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Pichon LC, Teti M, Betts JE, Brantley M. 'PrEP'ing Memphis: A qualitative process evaluation of peer navigation support. EVALUATION AND PROGRAM PLANNING 2022; 90:101989. [PMID: 34419307 PMCID: PMC9523887 DOI: 10.1016/j.evalprogplan.2021.101989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND HIV PrEP (pre-exposure prophylaxis) navigation comprises intervention strategies used to improve PrEP uptake via education, linkage, and follow-up/ongoing engagement. During 2016-2019, the Tennessee Department of Health (TDH) implemented a CDC-funded demonstration project ("Project PrIDE") focused on PrEP navigation in Memphis community-based organizations (CBOs) and the Shelby County Health Department (HD). A process evaluation was conducted to determine facilitators and barriers to the implementation of the Memphis-based Project PrIDE PrEP navigation activities. METHODS A total of fourteen in-depth qualitative interviews were conducted, with nine PrEP navigators in evaluation year 1 (2018) and five of the original navigators in evaluation year 2 (2019), to understand the navigation processes using thematic analysis. RESULTS Facilitators of PrEP navigation included accessing clients at testing events, accompanying clients to first appointments, rapport building with patient and clinic staff, and maintaining consistent engagement with clients. Factors impeding PrEP navigation included difficulties assessing client readiness, tracking client navigation status, and stigmatizing clinic and social experiences for clients. CONCLUSIONS AND LESSONS LEARNED Findings have informed the scale-up of PrEP navigation implementation statewide, along with priority setting and resource allocation for the local Ending the HIV Epidemic (EHE) initiative in Memphis.
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Affiliation(s)
- Latrice C Pichon
- The University of Memphis School of Public Health, Division of Social and Behavioral Sciences, 3825 Desoto Avenue, 209 Robison Hall, Memphis, TN 38152, USA.
| | - Michelle Teti
- The University of Missouri Department of Public Health, 512 Clark Hall Columbia, MO 65211, USA.
| | - Joshua E Betts
- ICF, 2635 Century Center Parkway, Suite 1000, Atlanta, GA 30345, USA; CDC, Atlanta, GA, USA.
| | - Meredith Brantley
- Tennessee Department of Health, HIV/STD/Viral Hepatitis, 710 James Robertson Pkwy, Nashville, TN 37243, USA.
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Buchbinder MH, Blue C, Brown ME, Bradley-Bull S, Rosen DL. Jail-Based Data-to-Care to Improve Continuity of HIV Care: Perspectives and Experiences from Previously Incarcerated Individuals. AIDS Res Hum Retroviruses 2021; 37:687-693. [PMID: 33764187 PMCID: PMC8501464 DOI: 10.1089/aid.2020.0296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Incarceration can disrupt retention in HIV care and viral suppression, yet it can also present an opportunity to reengage people living with HIV (PLWH) in care. Data-to-care (D2C) is a promising new public health strategy that uses HIV surveillance data to improve continuity of care for PLWH. The goal of this study was to examine perspectives on and experiences with D2C among PLWH who had recently been incarcerated in jail. Semistructured, qualitative interviews were conducted with 24 PLWH in community and prison settings about (1) knowledge of and experiences with D2C and (2) attitudes about implementing D2C in the jail setting. Participants who had been contacted for D2C described their interactions with state public health workers favorably, although almost half were not aware that the state performs HIV surveillance and D2C. While most participants indicated they would welcome assistance from the state for reengaging in care, they also framed retention in care as an individual responsibility. Most participants supported the idea of jail-based D2C. A vocal minority expressed adamant opposition, citing concerns about the violation of privacy and the threat of violence in the jail setting. Findings from this study suggest that D2C interventions in jails could be beneficial to reengaging PLWH in care, and acceptable to PLWH if done in a way that is sensitive to the needs and concerns of incarcerated individuals. If implemented, jail-based D2C programs must be designed with care to preserve privacy, confidentiality, and the autonomy of incarcerated individuals.
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Affiliation(s)
- Mara H. Buchbinder
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mersedes E. Brown
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve Bradley-Bull
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David L. Rosen
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Norkin SK, Benson S, Civitarese AM, Reich A, Chomsky Albright M, Convery C, Kasarskis IM, Cassidy-Stewart H, Howe K, Wang X, Golden MR, Khosropour CM, Glick SN, Kerani RP. Inadequate Engagement in HIV Care Among People With HIV Newly Diagnosed With a Sexually Transmitted Disease: A Multijurisdictional Analysis. Sex Transm Dis 2021; 48:601-605. [PMID: 33633070 PMCID: PMC9113732 DOI: 10.1097/olq.0000000000001381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A key challenge of HIV surveillance-based HIV care reengagement is locating people living with HIV (PLWH) who seem to be out of care to reengage them in care. Providing reengagement services to PLWH diagnosed with a sexually transmitted disease (STD)-individuals who are in jurisdiction and connected to the health care system-could be an efficient means of promoting HIV treatment and reducing HIV transmission. METHODS Early and late syphilis (ES/LS) and gonorrhea (GC) cases diagnosed in 2016 and 2017 in Louisiana, Michigan, Mississippi, Oregon, Rhode Island, and Texas were matched to each state's HIV surveillance data to determine the proportion of PLWH with these infections who (1) did not have evidence of a CD4 count or viral load in the prior ≥13 months (out of care) or (2) had a viral load ≥1500 copies/mL on their most recent HIV RNA test before STD diagnosis (viremic). RESULTS Previously diagnosed HIV infection was common among persons diagnosed with ES (n = 6942; 39%), LS (n = 4329; 27%), and GC (n = 9509; 6%). Among these ES, LS, and GC cases, 26% (n = 1543), 33% (n = 1113), and 29% (n = 2391) were out of HIV medical care or viremic at the time of STD diagnosis. CONCLUSIONS A large proportion of STD cases with prior HIV diagnosis are out of care or viremic. Integrating relinkage to care activities into STD partner services and/or the use of matching STD and HIV data systems to prioritize data to care activities could be an efficient means for relinking patients to care and promoting viral suppression.
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Affiliation(s)
- Sarah K Norkin
- From the Texas Department of State Health Services, Austin, TX
| | - Samantha Benson
- Health Services Research and Development, VA Puget Sound Healthcare System, Seattle, WA
| | | | - Amanda Reich
- From the Texas Department of State Health Services, Austin, TX
| | | | | | | | | | | | - Xueyan Wang
- Mississippi Department of Health, Jackson, MI
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Buchbinder M, Blue C, Juengst E, Brinkley-Rubinstein L, Rennie S, Rosen DL. Expert stakeholders' perspectives on a Data-to-Care strategy for improving care among HIV-positive individuals incarcerated in jails. AIDS Care 2020; 32:1155-1161. [PMID: 32160760 DOI: 10.1080/09540121.2020.1737641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Data-to-Care (D2C) uses surveillance data (e.g., laboratory, Medicaid billing) to identify out-of-care HIV-positive persons to re-link them to care. Most US states are implementing D2C, yet few studies have explored stakeholders' perspectives on D2C, and none have addressed these perspectives in the context of D2C in jail. This article reports findings from qualitative, semi-structured interviews conducted with expert stakeholders regarding their perspectives on the ethical challenges of utilizing D2C to understand and improve continuity of care among individuals incarcerated in jails. Participants included 47 professionals with expertise in ethics and privacy, public health and HIV care, the criminal justice system, and community advocacy. While participants expressed a great deal of support for extending D2C to jails, they also identified many possible risks. Stakeholders discussed many issues specific to D2C in jails, such as heightened stigma in the jail setting, the need for training of jail staff and additional non-medical community-based resources, and the high priority of this vulnerable population. Many experts suggested that the actual likelihood of benefits and harms would depend on contextual details. Implementation of D2C in jails may require novel strategies to minimize risk of disclosing out-of-care patients' HIV status.
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Affiliation(s)
- Mara Buchbinder
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Eric Juengst
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity Research, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Stuart Rennie
- Department of Social Medicine, Center for Bioethics, UNC Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - David L Rosen
- Division of Infectious Diseases, Department of Medicine, UNC Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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Torres-Cruz C, Suárez-Díaz E. The stratified biomedicalization of HIV prevention in Mexico City. Glob Public Health 2019; 15:598-610. [PMID: 31630626 DOI: 10.1080/17441692.2019.1679217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the late 1990s antiretroviral pharmaceuticals began to be used in the United States and Western Europe to prevent HIV infection in contexts of occupational exposure. One decade later, the application of Post Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP) had been extended to include cases of exposure to sexual assault, injection-drug use, and consensual sexual intercourse deemed at high risk. This article explores the implementation of biomedicalized HIV prevention protocols at a public healthcare clinic in Mexico City, building on sociological-feminist approaches in Science and Technology Studies (STS) and drawing on interviews with key actors, as well as digital ethnography. We emphasise the stratified biomedicalization or, said otherwise, the differences in PEP and PrEP accessibility and consumption among different populations and groups. We also describe the fragile grip of institutionalised biomedical solutions when alternative 'moral economies' intersect with them, particularly in contexts like Mexico, where governmental funding for experimental research on biomedical innovations has been limited. This text reveals both the existence of contrasting technoscientific interventions along class and gender differences, and the multiple and vivid ways by which individuals appropriate and interpret global biomedical practices.
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Affiliation(s)
- César Torres-Cruz
- Science and Technology Studies Group, School of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Edna Suárez-Díaz
- Science and Technology Studies Group, School of Sciences, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Williams KM, Taylor RD, Painter T, Jeffries WL, Prather C, Spikes P, Mulatu MS, Henny K, Hoyte T, Flores SA. Learning by Doing: Lessons From the Care and Prevention in the United States Demonstration Project. Public Health Rep 2019; 133:18S-27S. [PMID: 30457953 PMCID: PMC6262517 DOI: 10.1177/0033354918803611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kim M Williams
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Raekiela D Taylor
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Thomas Painter
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - William L Jeffries
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Cynthia Prather
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Pilgrim Spikes
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Mesfin S Mulatu
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Kirk Henny
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Tamika Hoyte
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Stephen A Flores
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
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Sweeney P, Hoyte T, Mulatu MS, Bickham J, Brantley AD, Hicks C, McGoy SL, Morrison M, Rhodes A, Yerkes L, Burgess S, Fridge J, Wendell D. Implementing a Data to Care Strategy to Improve Health Outcomes for People With HIV: A Report From the Care and Prevention in the United States Demonstration Project. Public Health Rep 2019; 133:60S-74S. [PMID: 30457958 DOI: 10.1177/0033354918805987] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. METHODS The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. RESULTS Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. CONCLUSIONS The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.
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Affiliation(s)
- Patricia Sweeney
- 1 HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamika Hoyte
- 2 Program and Performance Improvement Office, Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mesfin S Mulatu
- 3 Program Evaluation Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacquelyn Bickham
- 4 STD/HIV Program, Louisiana Department of Health, New Orleans, LA, USA
| | | | - Curt Hicks
- 5 STD/HIV Program, Illinois Department of Public Health, Springfield, IL, USA
| | - Shanell L McGoy
- 6 HIV, STD, and Viral Hepatitis, Tennessee Department of Health, Nashville, TN, USA
| | - Melissa Morrison
- 6 HIV, STD, and Viral Hepatitis, Tennessee Department of Health, Nashville, TN, USA
| | - Anne Rhodes
- 7 Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA
| | - Lauren Yerkes
- 7 Division of Disease Prevention, Virginia Department of Health, Richmond, VA, USA
| | - Samuel Burgess
- 4 STD/HIV Program, Louisiana Department of Health, New Orleans, LA, USA
| | - Jessica Fridge
- 4 STD/HIV Program, Louisiana Department of Health, New Orleans, LA, USA
| | - Deborah Wendell
- 4 STD/HIV Program, Louisiana Department of Health, New Orleans, LA, USA
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