Prostate Cancer Ambassadors: Process and Outcomes of a Prostate Cancer Informed Decision-Making Training Program

Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure

BACKGROUND

Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM).

METHODS

In Aim 1, we will recruit a longitudinal cohort of 1800 adult (≥18 years) PWH from our clinic-based population to determine the difference in the prevalence and incidence of cardiometabolic comorbidities between food-secure and food-insecure PWH. Food insecurity screening, indicators of cardiometabolic comorbidities, and other characteristics documented in the electronic health record (EHR) will be collected annually for up to 3 years from this cohort. In Aim 2, we will conduct a randomized controlled trial among a sample of food-insecure PWH who have prediabetes or T2DM to compare changes in insulin sensitivity over 6 months between participants in weCare/Secure and participants receiving usual care. In Aim 3, we will conduct semi-structured individual in-depth interviews to explore the effect of the intervention among intervention participants with varying insulin sensitivity outcomes.

TRIAL STATUS

Aim 1 (longitudinal cohort) recruitment began in May 2022 and is ongoing. Aim 2 (intervention) recruitment is planned for spring 2023 and is expected to be completed in spring 2024. Aim 3 (process evaluation) data collection will occur after sufficient completion of the 6-month assessment in Aim 2. Final results are anticipated in fall 2025.

CONCLUSIONS

This research seeks to advance our understanding of how food insecurity impacts the development of cardiometabolic comorbidities among PWH and how food insecurity interventions may alleviate relevant comorbidities. Given the growing interest among health systems in addressing food insecurity, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04943861 . Registered on June 29, 2021.

Prostate cancer knowledge gaps among community stakeholders in rural Nigeria: implications for seeking screening

PURPOSE

In Nigeria, knowledge about prostate cancer (PCa) is poor, so are the availability, accessibility, and utilization of PCa screening services. Poor knowledge increases the burden of disease, this is more so in rural settings. PCa, being gender-specific, has underlying cultural connotations. There is a dearth of evidence on the rural-cultural understanding of PCa onset. The study examined community stakeholders' knowledge, risk perception, as well as the perceived barriers to seeking PCa screening. Rosenstock's Health Belief Model provided the theoretical framing for the study.

METHODS

The study design was descriptive and a cross-sectional approach to the social constructionist ideas of the qualitative tradition was adopted. There were twenty-one interviews with purposively selected community stakeholders; Fourteen key informant (traditional healers and medical doctors) interviews and seven In-depth Interviews (traditional leaders) held in the Ijebu culture cluster of Ogun State, Nigeria. Narratives were analyzed based on the following theoretical themes: knowledge, risk perception, and perceived barriers to PCa screening. These themes derived their structures from content-analyzed findings.

RESULTS

Results show that traditional healers and leaders have limited scientific knowledge of PCa etiology. Folk beliefs form the basis of PCa knowledge among most stakeholders. However, all stakeholders consider PCa a threat to men. The cultural sense of 'maleness' and access to appropriate information about PCa are essential approaches to establishing perceived threat/susceptibility. Cancer health education and distance of screening facilities are primary barriers to seeking screening.

CONCLUSION

Stakeholders' knowledge of PCa and PCa screening should be improved by educating them and developing integrative community engagement strategies.

Prostate Cancer Screening among High-Risk Black Men

We explored potential barriers and facilitators for prostate cancer screening choices among high-risk Black men. In our sample of 264 Black men over 45 years of age living in the U.S. who met the American Cancer Society criteria for screening, we found that only 49.6% had ever been screened. We investigated potential barriers including screening intention, access to care, medical mistrust, and fatalism. Potential facilitating factors investigated were provider-patient conversations encompassing the pros and cons of screening, ethnicity taken into account, insurance, and previous prostate cancer screening. Recommendations and resources are suggested to increase screening of high-risk Black men.