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Rager TL, Tzilos Wernette G, Coleman JS, Schechter N, Mmeje O. "PrEPping" women's healthcare providers: motivational interviewing to support ending the HIV epidemic. Am J Obstet Gynecol 2024; 231:223-230.e1. [PMID: 38290644 PMCID: PMC11283574 DOI: 10.1016/j.ajog.2024.01.019] [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: 08/10/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
In 2018, cisgender women accounted for nearly 20% of new HIV infections, with women of color disproportionately affected. HIV pre-exposure prophylaxis uptake, adherence, and persistence are paramount to ending the HIV epidemic, but current strategies to promote it have not improved uptake among women. Alternatively, pre-exposure prophylaxis marketing and implementation have traditionally targeted men who have sex with men and transwomen. Women feel most comfortable turning to their primary care and reproductive health providers for HIV and pre-exposure prophylaxis counseling, but prescribing is the lowest among these providers. Thus, reframing pre-exposure prophylaxis counseling and education strategies is crucial to better engage providers and patients. Motivational interviewing is a person-centered counseling style for eliciting behavior change. Providers use 4 core skills-open-ended questions, affirmation, reflective listening, and summarizing-to empower individuals for behavior change, such as pre-exposure prophylaxis use. Motivational interviewing is brief, individualized, and effective in increasing pre-exposure prophylaxis uptake, regardless of patients' readiness to change. Primary care and reproductive health providers can employ motivational interviewing approaches with pre-exposure prophylaxis counseling to increase uptake among cisgender women and end the HIV epidemic.
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Affiliation(s)
- Theresa L Rager
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Golfo Tzilos Wernette
- Departments of Family Medicine and Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Jenell S Coleman
- Departments of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicole Schechter
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Okeoma Mmeje
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI.
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Goddard-Eckrich D, McCrimmon T, Bond K, Chang M, Hunt T, Hall J, Russo M, Ramesh V, Johnson KA, Downey DL, Wu E, El-Bassel N, Gilbert L. Effectiveness of a culturally tailored HIV intervention in promoting PrEP among black women who use drugs in community supervision programs in New York City: a randomized clinical trial. Addict Sci Clin Pract 2024; 19:55. [PMID: 39039560 PMCID: PMC11264441 DOI: 10.1186/s13722-024-00488-0] [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: 09/12/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND In the U.S. there are significant racial and gender disparities in the uptake of pre-exposure prophylaxis (PrEP). Black Americans represented 14% of PrEP users in 2022, but accounted for 42% of new HIV diagnoses in 2021 and in the South, Black people represented 48% of new HIV diagnoses in 2021 but only 21% of PrEP users in 2022. Women who use drugs may be even less likely than women who do not use drugs have initiated PrEP. Moreover, women involved in community supervision programs (CSP) are less likely to initiate or use PrEP, More PrEP interventions that focus on Black women with recent history of drug use in CSPs are needed to reduce inequities in PrEP uptake. METHODS We conducted a secondary analysis from a randomized clinical trial with a sub-sample (n = 336) of the total (N = 352) participants from the parent study (E-WORTH), who tested HIV negative at baseline were considered PrEP-eligible. Black women were recruited from CSPs in New York City (NYC), with recent substance use. Participants were randomized to either E-WORTH (n = 172) an HIV testing plus, receive a 5-session, culturally-tailored, group-based HIV prevention intervention, versus an HIV testing control group (n = 180). The 5 sessions included an introduction to PrEP and access. This paper reports outcomes on improved awareness of PrEP, willingness to use PrEP, and PrEP uptake over the 12-month follow-up period. HIV outcomes are reported in a previous paper. RESULTS Compared to control participants, participants in this study assigned to E-WORTH had significantly greater odds of being aware of PrEP as a biomedical HIV prevention strategy (OR = 3.25, 95% CI = 1.64-6.46, p = 0.001), and indicated a greater willingness to use PrEP as an HIV prevention method (b = 0.19, 95% CI = 0.06-0.32, p = 0.004) over the entire 12-month follow-up period. CONCLUSIONS These findings underscore the effectiveness of a culturally-tailored intervention for Black women in CSP settings in increasing awareness, and intention to initiate PrEP. Low uptake of PrEP in both arms highlight the need for providing more robust PrEP-on-demand strategies that are integrated into other services such as substance abuse treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02391233 .
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Affiliation(s)
- Dawn Goddard-Eckrich
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA.
| | - Tara McCrimmon
- Sociomedical Sciences Department at the Mailman School of Public Health, 722 W. 168th Street, 16th floor, New York, NY, 10032, USA
| | - Keosha Bond
- School of Medicine, Community Health & Social Medicine, City University of New York, Harris Hall, H-313I, New York, NY, 10031, USA
| | - Mingway Chang
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Timothy Hunt
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Jennifer Hall
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Mary Russo
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Vineha Ramesh
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Karen A Johnson
- University of Alabama School of Social Work, Box 870314, Tuscaloosa, AL, 35487-0314, USA
| | - Dget L Downey
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Elwin Wu
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Nabila El-Bassel
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
| | - Louisa Gilbert
- Social Intervention Group (SIG), Columbia University School of Social Work, 1255 Amsterdam Avenue, 8th Floor, New York, NY, 10027, USA
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Mathurin A, Tafuto B, Lechner DW. Barriers to HIV Pre-Exposure Prophylaxis Use Among Women in the US: A Systematic Literature Review. PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (2015) 2024; 10:10.21801/ppcrj.2024.101.4. [PMID: 39175750 PMCID: PMC11340659 DOI: 10.21801/ppcrj.2024.101.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
Introduction The high acquisition rate of HIV infection among women in the United States is concerning. Despite the FDA approving the first pre-exposure prophylaxis (PrEP) drug in 2012, PrEP utilization remains significantly lower among women. This literature review aims to analyze the current body of research concerning HIV PrEP usage among women in the US. Methods A search of three medical databases was conducted. After the screening, 19 studies were selected for analysis. A risk of bias assessment was performed. Results A final set of records meeting the inclusion criteria (n=19) was included in the review for data collection and analysis. The study methodology for these research articles included interview-based designs (semi-structured and brief formats) in 1-on-1 meetings, focus groups, surveys, and retrospective data analysis. Participants' HIV risk characteristics were reported by way of sexual behavior, drug use, combined sexual behavior and drug use, and living in a high HIV rate neighborhood. Nineteen themes were identified and organized into three categories: (1) Common medication administration barriers, (2) PrEP-specific barriers, and (3) Situational barriers. The three most common themes reported by participants included a concern about side effects, low perceived risks of HIV, and lack of PrEP information. The CASP Qualitative Checklist and risk assessment summary showed acceptable validity among studies. Discussion This review identifies significant barriers hindering women's PrEP utilization, which would benefit from more prevalent stakeholder communication and education directed to at-risk populations. Inconsistently reported descriptive data on participants and the low patient populations make it difficult to generalize outcomes.
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Affiliation(s)
- Alene Mathurin
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- NJ Alliance for Clinical and Translational Science
| | - Barbara Tafuto
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- NJ Alliance for Clinical and Translational Science
| | - Doreen W Lechner
- School of Health Professions, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
- NJ Alliance for Clinical and Translational Science
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Murphy M, Rogers BG, Ames E, Galipeau D, Uber J, Napoleon S, Brinkley-Rubinstein L, Toma E, Byrne S, Teitelman AM, Berk J, Chan PA, Ramsey S. Implementing Preexposure Prophylaxis for HIV Prevention in a Statewide Correctional System in the United States. Public Health Rep 2024; 139:174-179. [PMID: 37476929 PMCID: PMC10851896 DOI: 10.1177/00333549231186576] [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] [Indexed: 07/22/2023] Open
Abstract
HIV disproportionately affects populations experiencing incarceration. Preexposure prophylaxis (PrEP) is an effective approach to preventing HIV acquisition among populations at increased risk of acquiring HIV. Yet few, if any, efforts have been made to offer PrEP in correctional settings. Beginning in November 2019, the Rhode Island Department of Corrections (RIDOC) implemented a systemwide PrEP initiation program with linkage to PrEP care in the community upon reentry. Incarcerated individuals identified as being potentially at increased risk of HIV acquisition during standard clinical screenings and medical care were referred to a PrEP care provider for potential PrEP initiation. Of the 309 people who met with a PrEP care provider, 35% (n = 109; 88 men, 21 women) agreed to initiate PrEP while incarcerated. Clinical testing and evaluation were completed for 82% (n = 89; 69 men, 20 women) of those who agreed to initiate PrEP. Of those, 54% (n = 48; 29 men, 19 women) completed the necessary clinical evaluation to initiate PrEP, were determined to be appropriate candidates for PrEP use, and had the medication delivered to a RIDOC facility for initiation. Only 8 people (4 men, 4 women) were successfully linked to a PrEP care provider in the community after release. The RIDOC experience demonstrates notable levels of PrEP interest and moderate levels of PrEP uptake among this population. However, PrEP engagement in care after release and persistence in taking PrEP when in the community were relatively poor, indicating a need to better understand approaches to overcoming barriers to PrEP care in this unique setting.
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Affiliation(s)
- Matthew Murphy
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University School of Public Health, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Rhode Island Department of Corrections, Cranston, RI, USA
| | - Brooke G. Rogers
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University School of Public Health, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Evan Ames
- Rhode Island Hospital, Providence, RI, USA
| | | | - Julia Uber
- Rhode Island Hospital, Providence, RI, USA
| | - Siena Napoleon
- Brown University School of Public Health, Providence, RI, USA
| | | | - Emily Toma
- Brown University School of Public Health, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | | | | | - Justin Berk
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
- The Rhode Island Department of Corrections, Cranston, RI, USA
| | - Philip A. Chan
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Brown University School of Public Health, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
| | - Susan Ramsey
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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Mambro A, Afshar A, Leone F, Dussault C, Stoové M, Savulescu J, Rich JD, Rowan DH, Sheehan J, Kronfli N. Reimbursing incarcerated individuals for participation in research: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104283. [PMID: 38109837 DOI: 10.1016/j.drugpo.2023.104283] [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: 08/14/2023] [Revised: 11/18/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Little is known about global practices regarding the provision of reimbursement for the participation of people who are incarcerated in research. To determine current practices related to the reimbursement of incarcerated populations for research, we aimed to describe international variations in practice across countries and carceral environments to help inform the development of more consistent and equitable practices. METHODS We conducted a scoping review by searching PubMed, Cochrane library, Medline, and Embase, and conducted a grey literature search for English- and French-language articles published until September 30, 2022. All studies evaluating any carceral-based research were included if recruitment of incarcerated participants occurred inside any non-juvenile carceral setting; we excluded studies if recruitment occurred exclusively following release. Where studies failed to indicate the presence or absence of reimbursement, we assumed none was provided. RESULTS A total of 4,328 unique articles were identified, 2,765 were eligible for full text review, and 426 were included. Of these, 295 (69%) did not offer reimbursement to incarcerated individuals. A minority (n = 13; 4%) included reasons explaining the absence of reimbursement, primarily government-level policies (n = 7). Among the 131 (31%) studies that provided reimbursement, the most common form was monetary compensation (n = 122; 93%); five studies (4%) offered possible reduced sentencing. Reimbursement ranged between $3-610 USD in total and 14 studies (11%) explained the reason behind the reimbursements, primarily researchers' discretion (n = 9). CONCLUSIONS The majority of research conducted to date in carceral settings globally has not reimbursed incarcerated participants. Increased transparency regarding reimbursement (or lack thereof) is needed as part of all carceral research and advocacy efforts are required to change policies prohibiting reimbursement of incarcerated individuals. Future work is needed to co-create international standards for the equitable reimbursement of incarcerated populations in research, incorporating the voices of people with lived and living experience of incarceration.
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Affiliation(s)
- Andrea Mambro
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Avideh Afshar
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Frederic Leone
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark Stoové
- Burnet Institute, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Josiah D Rich
- Center for Health and Justice Transformation, The Miriam and Rhode Island Hospitals, Departments of Medicine and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Daniel H Rowan
- Division of Infectious Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Nadine Kronfli
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Division of Infectious Disease and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.
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Desai J, Krakower D, Harris BL, Culp S, Nijhawan AE. HIV/Sexually Transmitted Infection Screening and Eligibility for HIV Preexposure Prophylaxis Among Women Incarcerated in an Urban County Jail. Sex Transm Dis 2023; 50:675-679. [PMID: 37699368 PMCID: PMC10503027 DOI: 10.1097/olq.0000000000001852] [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] [Indexed: 09/14/2023]
Abstract
BACKGROUND Incarcerated women experience high rates of HIV and sexually transmitted infections (STIs); few are offered HIV preexposure prophylaxis (PrEP). We aimed to examine HIV/STI screening rates in this population and identify PrEP eligibility. METHODS Results of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) urine and HIV/syphilis screening in cisgender women in the Dallas County Jail were compiled from January to October 2020. An electronic health record review was conducted for a subgroup in March 2020 to identify PrEP eligibility. RESULTS Overall, 4398 of 13,292 women were screened for CT and 4389 of 13,292 for GC, and among them, 479 (11%) screened for HIV and 562 (13%) for syphilis. Furthermore, 462 of 4398 (11%) were positive for CT, 323 of 4389 (7%) were positive for GC, 10 of 479 (2%) had positive HIV test results, of whom 6 (1.3%) were new diagnoses and 75 (13%) had a reactive rapid plasma reagin test. In March 2020, of 541 women screened, 90 tested positive for CT or GC. Of these 90, 70 (78%) did not receive HIV or syphilis screening, including women with these risk factors: 10 (14%) were homeless, 11 (16%) reported heroin use, and 10 (14%) reported methamphetamine use. Based on the presence of an acute bacterial STI, 17% (96 of 541) were PrEP eligible. CONCLUSIONS Incarcerated women had high STI rates and other risk factors for HIV acquisition, although only 1 in 5 with acute STIs (11% overall) was also screened for HIV or syphilis. HIV prevention efforts should include comprehensive STI/HIV screening, linkage to treatment, and identification of PrEP candidates.
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Affiliation(s)
- Jui Desai
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Knittel AK, Jackson JB, Swartzwelder RA, Ferguson EG, Hulshult H, Adimora AA. PrEP and HIV prevention decision-making among social network members of women who have experienced incarceration: a qualitative study. AIDS Care 2023; 35:1375-1385. [PMID: 36912643 PMCID: PMC10363199 DOI: 10.1080/09540121.2023.2182872] [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: 10/07/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
ABSTRACTIncarceration and HIV are a syndemic for US women, yet very few women who have experienced incarceration use pre-exposure prophylaxis (PrEP) for HIV. We conducted semi-structured interviews with 32 participants recruited by women who have experienced incarceration from their social networks, informed by the modified social ecological model for PrEP. Emergent themes from the interviews included individual-level (low personal HIV risk assessment, personal responsibility for HIV prevention, and decisions in addiction versus recovery), network-level (influential sex partners and the importance of trust, supportive treatment peers, and high-risk but indifferent drug use networks), community-level (stigma, and mitigation of stigma in supportive substance use disorder treatment environments), and public policy-level (incarceration and PrEP cost and access) determinants. PrEP interventions for women who have experienced incarceration and their networks will need to incorporate contingency planning into HIV risk assessment, navigate complex network dynamics, and be situated in trusted contexts to address structural barriers.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Rita A. Swartzwelder
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Hannah Hulshult
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC USA
| | - Ada A. Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, NC, USA
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Dauria E, Rodriguez C, Bauerle Bass S, Tolou-Shams M, Christopoulos K. Implementation strategies to screen, refer and link women involved in the carceral system to PrEP for HIV prevention. Int J Prison Health 2023; 19:578-590. [PMID: 37113046 PMCID: PMC11058187 DOI: 10.1108/ijph-06-2022-0037] [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] [Indexed: 04/29/2023]
Abstract
PURPOSE Women involved in the carceral system (CS) experience several conditions that increase their risk for HIV (e.g. high rates of substance use, psychiatric disorders, histories of victimization). The purpose of this study is to explore perspectives on potential strategies to connect women in the CS to pre-exposure prophylaxis (PrEP) services. DESIGN/METHODOLOGY/APPROACH This study conducted in-depth interviews with 27 women involved in the CS eligible for PrEP. Using vignettes, interviews explored attitudes, barriers and facilitators toward PrEP screening, referral and linkage facilitated via a CS stakeholder, an mHealth application or providing PrEP service referrals during detention via a navigator. FINDINGS Most women were, on average, 41.3 years, from racial and ethnic minority groups (56% black/African American; 19% Latinx). Inductive thematic analysis revealed CS involved women expressed mostly positive attitudes toward CS-based PrEP implementation. Younger women were more accepting of and interested in mHealth interventions. Implementation facilitators included leveraging relationships with trusted allies (e.g. "peers") and existing systems collaborations. Recommended implementation strategies included providing HIV and PrEP-specific education and training for system stakeholders and addressing issues related to privacy, system mistrust and stigma. ORIGINALITY/VALUE Results provide a critical foundation for the implementation of interventions to improve PrEP access for women involved in the CS and have important implications for implementation strategies for all adults involved in the CS. Improving access to PrEP among this population may also support progress toward addressing national disparities in PrEP uptake, where women, black and Latinx populations have substantial unmet need.
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Affiliation(s)
- Emily Dauria
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Katerina Christopoulos
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Knittel AK, Ferguson EG, Jackson JB, Adimora AA. The influence of social relationships on PrEP attitudes among women with incarceration experience in the Southeastern USA. CULTURE, HEALTH & SEXUALITY 2023; 25:110-125. [PMID: 35015606 PMCID: PMC9271531 DOI: 10.1080/13691058.2021.2023760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Women who have experienced incarceration face a disproportionately high risk of acquiring HIV. Despite efficacy of pre-exposure prophylaxis (PrEP) for HIV, very few women with incarceration histories are using PrEP. Our objective was to learn how sexual, drug-use and social relationships shape decisions about PrEP among women who have experienced incarceration. We used an inductive approach to analyse data from four focus groups undertaken with women who had previously experienced incarceration recruited from three community-based organisations. We identified public policy (medical distrust, lack of prevention in prisons and jails, and cost and coverage of PrEP); community (incarceration stigma, gossip as prevention); social and sexual network (positive peer and parenting relationships, distrust of sexual partners, and networks as a source of risk); and individual-level (active addiction or recovery, change after incarceration, and medical concerns) factors influencing the use of PrEP. Actions and interventions to improve PrEP uptake among women who have experienced incarceration must take account of the multilevel context of HIV prevention decisions.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Meyer JP, Price CR, Ye Y, Qin Y, Tracey D, Demidont AC, Melbourne K, Altice FL. A PrEP Demonstration Project Using eHealth and Community Outreach to Justice-Involved Cisgender Women and Their Risk Networks. AIDS Behav 2022; 26:3807-3817. [PMID: 35672552 DOI: 10.1007/s10461-022-03709-2] [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] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Women involved in criminal justice systems (WICJ) are a key population at risk for HIV, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. This project was designed to evaluate the feasibility and acceptability of delivering PrEP via eHealth to WICJ and members of their risk network (RN). We recruited HIV-negative cisgender WICJ index participants (n = 38) and risk network (RN) members (n = 67) using modified respondent-driven sampling. TDF/FTC was initiated for PrEP in participants meeting clinical criteria and dispensed through eHealth using a community-based, low barrier-to-care outreach model. Key steps in the PrEP care continuum were measured over 12 months. Enrolled participants (n = 105) had high current and lifetime justice-involvement and were predominantly cisgender women and non-Hispanic white with a mean age of 40.9y (SD 9.6). Despite most having primary care providers and medical insurance, PrEP awareness was low, and participants experienced high levels of medical, psychiatric, substance use, social, and economic need. Fifty-two participants (50%) were PrEP-eligible, of whom 24 (46%) initiated PrEP. TDF/FTC was safe and well-tolerated throughout follow-up and 13 individuals chose to remain on PrEP following study conclusion. In this novel PrEP demonstration project for WICJ and RN members, despite high medical, psychiatric, and social comorbidity, PrEP was positively received and effectively delivered using a community outreach model via eHealth.Registered on clinicaltrials.gov under trial registration number NCT03293290.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States.
| | - Carolina R Price
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - Yiwen Ye
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States
| | - Yilu Qin
- Primary Care Program, Yale New Haven Health, HIV Training Track, New Haven, CT, United States
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - A C Demidont
- Gilead Sciences, Inc, Foster City, CA, United States
| | | | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
- Yale School of Public Health, Epidemiology of Microbial Diseases, New Haven, CT, United States
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Spaulding AC, Rabeeah Z, Del Mar González-Montalvo M, Akiyama MJ, Baker BJ, Bauer HM, Gibson BR, Nijhawan AE, Parvez F, Wangu Z, Chan PA. Prevalence and Management of Sexually Transmitted Infections in Correctional Settings: A Systematic Review. Clin Infect Dis 2022; 74:S193-S217. [PMID: 35416974 PMCID: PMC9989347 DOI: 10.1093/cid/ciac122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions-managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)-can counteract structural racism in healthcare.
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Affiliation(s)
- Anne C Spaulding
- Departments of Epidemiology and Global Health, Rollins School of Public Health; Emory University, Atlanta, Georgia, USA.,Department of Medicine, Division of Infectious Disease, Emory School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Zainab Rabeeah
- Departments of Epidemiology and Global Health, Rollins School of Public Health; Emory University, Atlanta, Georgia, USA
| | | | - Matthew J Akiyama
- Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Brenda J Baker
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Heidi M Bauer
- California Correctional Health Care Services, Elk Grove, California, USA.,Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Brent R Gibson
- National Commission on Correctional Healthcare, Chicago, Illinois, USA
| | - Ank E Nijhawan
- Department of Medicine, Division of Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Farah Parvez
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Field Services Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Bureau of Tuberculosis Control, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Zoon Wangu
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Field Services Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Bureau of Tuberculosis Control, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York City, New York, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, UMass Memorial Children's Medical Center & UMass Chan Medical School, Worcester, Massachusetts, USA.,Ratelle STD/HIV Prevention Training Center, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA
| | - Philip A Chan
- Department of Medicine, Division of Infectious Disease, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences at the Brown University School of Public Health, Providence, Rhode Island, USA.,National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of STD Elimination, National Centers for Disease Control and Elimination, Atlanta, Georgia, USA
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12
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Knittel AK, Rudolph JE, Shook-Sa BE, Edmonds A, Ramirez C, Cohen M, Taylor T, Adedimeji A, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl MA, Long DM, Adimora AA. Self-Reported Sexually Transmitted Infections After Incarceration in Women with or at Risk for HIV in the United States, 2007-2017. J Womens Health (Larchmt) 2022; 31:382-390. [PMID: 34967695 PMCID: PMC8972014 DOI: 10.1089/jwh.2021.0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: U.S. women who have been incarcerated report high rates of sexual risk behavior and sexually transmitted infections (STIs). Materials and Methods: We estimated the effect of incarceration on the time to first incident STI in a multicenter cohort of U.S. women with or at risk for HIV. We used marginal structural models to compare time to first self-reported gonorrhea, chlamydia, or trichomonas infection for nonincarcerated women and incarcerated women. Covariates included demographic factors, HIV status, sex exchange, drug/alcohol use, and prior incarceration. Results: Three thousand hundred twenty-four women contributed a median of 4 at-risk years and experienced 213 first incident STI events. The crude incidence of STIs was 3.7 per 100 person-years for incarcerated women and 1.9 per 100 person-years for nonincarcerated women. The weighted hazard ratio for incident STIs was 4.05 (95% confidence interval: 1.61-10.19). Conclusion: Women with or at risk for HIV in the United States who have recently experienced incarceration may be at increased STI risk.
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Affiliation(s)
- Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Jacqueline E Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. USA
| | | | - Tonya Taylor
- Division of Infectious Disease, College of Medicine at SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Katherine G Michel
- Department of Infectious Diseases, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D Donohue
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dustin M Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. USA
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