlling for age, living with the partner, and years living in the United States. CONCLUSION Hispanic women demonstrated high levels of comfort with different forms of technology. These results indicated the potential to expand future HIV intervention efforts by implementing electronic dissemination of bilingual and culturally appropriate information for Hispanic women of diverse ages.
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Affiliation(s)
- Natalia Villegas
- 1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Rosina Cianelli
- 1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Lila de Tantillo
- 1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Melanie Warheit
- 1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | | | - Lilian Ferrer
- 1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Shefali Patel
- 1 School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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Alhassan RK, Abdul-Fatawu A, Adzimah-Yeboah B, Nyaledzigbor W, Agana S, Mwini-Nyaledzigbor PP. Determinants of use of mobile phones for sexually transmitted infections (STIs) education and prevention among adolescents and young adult population in Ghana: implications of public health policy and interventions design. Reprod Health 2019; 16:120. [PMID: 31399123 PMCID: PMC6688338 DOI: 10.1186/s12978-019-0763-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually Transmitted Infections (STIs) are a major public health challenge globally especially among adolescents and young adults in lower-middle-income countries (LMICs) in Africa including Ghana. In light of this, mobile phone innovations are advocated to enhance public health education and prevention of STIs in developing health systems. OBJECTIVE This study assessed mobile phone usage among adolescents and young adult populations pursuing tertiary education and their use of these technologies in the education and prevention of STIs. METHOD This was a cross-sectional analytical study among 250 adolescents and young adults aged 18-24 at Ghana's premier and biggest public University. The study was however conducted in only one public university in the Greater Accra region which potentially poses generalizability challenges due to socio-cultural and economic differences in other regions of the country. Data was collected using structured questionnaire and data analysis done with STATA (version 12.0). Univariate probit regression (VCE, Robust) analysis was used to determine factors associated with adolescents and young adult population's usage of mobile phones in the education and prevention of STIs. RESULTS Out of the 250 adolescents and young adults interviewed, 99% owned mobile phones. Out of this number, 58% them were smartphone users. Also, it was found that male young adults (Coef. = 1.11, p = 0.000) and young adults who owned a smartphone (Coef. = 0.46, p = 0.013) were more likely to use mobile phones for education and prevention of STIs. CONCLUSION Mobile phone penetration among young adults is nearly 100% in line with the national trend. Additionally, these young adults largely believe in the use of mobile phone programmes for STIs education and prevention. Moreover, respondents were found to be more comfortable using mobile applications than traditional text messaging or phone calls in STIs education and prevention. Future mobile phone programmes for STIs education and prevention should consider innovating customized mobile applications to promote acceptability by the youth and enhance sustainability of such interventions on STIs in Ghana. Even though this study was conducted in only one public university in Ghana, the findings are nonetheless informative and future researchers could consider using a larger sample size across private and public universities in other regions of the country.
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Affiliation(s)
- Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery University of Health and Allied Sciences, Ho. PMB 31, Volta Region, Ho, Ghana.
| | - Abdulai Abdul-Fatawu
- Former student, School of Nursing and Midwifery, University of Ghana Legon, Accra, Ghana
| | - Belinda Adzimah-Yeboah
- Department of Public Health Nursing, School of Nursing and Midwifery University of Health and Allied Sciences, Ho. PMB 31, Volta Region, Ho, Ghana
| | | | - Samuel Agana
- ICT Directorate, University of Health and Allied Sciences, Ho, Ghana
| | - Prudence Portia Mwini-Nyaledzigbor
- Department of Public Health Nursing, School of Nursing and Midwifery University of Health and Allied Sciences, Ho. PMB 31, Volta Region, Ho, Ghana
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Swendeman D, Arnold EM, Harris D, Fournier J, Comulada WS, Reback C, Koussa M, Ocasio M, Lee SJ, Kozina L, Fernández MI, Rotheram MJ. Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11165. [PMID: 31400109 PMCID: PMC6707028 DOI: 10.2196/11165] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. OBJECTIVE This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. METHODS Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). RESULTS The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective. TRIAL REGISTRATION ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/11165.
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Affiliation(s)
- Dallas Swendeman
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Danielle Harris
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Jasmine Fournier
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States
| | - W Scott Comulada
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Cathy Reback
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Maryann Koussa
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Manuel Ocasio
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States
| | - Sung-Jae Lee
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
| | - Leslie Kozina
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, LA, United States
| | - Maria Isabel Fernández
- Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, FL, United States
| | - Mary Jane Rotheram
- University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA, United States
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Madkins K, Moskowitz DA, Moran K, Dellucci TV, Mustanski B. Measuring Acceptability and Engagement of The Keep It Up! Internet-Based HIV Prevention Randomized Controlled Trial for Young Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:287-305. [PMID: 31361516 PMCID: PMC6939469 DOI: 10.1521/aeap.2019.31.4.287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
HIV disproportionately impacts young men of color who have sex with men. Keep It Up! (KIU!) is an online intervention that addresses the needs of this population. The study objective was to examine intervention acceptability and engagement. Outcomes of interests were qualitative and quantitative acceptability and engagement measures, content ratings, and paradata. On average, participants rated content (4 out of 5 stars) and acceptability (3.5 out of 4) highly. Compared to White participants, Black participants found KIU! more useful, engaging, and acceptable; Latino participants found KIU! more engaging; and other non-White participants found KIU! more engaging and acceptable. Participants with high school or less education found KIU! more useful, engaging, acceptable, and deserving of five stars than college graduates (p values = .047, <.001, .002, .01) and graduate degree holders (p values = .04, .001, <.001, .004). KIU! is a promising prevention tool for highest risk populations.
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Affiliation(s)
- Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - David A. Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Kevin Moran
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Trey V. Dellucci
- The Graduate Center of the City University of New York, New York, NY
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
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Bond KT, Ramos SR. Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey. JMIR Form Res 2019; 3:e9995. [PMID: 31144667 PMCID: PMC6658301 DOI: 10.2196/formative.9995] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 04/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.
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Affiliation(s)
- Keosha T Bond
- Department of Public Health, New York Medical College, Valhalla, NY, United States
| | - S Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Whiteley L, Mena L, Craker LK, Healy MG, Brown LK. Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game. JMIR Serious Games 2019; 7:e11861. [PMID: 30916652 PMCID: PMC6456850 DOI: 10.2196/11861] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP’s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. Objective This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. Methods Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. Results A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors’ visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. Conclusions We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM.
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Leandro Mena
- University of Mississippi Medical Center, University of Mississippi, Jackson, MS, United States
| | - Lacey K Craker
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Garver Healy
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Larry K Brown
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
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Arnold EM, Swendeman D, Harris D, Fournier J, Kozina L, Abdalian S, Rotheram MJ. The Stepped Care Intervention to Suppress Viral Load in Youth Living With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10791. [PMID: 30810536 PMCID: PMC6414817 DOI: 10.2196/10791] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background Among youth living with HIV (YLH) aged 12-24 years who have health care in the United States, only 30% to 40% are virally suppressed. YLH must achieve viral suppression in order to reduce the probability of infecting others as well as increasing the length and quality of their own life. Objective This randomized controlled trial aimed to evaluate the efficacy of an Enhanced Standard Care condition (n=110) compared to an Enhanced Stepped Care intervention condition (n=110) to increase viral suppression among YLH aged 12-24 years with established infection (not acutely infected). Methods YLH (N=220) who are not virally suppressed will be identified at homeless shelters, health clinics, and gay-identified community-based organizations in Los Angeles, CA, and New Orleans, LA. Informed consent will be obtained from all participants. YLH will be randomly assigned to one of two study conditions: Enhanced Standard Care, which includes standard clinical care plus an automated messaging and monitoring intervention (AMMI), or an Enhanced Stepped Care, which includes three levels of intervention (AMMI, Peer Support via social media plus AMMI, or Coaching plus Peer Support and AMMI). The primary outcome is viral suppression of HIV, and YLH will be assessed at 4-month intervals for 24 months. For the Enhanced Stepped Care intervention group, those who do not achieve viral suppression (via blood draw, viral load<200 copies/mL) at any 4-month assessment will “step up” to the next level of intervention. Secondary outcomes will be retention in care, antiretroviral therapy adherence, alcohol use, substance use, sexual behavior, and mental health symptoms. Results Recruitment for this study began in June 2017 and is ongoing. We estimate data collection to be completed by the end of 2020. Conclusions This is the first known application of an Enhanced Stepped Care intervention model for YLH. By providing the lowest level of intervention needed to achieve viral suppression, this model has the potential to be a cost-effective method of helping YLH achieve viral suppression and improve their quality of life. Trial Registration ClinicalTrials.gov NCT03109431; https://clinicaltrials.gov/ct2/show/NCT03109431 International Registered Report Identifier (IRRID) DERR1-10.2196/10791
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Affiliation(s)
- Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Harris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jasmine Fournier
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Leslie Kozina
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Susan Abdalian
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Mary Jane Rotheram
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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22
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Rotheram MJ, Fernandez MI, Lee SJ, Abdalian SE, Kozina L, Koussa M, Comulada WS, Klausner JD, Mayfield Arnold E, Ocasio MA, Swendeman D. Strategies to Treat and Prevent HIV in the United States for Adolescents and Young Adults: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e10759. [PMID: 30664482 PMCID: PMC6360384 DOI: 10.2196/10759] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/24/2018] [Accepted: 11/08/2018] [Indexed: 12/20/2022] Open
Abstract
Background Over 20% of HIV diagnoses in the United States are among youth aged 12-24 years. Furthermore, youth have the lowest rates of uptake and adherence to antiretroviral (ARV) medications and are least aware of their HIV status. Objective Our objective was to design a set of interrelated studies to promote completion of each step of the HIV Prevention Continuum by uninfected youth at high risk (YHR), as well as completion of steps in the Treatment Continuum by youth living with HIV (YLH). Methods Gay, bisexual, and transgender youth; homeless youth; substance-abusing youth; youth with criminal justice contact; and youth with significant mental health challenges, particularly black and Latino individuals, are being recruited from 13 community-based organizations, clinics, drop-in centers, and shelters in Los Angeles and New Orleans. Youth are screened on the basis of self-reports and rapid diagnostic tests for HIV, drug use, and sexually transmitted infections and, then, triaged into one of 3 studies: (1) an observational cohort of YLH who have never received ARV medications and are then treated—half initially are in the acute infection period (n=36) and half with established HIV infection (n=36); (2) a randomized controlled trial (RCT) for YLH (N=220); and (3) an RCT for YHR (N=1340). Each study contrasts efficacy and costs of 3 interventions: an automated messaging and weekly monitoring program delivered via text messages (short message service, SMS); a peer support intervention delivered via social media forums; and coaching, delivered via text message (SMS), phone, and in-person or telehealth contacts. The primary outcomes are assessing youths’ uptake and retention of and adherence to the HIV Prevention or Treatment Continua. Repeat assessments are conducted every 4 months over 24 months to engage and retain youth and to monitor their status. Results The project is funded from September 2016 through May 2021. Recruitment began in May 2017 and is expected to be completed by June 2019. We expect to submit the first results for publication by fall 2019. Conclusions Using similar, flexible, and adaptable intervention approaches for YLH and YHR, this set of studies may provide a roadmap for communities to broadly address HIV risk among youth. We will evaluate whether the interventions are cost-efficient strategies that can be leveraged to help youth adhere to the actions in the HIV Prevention and Treatment Continua. International Registered Report Identifier (IRRID) DERR1-10.2196/10759
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Affiliation(s)
- Mary Jane Rotheram
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Maria Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Sung-Jae Lee
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Sue Ellen Abdalian
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Leslie Kozina
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Maryann Koussa
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Warren Scott Comulada
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Manuel A Ocasio
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
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- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States.,University of California Los Angeles, Los Angeles, CA, United States.,School of Medicine, University of California San Francisco, San Francisco, CA, United States
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23
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Gimbel S, Kawakyu N, Dau H, Unger JA. A Missing Link: HIV-/AIDS-Related mHealth Interventions for Health Workers in Low- and Middle-Income Countries. Curr HIV/AIDS Rep 2018; 15:414-422. [PMID: 30259258 PMCID: PMC7704394 DOI: 10.1007/s11904-018-0416-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Through a review of the peer-reviewed and gray literature on HIV mobile health (mHealth) tools for health workers and in-depth interviews with mHealth leaders in the field, we provide a synthesis of current work and propose mHealth research priorities for HIV prevention, care, and treatment. RECENT FINDINGS Significant investment in implementation research and bringing together researchers capable of identifying drivers of successful implementation and industry leaders capable of bringing efficacious tools to scale are needed to move this area forward. Effective and appropriate technologies to support health systems in the prevention and treatment of HIV/AIDS in low- and middle-income countries are needed to improve the efficiency and quality of health service delivery and ultimately improve health outcomes. Although a growing number of HIV mHealth tools have been developed to support health workers, few of these tools have been rigorously evaluated and even fewer have been brought to scale.
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Affiliation(s)
- Sarah Gimbel
- Department of Family and Child Nursing, University of Washington, Seattle, WA, 98105, USA.
- Department of Global Health, University of Washington, Seattle, WA, 98105, USA.
- Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, WA, 98105, USA.
| | - Nami Kawakyu
- Department of Global Health, University of Washington, Seattle, WA, 98105, USA
- Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, WA, 98105, USA
| | - Hallie Dau
- Department of Global Health, University of Washington, Seattle, WA, 98105, USA
- Center for Global Health Nursing, School of Nursing, University of Washington, Seattle, WA, 98105, USA
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, WA, 98105, USA
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, 98105, USA
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24
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Horberg MA, Blank JG, Rubenstein KB, Certa JM, Hurley LB, Kadlecik PM, Klein DB, Silverberg MJ. Impact of Alternative Encounter Types on HIV Viral Suppression Rates in an Integrated Health System. AIDS Patient Care STDS 2018; 32:425-431. [PMID: 30398954 DOI: 10.1089/apc.2018.0079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Kaiser Permanente Mid-Atlantic States (KPMAS) members are increasingly utilizing electronic encounter types, such as telephone appointments and secure messaging for healthcare purposes, although their impact on health outcomes is unknown. We evaluated whether use of alternative encounters by adult human immunodeficiency virus (HIV)-infected patients affected the likelihood of achieving viral suppression (VS). Our study population of 3114 patients contributed 6520 patient-years between 2014 and 2016. We compared VS (HIV RNA <200 copies/mL) by number of in-person visits (1 or ≥2), with further stratification for additional phone and/or e-mail encounters (none, phone only, e-mail only, and both phone and e-mail). Rate ratios (RRs) for VS by number of in-person visits and encounter types were obtained from Poisson modeling, adjusting for age, sex, race/ethnicity, and HIV risk. Compared to those with ≥2 visits, patients with one in-person visit alone were significantly less likely to achieve VS (RR = 0.93; 95% confidence interval, CI: [0.87-1.00]), as were those with one in-person visit plus a telephone encounter (0.93; [0.90-0.97]). We did not find significant differences in VS comparing patients with one in-person visit plus e-mail only (RR = 1.00; 95% CI: [0.97-1.02]) or plus e-mail and telephone (0.99; [0.97-1.01]) to those with ≥2 in-person visits. If supplemented by e-mail communications (with or without telephone contact), patients with one in-person visit per year had similar estimated rates of VS compared with ≥2 in-person visits. More research is needed to know if these findings apply to other care systems.
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Affiliation(s)
- Michael A. Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Jackie G. Blank
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Kevin B. Rubenstein
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Julia M. Certa
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Leo B. Hurley
- Kaiser Permanente Northern California, Division of Research, Oakland, California
| | - Peter M. Kadlecik
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Daniel B. Klein
- Kaiser Permanente Northern California, San Leandro, California
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25
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Zhang Q, Chai Y, Li X, Young SD, Zhou J. Using internet search data to predict new HIV diagnoses in China: a modelling study. BMJ Open 2018; 8:e018335. [PMID: 30337302 PMCID: PMC6196849 DOI: 10.1136/bmjopen-2017-018335] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/18/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Internet data are important sources of abundant information regarding HIV epidemics and risk factors. A number of case studies found an association between internet searches and outbreaks of infectious diseases, including HIV. In this research, we examined the feasibility of using search query data to predict the number of new HIV diagnoses in China. DESIGN We identified a set of search queries that are associated with new HIV diagnoses in China. We developed statistical models (negative binomial generalised linear model and its Bayesian variants) to estimate the number of new HIV diagnoses by using data of search queries (Baidu) and official statistics (for the entire country and for Guangdong province) for 7 years (2010 to 2016). RESULTS Search query data were positively associated with the number of new HIV diagnoses in China and in Guangdong province. Experiments demonstrated that incorporating search query data could improve the prediction performance in nowcasting and forecasting tasks. CONCLUSIONS Baidu data can be used to predict the number of new HIV diagnoses in China up to the province level. This study demonstrates the feasibility of using search query data to predict new HIV diagnoses. Results could potentially facilitate timely evidence-based decision making and complement conventional programmes for HIV prevention.
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Affiliation(s)
- Qingpeng Zhang
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- City University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Yi Chai
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sean D Young
- University of California Institute for Prediction Technology, Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jiaqi Zhou
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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Ventuneac A, John SA, Whitfield THF, Mustanski B, Parsons JT. Preferences for Sexual Health Smartphone App Features Among Gay and Bisexual Men. AIDS Behav 2018; 22:3384-3394. [PMID: 29948335 PMCID: PMC6148366 DOI: 10.1007/s10461-018-2171-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Given the popularity of geosocial networking applications ("apps") among gay, bisexual, and other men who have sex with men (GBMSM), this study sought to examine GBMSM's willingness to use sexual health and behavior tracking features if integrated within apps they are already using to meet sexual partners. Most GBMSM (91%) recruited on a popular app reported interest in one or more sexual health app features, including features to find LGBT-friendly providers (83%), receive lab results (68%), schedule appointment reminders (67%), chat with a healthcare provider (59%), and receive medication reminder alerts (42%). Fewer GBMSM were interested in tracking and receiving feedback on their sexual behavior (35%) and substance use (24%). Our data suggest that integrating sexual health and behavior tracking features for GBMSM who use apps could be promising in engaging them in HIV prevention interventions. Further research is needed on GBMSM's perspectives about potential barriers in using such features.
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Affiliation(s)
- Ana Ventuneac
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven A John
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - Thomas H F Whitfield
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Brian Mustanski
- Department of Medical Social Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, USA.
| | - Jeffrey T Parsons
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA
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Winskell K, Sabben G, Akelo V, Ondeng'e K, Obong'o C, Stephenson R, Warhol D, Mudhune V. A Smartphone Game-Based Intervention (Tumaini) to Prevent HIV Among Young Africans: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10482. [PMID: 30068501 PMCID: PMC6094086 DOI: 10.2196/10482] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/01/2018] [Accepted: 06/19/2018] [Indexed: 12/05/2022] Open
Abstract
Background There is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. Objective To pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. Methods Tumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. Results Intervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P<.001), behavioral intention for risk-avoidance strategies and sexual risk communication (P=.006), and overall survey scores (P<.001) compared with the control arm at T3. The postintervention survey revealed high subjective measures of the game’s value, relevance, and appeal. Focus groups identified a wide range of knowledge and skills the participants had gained, including setting goals and planning how to achieve them, which was perceived as a key motivator for avoiding or reducing risk. Conclusions The study supports the need for further research to assess the efficacy of the game-based intervention. If proven efficacious, smartphone games have the potential to dramatically increase the reach of culturally adapted behavioral interventions while ensuring fidelity to intervention design. Trial Registration ClinicalTrials.gov NCT03054051; http://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW)
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Affiliation(s)
- Kate Winskell
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Gaëlle Sabben
- Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Victor Akelo
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
| | - Ken Ondeng'e
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
| | | | - Rob Stephenson
- School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - David Warhol
- Realtime Associates, El Segundo, CA, United States
| | - Victor Mudhune
- Kenya Medical Research Institute- Centre for Global Health Research, HIV Research Branch, Kisumu, Kenya
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Miners A, Llewellyn C, King C, Pollard A, Roy A, Gilson R, Rodger A, Burns F, Shahmanesh M. Designing a brief behaviour change intervention to reduce sexually transmitted infections: a discrete choice experiment. Int J STD AIDS 2018; 29:851-860. [PMID: 29629651 DOI: 10.1177/0956462418760425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To understand whether people attending sexual health (SH) clinics are willing to participate in a brief behavioural change intervention (BBCI) to reduce the likelihood of future sexually transmitted infections (STIs) and to understand their preferences for different service designs, we conducted a discrete choice experiment (DCE) with young heterosexual adults (aged 16-25 years), and men who have sex with men (MSM) aged 16 or above, attending SH clinics in England. Data from 368 participants showed that people particularly valued BBCIs that involved talking (OR 1.45; 95%CI 1.35, 1.57 compared with an 'email or text'-based BBCIs), preferably with a health care professional rather than a peer. Findings also showed that 26% of respondents preferred 'email/texts' to all other options; the remaining 14% preferred not to participate in any of the offered BBCIs. These results suggest that most people attending SH clinics in England are likely to participate in a BBCI if offered, but the type/format of the BBCI is likely to be the single important determinant of uptake rather than characteristics such as the length and the number of sessions. Moreover, participants generally favoured 'talking'-based options rather than digital alternatives, which are likely to require the most resources to implement.
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Affiliation(s)
- Alec Miners
- 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carrie Llewellyn
- 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Carina King
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Alex Pollard
- 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Anupama Roy
- 2 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Richard Gilson
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Alison Rodger
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Fiona Burns
- 3 Research Department of Infection and Population Health, University College London, London, UK
| | - Maryam Shahmanesh
- 3 Research Department of Infection and Population Health, University College London, London, UK
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Zhang J, Xu JJ, Song W, Pan S, Chu ZX, Hu QH, Yu H, Mao X, Jiang YJ, Geng WQ, Shang H, Wang N. HIV Incidence and Care Linkage among MSM First-Time-Testers in Shenyang, China 2012-2014. AIDS Behav 2018; 22:711-721. [PMID: 28660379 DOI: 10.1007/s10461-017-1840-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV testing is the first step to the fulfillment of Treat as Prevention (TasP) and reaching the 90-90-90 goal in HIV control. However, there are still a large number of Men who have Sex with Men (MSM) have never been tested for HIV before, and little is known about the HIV incidence and care linkage among this population. A Mixed method was used to recruit MSM who had never tested for HIV before from January 2012 to December 2014 in Shenyang, China. Potential MSM participants were invited to attend the enrollment for HIV and syphilis testing at a general hospital-based voluntary counseling and test (VCT). HIV confirmed positive subjects were further tested by BED HIV-1 capture enzyme immunoassay (BED-CEIA) to determine the HIV incidence. Syphilis was screened by the rapid plasma reagent test (RPR) and confirmed by Treponema pallidum particle assay (TPPA). All the HIV positive subjects were referred to the local Center for Disease Control and Prevention (CDC) and clinics for HIV primary care and follow-ups. In total 646 HIV first-time-testers of MSM (FMSM) attended this study, 73.4% (474/646) were aged under 31-year-old and 57.3% (370/646) and used the Internet as their major cruising avenue for seeking male sexual partners. The average prevalence of HIV and current syphilis infection was 10.8% (70/646) and 11.0% (71/646), respectively. The HIV incidence was 10.3 (95% confidence interval [CI] 6.1-14.5)/100PY. Multivariate logistic analysis showed that factors such as use of the Internet as the major cruising avenue (adjusted OR [AOR] 2.7, 95% CI 0.9-7.6) and having a current syphilis infection (AOR 4.2, 95% CI 1.8-12.2) were independent correlates of a recent HIV infection. Of the 95 HIV screening test positive FMSM, 73.7% (70/95) returned and be confirmed positive, 92.9% (65/70) of confirmed patients were linked to care. Among those retained and underwent CD4+ T cell test, 76.3% (42/55) started HIV antiretroviral therapy. Among the unconfirmed, 84.0% (21/25) were non-local migrants. The HIV incidence of FMSM in Shenyang was high. Future HIV testing program needs to keep on expanding among the MSM who have never been tested for HIV yet. The Internet-based campaigns and syphilis testing and treatment could represent an opportunity to get access to this hard-to-reach population and link them to HIV care. Future linkage to HIV care of this population should underscore the usage of HIV rapid diagnostic tests to prevent lost at early steps of linkage.
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Affiliation(s)
- Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wei Song
- Shenyang Center for Disease Control and Prevention, No. 37, Qishanzhong Street, Heping District, Shenyang, Liaoning, China
| | - Shi Pan
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhen-Xing Chu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Huan Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiang Mao
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China.
| | - Ning Wang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, No 155, Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, China.
- National Center for AIDS/STI Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, China.
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Bond K, Ramos SR. Utilization of an Animated eHealth Video to Increase Knowledge of HIV Post- and Pre-exposure Prophylaxis among African American Women (Preprint). JMIR Res Protoc 2018. [DOI: 10.2196/resprot.9995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Villegas N, Cianelli R, Santisteban D, Lara L, Vargas J. Factores que Influencian la Adquisición de Infecciones de Transmisión Sexual y VIH en Mujeres Jóvenes Chilenas que Participaron en la Intervención Online I-STIPI (Factors That Influence the Acquisition of Sexually Transmitted Infections and HIV in Chilean Young Women Who Participated in the Online Intervention I-STIPI). HISPANIC HEALTH CARE INTERNATIONAL 2017; 14:47-56. [PMID: 27257190 DOI: 10.1177/1540415316629682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this descriptive cross-sectional study was to investigate the following factors associated with sexually transmitted infections and human immunodeficiency virus prevention: (a) knowledge, (b) attitudes, (c) self-efficacy, (d) vulnerability, (e) risky behaviors, (f) preventive behaviors, and (g) internet use among 40 Chilean women between 18 and 24 years who participated in the pilot of an Internet based STI/HIV prevention intervention (I-STIPI). A structured questionnaire available in a secure website was used for data collection and it included questions related to STI and HIV prevention. The results of the study indicated that young women are at risk of acquiring STIs and HIV and have special needs for prevention. Familiarity and frequency of use of internet in this population can be used for STIs and HIV prevention.
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Affiliation(s)
- Natalia Villegas
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Rosina Cianelli
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel Santisteban
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Loreto Lara
- Carrera de Enfermería, Universidad Del Desarrollo, Santiago, Chile
| | - Jessica Vargas
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
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Golub SA, Gamarel KE, Lelutiu-Weinberger C. The Importance of Sexual History Taking for PrEP Comprehension Among Young People of Color. AIDS Behav 2017; 21:1315-1324. [PMID: 27475944 PMCID: PMC5280583 DOI: 10.1007/s10461-016-1512-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Despite demonstrated efficacy, uptake of pre-exposure prophylaxis (PrEP) remains low, especially among highest priority populations. This study examined four PrEP messaging factors hypothesized to impact comprehension of PrEP educational information: (1) modality (video versus in-person message delivery); (2) frame (risk versus health focus); (3) specificity (gist versus verbatim efficacy information); and (4) sexual history (administered either before or after PrEP education). We examined message comprehension among 157 young people of color (YPoC) eligible for PrEP, using a series of multiple choice questions. Overall, 65.6 % (n = 103) got all message comprehension questions correct. In multivariate analyses, engaging in a sexual history before receiving PrEP education was associated with increased odds of message comprehension (aOR 2.23; 95 % CI 1.06-4.72). This effect was even stronger among those who received PrEP education via video (aOR 3.53; 95 % CI 1.16-10.81) compared to via health educator. This research underscores the importance of sexual history-taking as part of PrEP education and clinical practice for YPoC, and suggests that engaging patients in a sexual history prior to providing them with PrEP education may be key to increasing comprehension.
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Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of CUNY, New York, NY, USA.
- Department of Psychology, Graduate Center of CUNY, New York, NY, USA.
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA.
| | - Kristi E Gamarel
- Hunter HIV/AIDS Research Team (HART), New York, NY, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Yan J, Zhang A, Zhou L, Huang Z, Zhang P, Yang G. Development and effectiveness of a mobile phone application conducting health behavioral intervention among men who have sex with men, a randomized controlled trial: study protocol. BMC Public Health 2017; 17:355. [PMID: 28438144 PMCID: PMC5402667 DOI: 10.1186/s12889-017-4235-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behavioral intervention is a key approach to HIV prevention among men who have sex with men (MSM). Widespread use of mobile phones provide us with novel opportunities to decrease HIV infection and transmission of MSM. The objective of the study was to design and develop a mobile phone application (app) aims to conduct behavioral intervention to MSM and to evaluate the efficacy of the app-based intervention compared to usual care, to analyze cost-effectiveness and mechanism of the intervention. METHODS This study involves 2 phases, phase 1 use qualitative method and phase 2 is a randomized controlled trial lasting for 18 months, they will be conducted in Chagnsha, Hunan Province, China. Phase 1 is to design and develop the app, procedures including retrieval of domestic apps related to prevention and treatment about HIV and sexually transmitted diseases (HIV/STDs), personal interviews with MSM about preferences and functional needs of the HIV prevention app, multidisciplinary experts focused group discussions of the app, software engineers' development and users test of the app will be performed. In phase 2, we will recruit 800 MSM by cooperating with the local center of disease control and prevention and nongovernmental organizations, and divide them into intervention and control group evenly. Intervention group participants will receive app-based HIV prevention. Control group participants will be provided with usual care including HIV/STDs knowledge brochure and free voluntary counseling services. Data will be collected at baseline, 6, 12 and 18 months since subject's participation. Effectiveness of the intervention includes HIV/STDs infection rates, adherence to regularly HIV testing, sexual risk behavior, consistent condom use and relative risk of HIV infection. Cost-effectiveness will be analyzed by decision-analytic modeling, and mechanism analysis of this app-based intervention will be performed by path analysis. DISCUSSION This will be the first study of its kind in China to develop an app and implement app-based HIV prevention intervention among MSM. It is of great potential to determine whether app-based intervention is a cost-effective way to decrease HIV infection among MSM and explore intervention mechanism with an accurate method. TRIAL REGISTRATION Chinese Clinical Trial Register ( ChiCTR-IOR-15006724 ). Registered 10 July 2015.
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Affiliation(s)
- Jin Yan
- The Third Xiangya Hospital, Central South University, Tongzipo Road 138#, Changsha, 40013 China
| | - Aidi Zhang
- The Third Xiangya Hospital, Central South University, Tongzipo Road 138#, Changsha, 40013 China
| | - Liang Zhou
- Guangzhou Brain Hospital, Mingxin Road 32#, Guangzhou, 510370 China
| | - Zhulin Huang
- Changsha Center for Disease Control and Prevention, Weier Road 149#, Changsha, 410001 China
| | - Pan Zhang
- The Third Xiangya Hospital, Central South University, Tongzipo Road 138#, Changsha, 40013 China
| | - Guoli Yang
- The Third Xiangya Hospital, Central South University, Tongzipo Road 138#, Changsha, 40013 China
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34
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Sharma A, Sullivan SP, Stephenson RB. Detailed Knowledge About HIV Epidemiology and Transmission Dynamics and Their Associations With Preventive and Risk Behaviors Among Gay, Bisexual, and Other Men Who Have Sex With Men in the United States. JMIR Public Health Surveill 2017; 3:e11. [PMID: 28264795 PMCID: PMC5359415 DOI: 10.2196/publichealth.7255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background Gay, bisexual, and other men who have sex with men (GBMSM) in the United States remain disproportionately affected by human immunodeficiency virus (HIV). Yet their testing frequency is suboptimal and condomless anal sex (CAS) is increasing. Behavioral theories posit that information about HIV is a pivotal construct in individual risk reduction. However, measurements of knowledge have traditionally focused on ever hearing about HIV and being aware of the most common routes of spread. Objective Using a national Web-based sample of sexually active GBMSM, we sought to (1) quantify levels of detailed knowledge about HIV epidemiology and transmission dynamics, (2) describe variations in detailed knowledge levels across demographic strata, and (3) evaluate potential associations of increasing levels of detailed knowledge with HIV testing in the past year and engaging in CAS with a male partner in the past 3 months. Methods GBMSM were recruited through a social networking website (Facebook) from August to September 2015 and asked 17 knowledge-based questions pertaining to the following 2 domains using a Web-based survey: HIV epidemiology (9 questions including statistics on incidence, prevalence, and distribution) and HIV transmission dynamics (8 questions including modes of spread and per-act transmission probabilities). Ordinal domain-specific indices of detailed knowledge were created for each respondent by summing their number of correct responses. Separate cumulative logit models were used to identify factors independently associated with each index, and multivariable logistic regression models were used to characterize associations with HIV testing history and recently engaging in CAS. Results Of the 1064 participants in our study, only half (49.62%, 528/1064) had been tested for HIV in the past year, and almost half (47.84%, 509/1064) had engaged in CAS with a male partner in the past 3 months. Majority scored 3 of 9 epidemiology questions correct (26.88%, 286/1064) and 5 of 8 transmission dynamics questions correct (25.00%, 266/1064). Participants younger than 35 years, of non-Hispanic non-white or Hispanic race and ethnicity, with lower educational levels, and who reported a sexual orientation other than homosexual or gay were significantly less knowledgeable about HIV transmission dynamics. Increasing levels of knowledge about this domain were independently associated with testing in the past year (adjusted odds ratio for each additional correct response: 1.10, 95% CI 1.01-1.20) but not with recent CAS. Increasing knowledge about HIV epidemiology was not associated with either outcome. Conclusions Increasing detailed knowledge about HIV epidemiology might not be as important as educating sexually active GBMSM regarding transmission dynamics. Researchers and practitioners designing prevention messages targeting GBMSM should bear in mind that not all knowledge is equal and that some aspects might have a greater positive impact than others. Future research to identify influential content and contemporary modes of delivery is needed.
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Affiliation(s)
- Akshay Sharma
- Center for Sexuality and Health Disparities, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Stephen P Sullivan
- Center for Sexuality and Health Disparities, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Rob B Stephenson
- Center for Sexuality and Health Disparities, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
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Hall WJ, Sun CJ, Tanner AE, Mann L, Stowers J, Rhodes SD. HIV-Prevention Opportunities With GPS-Based Social and Sexual Networking Applications for Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:38-48. [PMID: 28195777 PMCID: PMC7842129 DOI: 10.1521/aeap.2017.29.1.38] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The goal of this study was to gain insight on the sexual health needs of men who have sex with men (MSM) who use GPS-based social and sexual networking mobile applications (apps) and the future utility of app-based interventions. A health educator promoted HIV-testing resources in four popular apps used by MSM. Content analysis was used to identify salient themes that emerged from the conversations. Four major themes were identified: (1) soliciting sexual encounters, (2) relationship building, (3) HIV and STI-testing inquiries, and (4) seeking other sexual health information. The results suggest the intervention's social media-based strategy, respect for community culture, and unobtrusive approach was advantageous in establishing credibility and rapport with app users. These results highlight a need for convenient and discreet methods to access accurate sexual health information and suggest that apps provide an alternative, non-traditional venue for sexual health education in addition to HIV testing promotion.
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Affiliation(s)
- Wendasha Jenkins Hall
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, NC
| | - Christina J. Sun
- School of Community Health, Portland State University, Portland, OR
| | - Amanda E. Tanner
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, NC
| | - Lilli Mann
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Livingston NA. Avenues for Future Minority Stress and Substance Use Research among Sexual and Gender Minority Populations. JOURNAL OF LGBT ISSUES IN COUNSELING 2017. [DOI: 10.1080/15538605.2017.1273164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicholas A. Livingston
- Department of Psychology, The University of Montana, Missoula, Montana, USA
- VA Boston Health Care System, Boston, Massachusetts, USA
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Polilli E, Sozio F, Di Stefano P, Sciacca A, Ursini T, Paoloni M, Vecchiet J, Di Giammartino D, Sciotti MP, Grimaldi A, Cortesi V, Fazii P, Ricci E, D'Amario C, Ippolito G, Pippa L, Parruti G. Web-Based HIV Testing in Abruzzo, Italy: Analysis of 15-Month Activity Results. AIDS Patient Care STDS 2016; 30:471-475. [PMID: 27749107 DOI: 10.1089/apc.2016.0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Undiagnosed cases of HIV infection in developed countries are estimated at 20-30% of individuals living with HIV. Web-based strategies may represent a new approach to easier, wider, and unrestricted access to early testing. The Abruzzo Region, Italy, developed a Web-based tool to recruit persons at high risk of HIV and other sexually transmitted infections (STIs). At the Website www.failtestanchetu.it , browsers found information on STIs (HIV, hepatitis B and C, and syphilis), a structured questionnaire called "risk calculator" to assess one's own risk behaviors and direct booking of their test at one of six sites throughout the region. The Website was advertised on local media and in pharmacies, high schools, sports facilities, and factories. Between February 1, 2014, and May 31, 2015, about 6000 users visited the Website; 3046 people attended a visit for counseling on risk behaviors, signs, or symptoms of STIs and accepted blood drawing for HIV, hepatitis B Virus (HBV), hepatitis C Virus (HCV), and syphilis tests. Fifty-eight (1.90%) subjects were positive for HCV, 56 (1.84%) for HBsAg, 90 (2.95%) for Treponema pallidum antibodies, and 28 (0.92%) for HIV. Ninety-two percent of HIV-positive patients were successfully linked to care. Late presenters were less frequent in this sample than in the population diagnosed with HIV in Italy in 2014. An overall 7% proportion of HIV, HBV, HCV, and syphilis-unaware cases were all transferred to care, with the exception of three people. HIV seropositivity among testers was higher than 2/1000, the cost-effectiveness threshold suggested for effective testing. Therefore, our Web-based unrestricted and free access methodology appears worth further and wider evaluation.
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Affiliation(s)
- Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Federica Sozio
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Paola Di Stefano
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Antonina Sciacca
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Tamara Ursini
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Maurizio Paoloni
- Infectious Diseases Unit, Avezzano General Hospital, Avezzano, Italy
| | - Jacopo Vecchiet
- Infectious Diseases Clinic, University of Chieti, Chieti, Italy
| | | | | | | | | | - Paolo Fazii
- Microbiology and Virology Unit, Pescara General Hospital, Italy
| | - Elena Ricci
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Lucio Pippa
- Fondazione Onlus Camillo de Lellis per l'Innovazione e la Ricerca in Medicina, Pescara, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Do M, Figueroa ME, Lawrence Kincaid D. HIV Testing Among Young People Aged 16-24 in South Africa: Impact of Mass Media Communication Programs. AIDS Behav 2016; 20:2033-44. [PMID: 27102409 DOI: 10.1007/s10461-016-1402-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Knowing one's serostatus is critical in the HIV prevention, care and treatment continuum. This study examines the impact of communication programs on HIV testing in South Africa. Data came from 2204 young men and women aged 16-24 who reported to be sexually active in a population based survey. Structural equation modeling was used to test the directions and causal pathways between communication program exposure, HIV testing discussion, and having a test in the last 12 months. Bivariate and multivariate probit regressions provided evidence of exogeneity of communication exposure and the two HIV-related outcomes. One in three sampled individuals had been tested in the last 12 months. Communication program exposure only had an indirect effect on getting tested by encouraging young people to talk about testing. The study suggests that communication programs may create an environment that supports open HIV-related discussions and may have a long-term impact on behavior change.
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Affiliation(s)
- Mai Do
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA.
| | - Maria Elena Figueroa
- Johns Hopkins University Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - D Lawrence Kincaid
- Johns Hopkins University Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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Falzon D, Timimi H, Kurosinski P, Migliori GB, Van Gemert W, Denkinger C, Isaacs C, Story A, Garfein RS, do Valle Bastos LG, Yassin MA, Rusovich V, Skrahina A, Van Hoi L, Broger T, Abubakar I, Hayward A, Thomas BV, Temesgen Z, Quraishi S, von Delft D, Jaramillo E, Weyer K, Raviglione MC. Digital health for the End TB Strategy: developing priority products and making them work. Eur Respir J 2016; 48:29-45. [PMID: 27230443 PMCID: PMC4929075 DOI: 10.1183/13993003.00424-2016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/10/2016] [Indexed: 12/23/2022]
Abstract
In 2014, the World Health Organization (WHO) developed the End TB Strategy in response to a World Health Assembly Resolution requesting Member States to end the worldwide epidemic of tuberculosis (TB) by 2035. For the strategy's objectives to be realised, the next 20 years will need novel solutions to address the challenges posed by TB to health professionals, and to affected people and communities. Information and communication technology presents opportunities for innovative approaches to support TB efforts in patient care, surveillance, programme management and electronic learning. The effective application of digital health products at a large scale and their continued development need the engagement of TB patients and their caregivers, innovators, funders, policy-makers, advocacy groups, and affected communities.In April 2015, WHO established its Global Task Force on Digital Health for TB to advocate and support the development of digital health innovations in global efforts to improve TB care and prevention. We outline the group's approach to stewarding this process in alignment with the three pillars of the End TB Strategy. The supplementary material of this article includes target product profiles, as developed by early 2016, defining nine priority digital health concepts and products that are strategically positioned to enhance TB action at the country level.
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Affiliation(s)
- Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Hazim Timimi
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | - Giovanni Battista Migliori
- European Respiratory Society, Lausanne, Switzerland WHO Collaborating Centre, Fondazione S. Maugeri, Tradate, Italy
| | - Wayne Van Gemert
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Alistair Story
- Find & Treat, University College London Hospitals, London, UK
| | - Richard S Garfein
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | | | - Mohammed A Yassin
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Alena Skrahina
- Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | | | | | - Andrew Hayward
- Farr Institute of Health Informatics, University College London, London, UK
| | | | | | | | | | | | - Karin Weyer
- Global TB Programme, World Health Organization, Geneva, Switzerland
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Hergenrather KC, Emmanuel D, Durant S, Rhodes SD. Enhancing HIV Prevention Among Young Men Who Have Sex With Men: A Systematic Review of HIV Behavioral Interventions for Young Gay and Bisexual Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:252-71. [PMID: 27244193 DOI: 10.1521/aeap.2016.28.3.252] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Men who have sex with men (MSM) represent 64.0% of people living with HIV (PLWH) over the age of 13 years. Young men who have sex with men (YMSM) are particularly affected by HIV/AIDS; the rate of HIV infection for YMSM between the ages of 13 and 24 represents 72.0% of new infections among youth. To understand the current state of the science meant to prevent HIV for YMSM, we reviewed studies of HIV behavioral prevention interventions for YMSM. Five literature databases were searched, from their inception through October 2015, using key words associated with HIV prevention intervention evaluation studies for YMSM. The review criteria included behavioral HIV/AIDS prevention interventions, articles published in English-language peer-reviewed journals, YMSM between 13 and 24 years of age, and longitudinal repeated measures design. A total of 15 YMSM behavioral HIV prevention intervention studies were identified that met inclusion criteria and reported statistically significant findings. Common outcomes included unprotected sexual intercourse, HIV/AIDS risk behavior, condom use, HIV testing, safer sex attitude, and HIV prevention communication. Participant age, representation of Black/African American YMSM, application of theoretical and model underpinnings, congruence of assessment measures used, follow-up assessment times, and application of process evaluation were inconsistent across studies. To advance HIV prevention intervention research for YMSM, future studies should be theory-based, identify common constructs, utilize standard measures, include process evaluation, and evaluate sustained change over standard periods of time. HIV prevention interventions should incorporate the needs of the diverse, well-educated, web-connected millennial generation and differentiate between adolescent YMSM (13 to 18 years of age) and young adulthood YMSM (19 to 24 years of age). Because Black/African American YMSM represent more than 50% of new HIV infections, future HIV prevention intervention studies should prioritize these young men.
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Affiliation(s)
- Kenneth C Hergenrather
- Department of Counseling/Human and Organizational Studies, Graduate School of Education and Human Development, George Washington University, Washington, D.C
| | - Diona Emmanuel
- Department of Counseling/Human and Organizational Studies, Graduate School of Education and Human Development, George Washington University, Washington, D.C
| | - Sarah Durant
- Department of Counseling/Human and Organizational Studies, Graduate School of Education and Human Development, George Washington University, Washington, D.C
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Danielson CK, McCauley JL, Gros KS, Jones AM, Barr SC, Borkman AL, Bryant BG, Ruggiero KJ. SiHLEWeb.com: Development and usability testing of an evidence-based HIV prevention website for female African-American adolescents. Health Informatics J 2016; 22:194-208. [PMID: 25167865 PMCID: PMC4344934 DOI: 10.1177/1460458214544048] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African-American adolescent girls are at disproportionate risk for HIV infection. Although numerous evidence-based risk-reduction interventions exist, dissemination and implementation resources remain limited, and prevention services remain notably inaccessible to the very populations at highest risk for HIV infection. Internet delivery of HIV risk-reduction programming has promise as a mechanism for extending the reach of existing prevention efforts and overcoming barriers associated with traditional service delivery. This article (1) details the development process for the creation of SiHLEWeb, a web-adapted version of an evidence-based, culturally informed HIV prevention program traditionally delivered to female African-American adolescents via an in-person group format, and (2) presents findings from quantitative and qualitative usability testing conducted among 18 African-American girls (13-18 years). Results suggest that users found the website improved knowledge and learning, was helpful, efficient to use, and generally attractive. Users reported some concerns about website navigation. Implications for Internet delivery of health prevention programming are discussed.
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Affiliation(s)
| | | | | | | | - Simone C Barr
- The University of Texas Medical School at Houston, USA
| | | | | | - Kenneth J Ruggiero
- Medical University of South Carolina (MUSC), USA; Ralph H. Johnson VA Medical Center, USA
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42
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Nachega JB, Skinner D, Jennings L, Magidson JF, Altice FL, Burke JG, Lester RT, Uthman OA, Knowlton AR, Cotton MF, Anderson JR, Theron GB. Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study. Patient Prefer Adherence 2016; 10:683-90. [PMID: 27175068 PMCID: PMC4854240 DOI: 10.2147/ppa.s100002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). DESIGN AND METHODS A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18-30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life ("Option B+") were interviewed about mobile phone access, SMS use, and potential treatment supporters. SETTING A community primary care clinic in Cape Town, South Africa. PARTICIPANTS HIV-infected pregnant women. MAIN OUTCOMES Acceptability and feasibility of mHealth and cDOT interventions. RESULTS Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. CONCLUSION mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Medicine, Centre for Infectious Diseases, and ACTG Clinical Trial Unit (CTU)/Family Clinical Research Unit (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Donald Skinner
- Research on Health and Society, Department of Interdisciplinary Health Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frederick L Altice
- Division of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Richard T Lester
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark F Cotton
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gerhard B Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Militello L, Melnyk BM, Hekler EB, Small L, Jacobson D. Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study. JMIR Mhealth Uhealth 2016; 4:e21. [PMID: 26976387 PMCID: PMC4810011 DOI: 10.2196/mhealth.4398] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/11/2015] [Accepted: 11/11/2015] [Indexed: 12/15/2022] Open
Abstract
Background Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. Objective The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. Methods Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. Results Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. Conclusions Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.
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Affiliation(s)
- Lisa Militello
- The Ohio State University, College of Nursing, Columbus, OH, United States.
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Friedman MS, Chiu CJ, Croft C, Guadamuz TE, Stall R, Marshal MP. Ethics of Online Assent: Comparing Strategies to Ensure Informed Assent Among Youth. J Empir Res Hum Res Ethics 2016; 11:15-20. [PMID: 26928895 DOI: 10.1177/1556264615624809] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals, including youth, often participate in online research without understanding the characteristics of studies they have agreed to be part of. We assessed the impact of including questions as part of the assent process by randomizing 568 youth to one of three groups: (a) asking youth to only read study information and then indicate their willingness to participate, (b) requiring youth to answer two questions about the study's risks and voluntary nature as part of the assent process, and (c) requiring youth to answer seven questions. Participants in the two- and seven-question groups, compared with the no-question group, were less likely to complete the assent process but, among those who did complete it, were more likely to read and understand study information.
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Affiliation(s)
| | | | - Colby Croft
- University of California, San Francisco, USA
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45
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Young SD, Swendeman D, Holloway IW, Reback CJ, Kao U. Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review. Curr HIV/AIDS Rep 2015; 12:462-71. [PMID: 26475670 PMCID: PMC4749410 DOI: 10.1007/s11904-015-0295-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.
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Affiliation(s)
- Sean D Young
- UCLA Department of Family Medicine, University of California Institute for Prediction Technology, 10880 Wilshire Blvd Suite 1800, Los Angeles, CA, 90049, USA.
| | - Dallas Swendeman
- UCLA Department of Psychiatry and Biobehavioral Sciences, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Cathy J Reback
- Friends Research Institute, Inc., David Geffen School of Medicine, Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Uyen Kao
- UCLA Department of Family Medicine, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
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46
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IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care 2015; 14 Suppl 1:S3-S34. [PMID: 26527218 DOI: 10.1177/2325957415613442] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. METHODS A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. RECOMMENDATIONS Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.
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47
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Devi BR, Syed-Abdul S, Kumar A, Iqbal U, Nguyen PA, Li YCJ, Jian WS. mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:257-265. [PMID: 26304621 DOI: 10.1016/j.cmpb.2015.08.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/25/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the utilization of mobile phone technology for treatment adherence, prevention, education, data collection, monitoring long-term management of HIV/AIDS and TB patients. METHODS Articles published in English language from January 2005 until now from PubMed/MEDLINE, EMBASE, Web of Science, WHO databases, and clinical trials were included. Data extraction is based on medication adherence, quality of care, prevention, education, motivation for HIV test, data collection from HIV lab test results and patient monitoring. Articles selected for the analysis cover RCTs and non RCTs related to the use of mobile phones for long-term care and treatment of HIV/AIDS and TB patients. RESULTS Out of 90 articles selected for the analysis, a large number of studies, 44 (49%) were conducted in developing countries, 24 (26%) studies from developed countries, 12 (13%) are systematic reviews and 10 (11%) did not mention study location. Forty seven (52.2%) articles focused on treatment, 11 (12.2%) on quality of care, 8 (9%) on prevention, 13 (14.4%) on education, 6 (6.6%) on data collection, and 5 (5.5%) on patient monitoring. Overall, 66 (73%) articles reported positive effects, 21 (23%) were neutral and 3 (4%) reported negative results. CONCLUSIONS Mobile phone technology is widely reported to be an effective tool for HIV/AIDS and TB long-term care. It can substantially reduce disease burden on health care systems by rendering more efficient prevention, treatment, education, data collection and management support.
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Affiliation(s)
- Balla Rama Devi
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Arun Kumar
- Department of Pharmacy Practice, ISF College of Pharmacy, India
| | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Phung-Anh Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
| | - Wen-Shan Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; Faculty of Health Sciences, Macau University of Science and Technology, Macau, China.
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48
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Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, Murray E. Sexual health promotion for young people delivered via digital media: a scoping review. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03130] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Julia Bailey
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King’s College Hospital, London, UK
| | - Sonali Wayal
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elizabeth Murray
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Evaluation of a new website design for iwantthekit for chlamydia, gonorrhea, and trichomonas screening. Sex Transm Dis 2015; 42:243-5. [PMID: 25868135 DOI: 10.1097/olq.0000000000000270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The www.iwantthekit.org provides Internet-based, at-home sexually transmitted infection screening. The Web site implemented an automated test result access system. To evaluate potential deleterious effects of the new system, we analyzed demographics, Web site usage, and treatment. The post-Web site design captured more participant information and no decrease in requests, kit return, or treatment adherence.
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50
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Mimiaga MJ, Biello KB, Robertson AM, Oldenburg CE, Rosenberger JG, O'Cleirigh C, Novak DS, Mayer KH, Safren SA. High prevalence of multiple syndemic conditions associated with sexual risk behavior and HIV infection among a large sample of Spanish- and Portuguese-speaking men who have sex with men in Latin America. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1869-78. [PMID: 26159862 DOI: 10.1007/s10508-015-0488-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 05/08/2023]
Abstract
The HIV epidemic in Latin America is highly concentrated in men who have sex with men (MSM). In the United States, multiple co-occurring psychosocial conditions have been shown to act as intertwined epidemics to potentiate HIV transmission among MSM. To date, no study has examined the role of syndemics and condomless sex among MSM in Latin America. In 2012, an online survey was conducted among members of the largest social/sexual networking website for MSM in Latin America. Participants were asked about demographics, sexual behaviors, HIV/STI diagnoses, and psychosocial well-being, including depression, suicidal ideation, hazardous alcohol use, hard drug use during sex, history of childhood/adolescent sexual abuse, intimate partner violence, and sexual compulsivity. Multivariable logistic generalized estimation equations were used to assess the relationship of syndemic factors and (1) engagement in higher risk condomless anal sex and (2) self-report of prior HIV diagnosis. Among 24,274 survey respondents, 74.6 % of the sample had at least one syndemic factor. In an additive model, syndemics were associated with increased odds of higher risk condomless anal sex, ranging from adjusted odds ratio of 1.31 (95 % CI 1.20, 1.43) for one syndemic factor to 4.06 (95 % CI 3.25, 5.09) for 6/7 syndemic factors. Similarly, syndemics were associated with increased odds of HIV infection (p < .0001). This study provides initial evidence that intertwined syndemics increase HIV risk behavior and HIV infection among MSM in Latin America. In the Latin American context, comprehensive HIV prevention interventions for MSM should be developed and tested that simultaneously address co-occurring psychosocial conditions and HIV risk.
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Affiliation(s)
- Matthew J Mimiaga
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital Behavioral Medicine, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
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