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Hoffman ND, Ciarleglio A, Lesperance-Banks S, Corbeil T, Kaur H, Silver EJ, Bauman L, Sandfort TGM. A Provider-Focused Intervention to Increase Universal HIV Testing among Adolescents in School-Based Health Centers. AIDS Behav 2024:10.1007/s10461-024-04444-6. [PMID: 39046611 DOI: 10.1007/s10461-024-04444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/25/2024]
Abstract
We describe a provider-focused intervention to increase universal HIV testing among adolescent users in a network of School-Based Health Centers (SBHC) and compare the rate of HIV test offer and acceptance for SBHCs with and without the HIV testing intervention. The intervention was implemented at the six largest SBHCs in the 12-site network and included system- and staff-level initiatives, including an implementation coach to support SBHC associates. Rates of HIV test offer and acceptance at six sites in the Intervention Cohort were compared to that at the six sites in a Non-Intervention Cohort which was not randomly selected but had comparable distributions by age, gender and race/ethnicity. The model showed an intervention effect for universal HIV test offer, but no overall effect for test acceptance. Analyzing the intervention effect by whether a patient had a history of sexual activity, the intervention was very effective early in its implementation at increasing test offer to those with no history of sexual activity, and late in its implementation at increasing test acceptance for those with no or unknown sexual activity. Increasing and sustaining universal HIV testing in SBHCs may benefit from using Implementation Science frameworks to guide adaptation of the intervention.
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Affiliation(s)
- Neal D Hoffman
- Division of Adolescent Medicine, Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA.
| | - Adam Ciarleglio
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Tom Corbeil
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Harpreet Kaur
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen J Silver
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Laurie Bauman
- Preventive Intervention Research Center for Child Health, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theo G M Sandfort
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
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Fields EL, Hussen SA, Malebranche DJ. Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men. Curr HIV/AIDS Rep 2021; 17:632-642. [PMID: 32914329 PMCID: PMC7483045 DOI: 10.1007/s11904-020-00532-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Young Black men who have sex with men (YBMSM) suffer profound health inequities in new HIV diagnoses and clinical outcomes. While the evolution of HIV prevention options has become increasingly biomedical, inequities in access and uptake of these modalities persist. RECENT FINDINGS Studies suggest that while YBMSM display interest and acceptability of varied HIV prevention options, uptake lags due to the lingering effects of intersectional oppression from racism and sexual prejudice, HIV stigma, institutional and provider bias, and unresolved health policy barriers. Promising avenues to address these barriers have yet to be fully explored. We have the tools to effectively prevent HIV transmission and acquisition among YBMSM, but we have not yet effectively implemented these tools for this priority population. To end the epidemic, we must tailor and adapt HIV prevention strategies to meet the unique intersecting needs, identities, and social contexts of YBMSM.
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Affiliation(s)
- Errol L Fields
- Division of Adolescent/Young Adult Medicine, Johns Hopkins School of Medicine, 200 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - David J Malebranche
- Department of General Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA.
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Zhao Y, Bromberg DJ, Khoshnood K, Sheng Y. Factors associated with regular HIV testing behavior of MSM in China: a cross-sectional survey informed by theory of triadic influence. Int J STD AIDS 2020; 31:1340-1351. [PMID: 33081648 DOI: 10.1177/0956462420953012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of HIV infection among men who have sex with men (MSM) in China has increased in recent years. Regular HIV testing is a key prevention strategy for identifying HIV infections among MSM. Informed by the theory of triadic influence, we aimed to determine individual, social and environmental factors associated with regular HIV testing behavior. Regular HIV testing is defined as taking an HIV test every 3 to 6 months. Both an online survey and a face-to-face survey was administered to MSM in China. Logistic regression was used to examine associations with testing behavior. 500 MSM were surveyed, the prevalence of regular testing was 56.4%. In the final model, age of first sexual intercourse, self-efficacy, perceived risk, number of partners, orientation disclosure, knowledge of HIV testing, behavioral intention and HIV relevant behaviors (sexually transmitted infection testing history) were associated with regular HIV testing; social stream characteristics had stronger associations with regular testing than individual and environmental factors. Findings implicated that interventions aimed at improving the effective counseling service from healthcare providers and the medical environment and intrapersonal changes should be combined to encourage MSM to have their first HIV test and to keep coming back at regular intervals.
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Affiliation(s)
- Yafang Zhao
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Daniel J Bromberg
- Yale School of Public Health, Yale University. New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Yale University. New Haven, CT, USA
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Balaji AB, An Q, Smith JC, Newcomb ME, Mustanski B, Prachand NG, Brady KA, Braunstein S, Paz-Bailey G. High Human Immunodeficiency Virus Incidence and Prevalence and Associated Factors Among Adolescent Sexual Minority Males-3 Cities, 2015. Clin Infect Dis 2019; 66:936-944. [PMID: 29069298 DOI: 10.1093/cid/cix902] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background Much has been written about the impact of human immunodeficiency virus (HIV) among young (13-24) sexual minority men (SMM). Evidence for concern is substantial for emerging adult (18-24 years) SMM. Data documenting the burden and associated risk factors of HIV among adolescent SMM (<18 years) remain limited. Methods Adolescent SMM aged 13-18 years were recruited in 3 cities (Chicago, New York City, and Philadelphia) for interview and HIV testing. We used χ2 tests for percentages of binary variables and 1-way analysis of variance for means of continuous variables to assess differences by race/ethnicity in behaviors. We calculated estimated annual HIV incidence density (number of HIV infections per 100 person-years [PY] at risk). We computed Fisher's exact tests to determine differences in HIV prevalence by selected characteristics. Results Of 415 sexually active adolescent SMM with a valid HIV test result, 25 (6%) had a positive test. Estimated annual HIV incidence density was 3.4/100 PY; incidence density was highest for blacks, followed by Hispanics, then whites (4.1, 3.2, and 1.1/100 PY, respectively). Factors associated with higher HIV prevalence included black race; ≥4 male partners, condomless anal sex, and exchange sex in the past 12 months; and a recent partner who was older, black, HIV-infected, or had ever been in jail or prison (P < .05). Conclusions HIV-related risk behaviors, prevalence, and estimated incidence density for adolescent SMM were high, especially for minority SMM. Our findings suggest that initiating intervention efforts early may be helpful in combating these trends.
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Affiliation(s)
- Alexandra B Balaji
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Qian An
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Justin C Smith
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.,Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Tennessee
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, Illinois
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, Illinois
| | - Nikhil G Prachand
- Office of Epidemiology, Chicago Department of Public Health, Illinois
| | - Kathleen A Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Pennsylvania
| | - Sarah Braunstein
- HIV Epidemiology and Field Services Unit, New York City Department of Health and Mental Hygiene, New York
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Frye V, Wilton L, Hirshfield S, Chiasson MA, Lucy D, Usher D, McCrossin J, Greene E, Koblin B. Preferences for HIV test characteristics among young, Black Men Who Have Sex With Men (MSM) and transgender women: Implications for consistent HIV testing. PLoS One 2018; 13:e0192936. [PMID: 29462156 PMCID: PMC5819791 DOI: 10.1371/journal.pone.0192936] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 01/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Promoting consistent HIV testing is critical among young, Black Men Who Have Sex With Men (MSM) and transgender women who are overrepresented among new HIV cases in the United States. New HIV test options are available, including mobile unit testing, one-minute testing, at home or self-testing and couples HIV testing and counseling (CHTC). In the context of these newer options, the objective of this study was to explore whether and how preferences for specific characteristics of the tests acted as barriers to and/or facilitators of testing in general and consistent testing specifically among young Black MSM and transgender women aged 16 to 29. METHODS We conducted 30 qualitative, semi-structured, in-depth interviews with young, Black, gay, bisexual or MSM and transgender women in the New York City metropolitan area to identify preferences for specific HIV tests and aspects of HIV testing options. Participants were primarily recruited from online and mobile sites, followed by community-based, face-to-face recruitment strategies to specifically reach younger participants. Thematic coding was utilized to analyze the qualitative data based on a grounded theoretical approach. RESULTS We identified how past experiences, perceived test characteristics (e.g., accuracy, cost, etc.) and beliefs about the "fit" between the individual, and the test relate to preferred testing methods and consistent testing. Three major themes emerged as important to preferences for HIV testing methods: the perceived accuracy of the test method, venue characteristics, and lack of knowledge or experience with the newer testing options, including self-testing and CHTC. CONCLUSIONS These findings suggest that increasing awareness of and access to newer HIV testing options (e.g., free or reduced price on home or self-tests or CHTC available at all testing venues) is critical if these new options are to facilitate increased levels of consistent testing among young, Black MSM and transgender women. Addressing perceptions of test accuracy and supporting front line staff in creating welcoming and safe testing environments may be key intervention targets. Connecting young Black MSM and transgender women to the best test option, given preferences for specific characteristics, may support more and more consistent HIV testing.
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Affiliation(s)
- Victoria Frye
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, CUNY School of Medicine, City University of New York, New York, New York, United States of America
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), Binghamton University, Binghamton, New York, United States of America
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Sabina Hirshfield
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Mary Ann Chiasson
- Division of Research and Evaluation, Public Health Solutions, New York, New York, United States of America
| | - Debbie Lucy
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - DaShawn Usher
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Jermaine McCrossin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
| | - Emily Greene
- Laboratory of Social and Behavioral Sciences, New York Blood Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Beryl Koblin
- Project ACHIEVE, Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
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