1
|
Velloza J, Liu AY, Katz AWK, van der Straten A, Siegler AJ, Scott H, Wilde G, Lockard A, Christie RH, Buchbinder SP. Acceptability of an automated directly observed therapy (DOT) application for PrEP adherence support among young men who have sex with men: a qualitative exploration. AIDS Care 2024:1-15. [PMID: 39222964 DOI: 10.1080/09540121.2024.2397133] [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: 02/06/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Pre-exposure prophylaxis (PrEP) adherence remains a challenge among young men who have sex with men (MSM). We developed and tested a smartphone application ("app"), "DOT Diary", which combines automated directly observed therapy (DOT) with information about PrEP protection levels, pill-taking reminders, a sexual behavior diary, and a PrEP dosing calendar. To contextualize trial results, we qualitatively explored participants' app experiences. The trial enrolled 100 young MSM in San Francisco and Atlanta. Participants were randomized 2:1 to DOT Diary versus standard-of-care and followed for 24 weeks. Interviews were conducted with 24 intervention participants. Data were analyzed using a memo-writing approach. Most expressed overall satisfaction with the app ("it was good for its purpose"), despite concerns about technical glitches. The most popular app features were the monthly calendar showing days PrEP was taken and information about level of protection based on pills taken. The DOT component helped participants establish PrEP routines. The reminders were "annoying but effective" at motivating dosing. Opinions about the sexual behavior diary varied. Overall, DOT Diary was acceptable; participants were willing to use it daily to record pill-taking. Critical components included the information about PrEP protection levels and calendar, while others may be modified to improve future success.Trial registration: ClinicalTrials.gov identifier: NCT03771638.
Collapse
Affiliation(s)
- Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ariana W K Katz
- RTI International, Women's Global Health Imperative, Berkeley, CA, USA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| |
Collapse
|
2
|
Kielhold K, Storholm ED, Reynolds HE, Vincent W, Siconolfi DE, Kegeles SM, Pollack L, Campbell CK. "I Don't Feel Judged, I Don't Feel Less of a Person" - Engaged and Supportive Providers in the HIV Care Experiences of Black Sexual Minority Men Living with HIV. Patient Prefer Adherence 2024; 18:1641-1650. [PMID: 39131692 PMCID: PMC11313489 DOI: 10.2147/ppa.s467587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/20/2024] [Indexed: 08/13/2024] Open
Abstract
Background Black sexual minority men (BSMM) in the Southern region of the United States experience a disproportionate burden of HIV. Research findings suggest that having supportive patient-provider relationships are critical for sustained HIV care engagement. The present study explores the role of supportive healthcare providers in the care engagement among BSMM living with HIV (BSMM+) in the US South. Methods Semi-structured qualitative interviews were conducted with BSMM+ in Texas (n=27) to explore perceived barriers and facilitators of sustained care engagement. Interviews lasted 60 minutes on average, were transcribed, coded, and analyzed using applied thematic analysis. Findings Participants described how important having relationships with engaged and supportive HIV care and service providers is to sustained engagement in care and positive HIV clinical outcomes. Supportive providers were characterized as non-judgmental, meeting patients' needs, and making patients feel "seen". Less supportive providers were described as making their patients "feel like a number" and having lack of follow through on proposed support and resources. Supportive providers were associated with increased care engagement of their patients while less supportive providers often led to patients switching providers, losing touch with services, and getting off track with their care. Discussion We found that among BSMM+ an important facilitator of sustained care engagement was having positive, affirming, and knowledgeable healthcare providers, while negative and dismissive experiences with providers was a notable barrier to care engagement. This work highlights the need for a scale up of comprehensive, ongoing trainings in patient-centered and person-first communication for providers. Further, manageable provider caseloads can facilitate more thorough patient interactions where tailored HIV care and education can be provided in a safe and non-judgmental environment.
Collapse
Affiliation(s)
- Kirstin Kielhold
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - Hannah E Reynolds
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | | | - Susan M Kegeles
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lance Pollack
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Chadwick K Campbell
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
3
|
Kelly JA, Walsh JL, DiFranceisco WJ, Amirkhanian YA, Quinn K, Brown KD, Pearson B, Foster J, Rosado AN, McAuliffe TL. Factors associated with PrEP use in a community sample of African American men who have sex with men (MSM) and transgender women (TGW) in the United States Midwest. AIDS Care 2024; 36:101-108. [PMID: 38311890 PMCID: PMC11283983 DOI: 10.1080/09540121.2024.2308743] [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: 08/18/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
Black sexual minority men who have sex with men (MSM) in the United States are at disparate risk for contracting HIV infection, but pre-exposure prophylaxis (PrEP) use is suboptimal. Social network methods were used to recruit a community sample of racial minority MSM and transgender women (TGW) in two Midwestern US cities. 250 PrEP-eligible (HIV-negative) participants completed measures assessing current and intended PrEP use; demographic characteristics; PrEP knowledge, attitudes, norms, stigma, and self-efficacy; and structural barriers to PrEP. Multivariate analyses established predictors of current and intended PrEP use. Only 12% of participants reported currently using PrEP, which was associated with greater PrEP knowledge and not having a main partner, with trends for greater PrEP use by younger participants and those with partners living with HIV. Among participants not currently on PrEP, strength of PrEP use intentions was associated with higher PrEP knowledge, PrEP descriptive social norms, and PrEP use self-efficacy. This study is among few to directly compare Black who have adopted PrEP with those who have not. Its findings underscore the potential benefits of employing social network approaches for strengthening PrEP use peer norms, increasing PrEP knowledge and self-efficacy, and optimizing PrEP uptake among racial minority MSM and TGW.
Collapse
Affiliation(s)
- Jeffrey A. Kelly
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer L. Walsh
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wayne J. DiFranceisco
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Yuri A. Amirkhanian
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Quinn
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin D. Brown
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Broderick Pearson
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jordian Foster
- AIDS Task Force of Greater Cleveland, Cleveland, Ohio, USA
| | - A. Noel Rosado
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy L. McAuliffe
- Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
4
|
Misra K, Huang JS, Udeagu CCN, Forgione L, Xia Q, Torian LV. Pre-exposure Prophylaxis Use History in People With Antiretroviral Resistance at HIV Diagnosis: Findings From New York City HIV Surveillance and Partner Services, 2015-2022. Clin Infect Dis 2024; 78:1240-1245. [PMID: 37976185 DOI: 10.1093/cid/ciad699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/03/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Drug resistance may be acquired in people starting human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) during undiagnosed infection. Population-based estimates of PrEP-related resistance are lacking. METHODS We used New York City surveillance and partner services data to measure the effect of PrEP use (tenofovir disoproxil fumarate/tenofivir alafenamide fumarate with emtricitabine) history on the baseline prevalence of M184I/V mutations in people with HIV diagnosed in 2015-2022. PrEP use was categorized as "recent" (defined as PrEP stopped ≤90 days before diagnosis), "past" (PrEP stopped >90 days before diagnosis), or "no known use." Resistance-associated mutations were determined using the Stanford algorithm. We used log binomial regression to generate the adjusted relative risk (aRR) of M184I/V by PrEP use history in people with or without acute HIV infection (AHI). RESULTS Of 4246 people with newly diagnosed HIV and a genotype obtained within ≤30 days of diagnosis, 560 (13%) had AHI; 136 (3%) reported recent and 124 (35%) past PrEP use; and 98 (2%) harbored M184I/V. In people with AHI, recent PrEP use was associated with a 6 times greater risk of M184I/V than no known use (aRR, 5.86 [95% confidence interval, 2.49-13.77]). Among people without AHI, the risk of M184I/V in recent users was 7 times that in people with no known use (aRR, 7.26 [95% confidence interval, 3.98-13.24]), and in past users, it was 4 times that in those with no known use (4.46 [2.15-9.24]). CONCLUSIONS PrEP use was strongly associated with baseline M184I/V in New York City, regardless of AHI status. Ordering a nucleic acid test when indicated after assessment of exposure, antiretroviral history, and AHI symptoms can decrease PrEP initiation in people with undetected infection.
Collapse
Affiliation(s)
- Kavita Misra
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jamie S Huang
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Chi-Chi N Udeagu
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Lisa Forgione
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Qiang Xia
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Lucia V Torian
- Bureau of Hepatitis, HIV and STIs, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| |
Collapse
|
5
|
Sullivan PS, DuBose SN, Castel AD, Hoover KW, Juhasz M, Guest JL, Le G, Whitby S, Siegler AJ. Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100738. [PMID: 38659491 PMCID: PMC11041841 DOI: 10.1016/j.lana.2024.100738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
Background PrEP was approved for HIV prevention in the US in 2012; uptake has been slow. We describe relative equity with the PrEP Equity Ratio (PER), a ratio of PrEP-to-Need Ratios (PnRs). Methods We used commercial pharmacy data to enumerate PrEP users by race and ethnicity, sex, and US Census region from 2012 to 2021. We report annual race and ethnicity-, sex-, and region-specific rates of PrEP use and PnR, a metric of PrEP equity, to assess trends. Findings PrEP use increased for Black, Hispanic and White Americans from 2012 to 2021. By 2021, the rate of PrEP use per population was similar in Black and White populations but slightly lower among Hispanic populations. PnR increased from 2012 to 2021 for all races and ethnicities and regions; levels of PrEP use were inconsistent across regions and highly inequitable by race, ethnicity, and sex. In all regions, PnR was highest for White and lowest for Black people. Inequity in PrEP use by race and ethnicity, as measured by the PER, grew early after availability of PrEP and persisted at a level substantially below equitable PrEP use. Interpretation From 2012 to 2021, PrEP use increased among Americans, but PrEP equity for Black and Hispanic Americans decreased. The US South lagged all regions in equitable PrEP use. Improved equity in PrEP use will be not only just, but also impactful on the US HIV epidemic; persons most at-risk of acquiring HIV should have the highest levels of access to PrEP. Prevention programs should be guided by PrEP equity, not PrEP equality. Funding National Institutes of Health, Gilead Sciences.
Collapse
Affiliation(s)
| | | | - Amanda D. Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Karen W. Hoover
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Le
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shamaya Whitby
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron J. Siegler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
6
|
Li C, Zhao P, Tan RKJ, Wu D. Community engagement tools in HIV/STI prevention research. Curr Opin Infect Dis 2024; 37:53-62. [PMID: 38050762 DOI: 10.1097/qco.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW Community engagement is key to the success of sustainable public health interventions. This review highlights recent published studies that describe the use of community-engaged methods in sexually transmitted infection (STI) prevention research. RECENT FINDINGS We organized the findings using a socio-ecological model. At the individual level, communities were engaged through participation in formative research, short-term consultations and community advisory board participation, as well as co-creation activities. At the interpersonal level, studies reviewed described peer-led interventions that leverage the influence and guidance of peers, patient-led interventions in the form of patient navigation and notification, as well as those that mobilize social networks and the power of social relationships to promote health. At the organizational and community level, multisectoral, multifacility collaborations between community, government, and academic stakeholders were highlighted. At the policy and population level, communities were engaged through community dialogues to disseminate research findings, as well as in developing strategic frameworks and clinical guidelines. Digital tools have also been leveraged for effective community engagement. SUMMARY Communities have an effective role to play in STI prevention and can be engaged at multiple levels. Future efforts may consider the use of community engagement tools highlighted in this review, including digital technologies that have the potential to reach more diverse end-users.
Collapse
Affiliation(s)
- Chunyan Li
- Tokyo College, The University of Tokyo, Tokyo, Japan
- The University of North Carolina Project China, Guangzhou, China
| | - Peipei Zhao
- Jane Addams College of Social Work, University of Illinois, Chicago, Illinois, USA
| | - Rayner K J Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health of Nanjing Medical University, Nanjing, China
| |
Collapse
|
7
|
Sherman AD, Febres-Cordero S, Bonds Johnson K, Clark KD, Klepper M, Duroseau B, Lin Y, Zhang W, Coleman M, Prakash D, Daniel GA, Chand AT, Kalu U, Tarter R, Allgood S, Cohen S, Kelly U, Balthazar M. Intersectionality in nursing research: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100155. [PMID: 37982092 PMCID: PMC10655863 DOI: 10.1016/j.ijnsa.2023.100155] [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: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
Background An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants. Objective This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision. Design & Methods Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research. Results The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years. Conclusions Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.
Collapse
Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | | | | | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Mercy Coleman
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Prakash
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Gaea A. Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Arzina Tabassum Chand
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ugo Kalu
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Robin Tarter
- Oregon Health and Science University, Portland, OR, USA
| | | | - Sydney Cohen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
8
|
Rich KM, Pandya A, Chiosi JJ, Reddy KP, Shebl FM, Ciaranello AL, Neilan AM, Pinkney JA, Losina E, Freedberg KA, Ahonkhai AA, Hyle EP. Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men. JAMA Netw Open 2023; 6:e2344385. [PMID: 38015507 PMCID: PMC10685884 DOI: 10.1001/jamanetworkopen.2023.44385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Substantial racial inequities exist across the HIV care continuum between non-Hispanic Black and White men who have sex with men (MSM) in the US. Objectives To project years of life gained (YLG) with improving the HIV care continuum among Black MSM and White MSM in the US and to determine the outcomes of achieving health equity goals. Design, Setting, and Participants The Cost-Effectiveness of Preventing AIDS Complications microsimulation model was used and populated with 2021 race-specific data to simulate HIV care among Black MSM and White MSM in the US who have acquired HIV. Analyses were completed from July 2021 to October 2023. Intervention The study simulated status quo care using race-specific estimates: age at infection, time to diagnosis, receipt of care, and virologic suppression. The study next projected the outcomes of attaining equity-centered vs non-equity-centered goals by simulating 2 equal improvements in care goals: (10-point increased receipt of care and 5-point increased virologic suppression), 3 equity-centered goals (annual HIV testing, 95% receiving HIV care, and 95% virologic suppression) and lastly, an equitable care continuum that achieves annual HIV testing, 95% receiving care, and 95% virologic suppression in Black MSM and White MSM. One-way and multiway sensitivity and scenario analyses were conducted. Main Outcomes and Measures Mean age at death and YLG. Results In the simulated cohort, the mean (SD) age at HIV infection was 27.0 (10.8) years for Black MSM and 35.5 (13.6) years for White MSM. In status quo, mean age at death would be 68.8 years for Black MSM and 75.6 years for White MSM. The equal improvements in care goals would result in 0.5 YLG for Black MSM and 0.5 to 0.9 YLG for White MSM. Achieving any 1 equity-centered goal would result in 0.5 to 1.7 YLG for Black MSM and 0.4 to 1.3 YLG for White MSM. With an equitable care continuum compared with the nationally reported status quo, Black MSM and White MSM would gain 3.5 and 2.1 life-years, respectively. If the status quo HIV testing was every 6 years with 75% retained in care and 75% virologically suppressed, Black MSM would gain 4.2 life-years with an equitable care continuum. Conclusions and Relevance In this simulation modeling study of HIV care goals, equal improvements in HIV care for Black and White MSM maintained or worsened inequities. These results suggest that equity-centered goals for the HIV care continuum are critical to mitigate long-standing inequities in HIV outcomes.
Collapse
Affiliation(s)
- Katherine M. Rich
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John J. Chiosi
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Krishna P. Reddy
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
| | - Fatma M. Shebl
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Andrea L. Ciaranello
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Anne M. Neilan
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston
| | - Jodian A. Pinkney
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Elena Losina
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Policy and Innovation Evaluation in Orthopedic Treatments (PIVOT) Center, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| | - Aima A. Ahonkhai
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily P. Hyle
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| |
Collapse
|