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Zapata JP, Hurtado M, Avila AA, Mustanski B. A Mixed Methods Investigation Examining the PrEP Cascade Among 13-18-Year-Old Latino Adolescent Sexual Minority Men. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02091-0. [PMID: 38995513 DOI: 10.1007/s40615-024-02091-0] [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: 12/08/2023] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
Latino adolescent sexual minority men (ASMM) are at high risk of HIV. Limited research has explored the impact of parent-adolescent communication and beliefs on PrEP adoption among Latino ASMM. Our objective was to examine how parental support and beliefs influence decisions regarding PrEP use. We analyzed PrEP-related attitudes and behaviors within a national cohort of 524 Latino ASMM aged 13-18. Out of the participants, 60.5% were suitable for PrEP. Among them, 59.7% were in the precontemplation stage (stage 1), indicating a lack of willingness or belief of unsuitability. However, 86.4% moved to reach the contemplation stage (stage 2), demonstrating willingness and suitability for PrEP. Only 16.8% moved on to the PrEParation stage (stage 3), indicating their intention to start using PrEP. Furthermore, 4.3% progressed to the PrEP action stage and initiation (stage 4), signifying they had received a prescription, and all reported high adherence (stage 5). Factors associated with reaching later stages included older age, parental support of sexual orientation, and previous HIV/STI testing. The qualitative findings revealed diverse attitudes towards parental involvement in PrEP care among Latino ASMM, including positive, negative, and ambivalent perspectives. Notably, Spanish-speaking participants expressed specific barriers to PrEP communication between ASMM and their parents. Given that parental support and attitudes emerged as significant factors in both our quantitative and qualitative findings, it is evident that public health approaches aiming to disseminate education and awareness about PrEP to parents and families could alleviate the burden on adolescents to educate their parents and enhance support.
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Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Manuel Hurtado
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Andrés Alvarado Avila
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Medicine- Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Prescott MR, Montoya JL, Perry C, Teran R, Armenta R, Gaines TL. Community-Identified Implementation Strategies for Promoting the Adoption of HIV Self-Testing in a Southern California American Indian community: A Rapid Qualitative Analysis. AIDS Behav 2024; 28:2101-2112. [PMID: 38594409 PMCID: PMC11161417 DOI: 10.1007/s10461-024-04309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
HIV incidence increased by 18% between 2015 and 2019 among American Indians (AIs) despite declining rates in other racial/ethnic groups. Culturally-appropriate implementation of prevention programs is needed to address the intersectional conditions contributing to HIV vulnerabilities experienced by AIs. The objectives of this study were to understand factors influencing HIV testing decisions and identify implementation strategies to promote the acceptability of HIV self-testing (HIVST) in a southern California AI community. A total of 15 semi-structured interviews were completed with adult community members of a southern California AI reservation. Analysis used a rapid analytic approach that was guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and expert recommendations for implementing change (ERIC) compilation. Two team members applied a standardized summary template to elucidate implementation determinants and implementation strategies for adopting HIVST. Barriers to HIV testing identified by community members included HIV-related stigma and privacy concerns within their community. Community members expressed positive perceptions of the acceptability of HIVST, with many identifying ease of use and privacy as appealing attributes. Several implementation strategies were suggested for facilitating the adoption of HIVST, including increasing access to tests by mailing kits to community members and increasing demand for kits through media campaigns (e.g., local flyers, social media posts, and booths at tribal events). Community members also recommended discreet packaging of kits and cultural adaptation of accompanying materials (e.g., educational videos featuring community members). The qualitative input from AI community members facilitated identification of implementation strategies that may promote the acceptability and culturally-appropriateness of HIVST.
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Affiliation(s)
- Maximo R Prescott
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
- University of California, San Diego, La Jolla, CA, USA.
| | | | - Christina Perry
- Southern California Tribal Wellness Center, San Diego, CA, USA
| | - Ray Teran
- Southern California Tribal Wellness Center, San Diego, CA, USA
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Zapata JP, Hurtado M, Avila AA, John SA, Rodriguez-Diaz CE, de St Aubin E. Factors Influencing Engagement Across the Motivational PrEP Cascade Among Latino SMM: A Mixed-Methods Analysis from the Perspectives of Community Providers and Latino SMM. AIDS Behav 2024:10.1007/s10461-024-04372-5. [PMID: 38780867 DOI: 10.1007/s10461-024-04372-5] [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: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Latino sexual minority men (SMM) are a highly vulnerable population to HIV, and while pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical tool for HIV prevention among them, its utilization remains disproportionately low in this community despite its potential. Understanding the barriers along the PrEP continuum of care, known as the "PrEP cascade," is crucial for effectively implementing PrEP interventions. Therefore, the objective of our study was twofold: first, to explore the stage of Latino SMM in the PrEP cascade by examining disparities in demographics, social factors, and healthcare aspects; second, to gain insights from healthcare providers who have direct clinical experience with our population regarding the challenges faced by Latino SMM in accessing and adhering to PrEP. Based on the study findings, the majority of participants (n = 74; 49%) were in the contemplation stage, and only one in ten Latino SMM (10.6%) were currently adherent to PrEP. Compared to those who were at least second-generation, first-generation status had a positive association (B = 0.699, SE = 0.208, β = 0.351, p < .001) with engagement along the PrEP Contemplation Ladder. Conversely, having at least one parent who did not have legal residency, relative to those whose parents were both U.S. citizens or held legal residency documentation, was found to have a negative association (B = - 0.689, SE = 0.245, β = 0.245, p = .006) with engagement along the PrEP Contemplation Ladder. Additionally, discussing PrEP with a healthcare provider had a positive association (B = 0.374, SE = 0.179, β = 0.185, p = .038) with engagement along the PrEP Contemplation Ladder. Qualitative results from our study suggest that some Latinos who initially agreed to start using PrEP ended up getting lost in the care pipeline and failed to attend their scheduled appointments. Providers also noted that many patients lacked access to a pharmacy where they felt comfortable obtaining their PrEP prescription, leading them to discontinue use after only a few months. These findings emphasize the importance of considering the unique needs, culture, and background of Latinos, including care delivery and provider attitudes that can facilitate progress through the PrEP cascade.
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Affiliation(s)
- Juan Pablo Zapata
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA.
| | - Manuel Hurtado
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Andrés Alvarado Avila
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Chicago, IL, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carlos E Rodriguez-Diaz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Ed de St Aubin
- Department of Psychology, Marquette University, Milwaukee, WI, USA
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Jaramillo J, Reyes N, Atuluru P, Payen N, Taylor K, Safren SA, Saber R, Harkness A. Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida. AIDS Care 2024; 36:569-579. [PMID: 38157344 PMCID: PMC10932813 DOI: 10.1080/09540121.2023.2287736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nequiel Reyes
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, FL, USA
| | - Naomie Payen
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Kayla Taylor
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Smith JD, Li DH, Merle JL, Keiser B, Mustanski B, Benbow ND. Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations. Implement Sci 2024; 19:10. [PMID: 38331832 PMCID: PMC10854146 DOI: 10.1186/s13012-024-01345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient's health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term-adjunctive interventions-to classify change methods that are distinct from the common intervention/strategy taxonomy. MAIN TEXT Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients' motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention ("the thing"), as an adjunctive intervention, or an implementation strategy in different studies-further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients' attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients' utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided. CONCLUSION Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.
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Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Third Coast Center for AIDS Research, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nanette D Benbow
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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