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Colón-Burgos JF, Rojas P, Vazquez V, Khalona MA, Canedo M, Pinzón Iregui MC, Gómez-Estern BM, De La Rosa M, Sánchez M, Ángel Cano M, Ravelo GJ, Westrick A, Behar-Zusman V. A qualitative community health assessment of HIV prevention awareness in a semi-rural Latinx seasonal farm working community in South Florida. CULTURE, HEALTH & SEXUALITY 2024; 26:1072-1087. [PMID: 38156981 PMCID: PMC11213830 DOI: 10.1080/13691058.2023.2296483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
This article explores HIV awareness and prevention in a Latinx seasonal farmworker community of south Miami-Dade County in the USA. The study took place as part of a larger community assessment that aimed to determine community needs and resources related to substance abuse, violence and HIV in the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on fathers' and their male sons' relationships. The study collected data on HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention between fathers and sons. Data were collected through in-depth interviews with community leaders, two focus groups with social and health services providers, and four focus groups involving fathers and their adolescent sons. A deductive approach to data analysis was undertaken. Five major themes were identified: (1) HIVrelated knowledge and perception; (2) HIV prevention strategies; (3) barriers and needs for tailored preventive health and care services in the community; (4) stress over sex-related communication; and (5) the dominance of traditional masculine gender norms in the household and the community.
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Affiliation(s)
- José F. Colón-Burgos
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Patria Rojas
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Vicky Vazquez
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Maria Antonina Khalona
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Marisabel Canedo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - María C. Pinzón Iregui
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Beatriz Macías Gómez-Estern
- Department of Social Anthropology, Basic Psychology and Public Health, Universidad Pablo de Olavide, Seville, Spain
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Mariana Sánchez
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Miguel Ángel Cano
- School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gira J. Ravelo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, Florida International University, Miami, FL, USA
| | - Ashly Westrick
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Shah HS, Serrano PA, Phillips Ii G. Adaptation and Reach of a Pre-Exposure Prophylaxis Social Marketing Campaign for Latino, Latina, and Latinx Populations: Development Study. JMIR Form Res 2024; 8:e52842. [PMID: 39018099 PMCID: PMC11292145 DOI: 10.2196/52842] [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: 09/17/2023] [Revised: 03/16/2024] [Accepted: 04/24/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Latino, Latina, and Latinx (Latino/a/x) individuals remain disproportionately impacted by HIV, particularly sexual minority men and transgender women. Pre-exposure prophylaxis (PrEP) is an effective means of biomedical HIV prevention, but awareness and uptake remain low among marginalized Latino/a/x populations. Social marketing campaigns have demonstrated promise in promoting PrEP in other populations but are poorly studied in Latino/a/x sexual minority men and transgender women. OBJECTIVE This study aims to (1) adapt and pilot a PrEP social marketing campaign tailored to Latino/a/x populations with a focus on sexual minority men and transgender women through community-based participatory research (CBPR) and (2) evaluate the reach and ad performance of the adapted PrEP social marketing campaign. METHODS We used the ADAPT-ITT (assessment, decision, adaptation, production, topical experts-integration, training, and testing) framework for adapting evidence-based interventions for new settings or populations. This paper presents how each phase of the ADAPT-ITT framework was applied via CBPR to create the PrEPárate ("Be PrEPared") campaign. Key community engagement strategies included shared ownership with community partners, focus groups to guide content, crowdsourcing to name the campaign, design by local Latino/a/x artists, and featuring local influencers as the faces of PrEPárate. We evaluated campaign reach and advertisement performance using social media platform metrics (paid and organic reach, impressions, unique clicks, and click-through rates [CTR]) and website use statistics from Google Analytics. RESULTS The PrEPárate campaign ran in Cook County, Illinois, from April to September 2022. The campaign reached over 118,750 people on social media (55,750 on Facebook and Instagram [Meta Platforms Inc] and 63,000 on TikTok [ByteDance Ltd]). The Meta ads performed over the industry benchmark with ads featuring local transgender women (2% CTR) and cisgender sexual minority men (1.4% CTR). Of the different Grindr (Grindr Inc) ad formats piloted, the interstitial Grindr ads were the highest performing (1183/55,479, 2.13% CTR). YouTube (Google) ads were low performing at 0.11% (153/138,337) CTR and were stopped prematurely, given limits on sexual education-related content. In the first year, there were 5006 visitors to the website. CONCLUSIONS Adaptation of an existing evidence-based intervention served as an effective method for developing a PrEP social marketing campaign for Latino/a/x audiences. CBPR and strong community partnerships were essential to tailor materials and provide avenues to systematically address barriers to PrEP access. Social marketing is a promising strategy to promote PrEP among underserved Latino/a/x populations.
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Affiliation(s)
- Harita S Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Pedro Alonso Serrano
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Gregory Phillips Ii
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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Dawit R, Goedel WC, Reid SC, Doshi JA, Nunn AS, Chan PA, Dean LT. Geographic variations of pre-exposure prophylaxis reversal and abandonment among United States counties. AIDS 2024; 38:557-566. [PMID: 37976040 PMCID: PMC10922568 DOI: 10.1097/qad.0000000000003790] [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: 11/19/2023]
Abstract
OBJECTIVE In the United States, one in five newly insurer-approved pre-exposure prophylaxis (PrEP) prescriptions are reversed with over 70% of those reversed, being abandoned. Given the Ending the HIV Epidemic (EHE) initiative's goals, we assessed geographic variations of PrEP reversal and abandonment across EHE and non-EHE counties in the United States. DESIGN This was a cross-sectional analysis of secondary data. METHODS Data were collected from Symphony Analytics for adults 18 years and older, with a newly prescribed PrEP claim. Using the proportion of PrEP prescriptions by county, hotspot analysis was conducted utilizing Getis Ord Gi∗ statistics stratified by EHE and non EHE counties. Multivariable logistic regression was used to identify factors associated with residing in hotspots of PrEP reversal or PrEP abandonments. RESULTS Across 516 counties representing 36,204 patients, the overall PrEP reversal rate was 19.4%, whereas the PrEP abandonment rate was 13.7%. Reversals and abandonments were higher for non-EHE (22.7 and 17.1%) than EHE (15.6 and 10.5%) counties. In both EHE and non-EHE counties, younger age, less education, females, and an out-of-pocket cost of greater than $100, were significantly associated with greater likelihood of residing in hotspots of PrEP reversal or abandonment, while Hispanics, Medicaid recipients, and an out-of-pocket cost of $10 or less had lower likelihood of residing in hotspots of reversal and abandonment. CONCLUSION Findings indicate the need for implementation of focused interventions to address disparities observed in PrEP reversal and abandonment. Moreover, to improve primary PrEP adherence, national PrEP access programs should streamline and improve PrEP accessibility across different geographic jurisdictions.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sean C. Reid
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Jalpa A. Doshi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Harkness A, Morales V, Atuluru P, Jaramillo J, Safren SA, Balise R, Turner D. PrEP and Behavioral Health Treatment Referral Among HIV Test Counselors in Miami-Dade County: A Rapid Qualitative Study Using the Consolidated Framework for Implementation Research. AIDS Behav 2024; 28:820-836. [PMID: 37792227 PMCID: PMC11110539 DOI: 10.1007/s10461-023-04184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
HIV test counselors are well positioned to refer individuals to pre-exposure prophylaxis (PrEP) and behavioral health treatments. HIV test counselors in Miami-Dade County (N = 20), a priority jurisdiction for Ending the HIV Epidemic, completed interviews to assess determinants of PrEP and behavioral health treatment referrals. To identify determinants, we used a rapid deductive qualitative analysis approach and the Consolidated Framework for Implementation Research (CFIR). Identified determinants sometimes served as facilitators (e.g., relative priority, leadership importance) and sometimes as barriers (e.g., lack of access to knowledge and information, available resources for referrals) to making referrals. We also observed differences in determinants between PrEP and behavioral health referrals. For example, complexity (perceived difficulty of the referral) was a barrier to behavioral health more often than PrEP referral. Our findings suggest that determinants across many CFIR domains affect referral implementation, and the corresponding need for multiple implementation strategies to improve implementation of PrEP and behavioral health referrals in the context of HIV testing.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr Coral Gables, Coral Gables, FL, 33146, USA.
| | - Vanessa Morales
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | | | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Raymond Balise
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - DeAnne Turner
- College of Nursing, University of South Florida, Tampa, FL, USA
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Boudewyns V, Uhrig JD, Williams PA, Anderson SKE, Stryker JE. Message Framing Strategies to Promote the Uptake of PrEP: Results from Formative Research with Diverse Adult Populations in the United States. AIDS Behav 2024; 28:535-546. [PMID: 38151665 DOI: 10.1007/s10461-023-04242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
There are no evidence-based recommendations for communicating about pre-exposure prophylaxis (PrEP) as part of a broader HIV-prevention messaging approach. To inform future message development related to PrEP uptake, we interviewed 235 individuals across ten locations in the U.S. to explore their understanding and perceptions of draft HIV prevention messages and assess their overall preferences for a broad or PrEP-focused messaging approach. Participants responded favorably to and related to both draft messages. Participants who were not aware of PrEP were more likely to say the broad HIV-prevention message was personally relevant than those aware of PrEP. There were no significant differences in perceived personal relevance for the PrEP-focused message. Qualitative findings suggest that HIV prevention messages should use specific well-defined terms, include links to additional information, and use choice-enhancing language that emphasizes personal agency and frames the call to action as an informed decision among an array of effective prevention options.
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Affiliation(s)
- Vanessa Boudewyns
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA.
| | - Jennifer D Uhrig
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Pamela A Williams
- RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC, USA
| | - Stefanie K E Anderson
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jo Ellen Stryker
- Division of HIV Prevention, Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rodriguez A, Horvath KJ, Dowshen N, Voss R, Warus J, Jacobs M, Kidd KM, Inwards-Breland DJ, Blumenthal J. Awareness and utilization of pre-exposure prophylaxis and HIV prevention services among transgender and non-binary adolescent and young adults. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 5:1150370. [PMID: 38318604 PMCID: PMC10839107 DOI: 10.3389/frph.2023.1150370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Transgender and gender non-binary (TGNB) individuals are disproportionally affected by HIV and face high rates of discrimination and stigmatization, resulting in limited access to HIV prevention services. Pre-exposure prophylaxis (PrEP) is highly efficacious for reducing the risk of HIV transmission. However, little research is available regarding PrEP awareness and utilization among TGNB adolescents and young adults (AYA). Methods TGNB AYA ages 15-24 years old were recruited between December 2021 and November 2022 for participation in a one-time, anonymous online survey study to assess PrEP awareness and perceptions, as well as barriers to its use. Participants were recruited from seven academic centers offering gender-affirming care to TGNB AYA across the United States. Results Of the 156 TGNB AYA individuals who completed the survey, most (67%) were aware of PrEP; however, few (7%) had been prescribed PrEP. Many (60%) had not spoken to a medical provider and, even if the medication was free and obtained confidentially, most participants did not plan to take PrEP due to low perceived HIV risk, lack of PrEP knowledge, and concern about interactions between their hormone therapy and PrEP. Discussion These findings underscore the need for broad PrEP educational efforts for both TGNB AYA and their providers to improve knowledge, identify potential PrEP candidates among TGNB AYA and improve access by addressing identified barriers.
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Affiliation(s)
- Arianna Rodriguez
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina Voss
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Jonathan Warus
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Megan Jacobs
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
| | - Kacie M. Kidd
- Division of Adolescent Medicine, WVU Medicine Children’s, Morgantown, WV, United States
| | | | - Jill Blumenthal
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
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Ross J, Betancourt GS, Andrade EA, Klein A, Marrero L, Morales GA, Rivera S, Watnick DL, Patel VV. Collaborative PrEP Implementation Strategies for Latino Men Who have Sex with Men: A Health Center-Community Consensus Process. J Community Health 2023; 48:994-1003. [PMID: 37548892 PMCID: PMC10558404 DOI: 10.1007/s10900-023-01266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
Community-based organizations (CBOs) deliver services in culturally-responsive ways, and could effectively partner with health centers to deliver HIV pre-exposure prophylaxis (PrEP) to Latino men who have sex with men (LMSM). However, few such models exist. We conducted a planning study in collaboration with three CBOs serving LMSM to identify optimal PrEP delivery strategies for health centers and CBOs to implement jointly. We established a Community Expert Panel (CEP) of eight client-facing CBO and health center staff. Over 6 months, the panel met monthly to identify collaborative strategies for PrEP delivery, using a modified Delphi method consisting of the following steps: (1) brainstorming strategies; (2) rating strategies on acceptability, appropriateness and feasibility; (3) review of data from qualitative focus group discussions with CBO clients; and (4) final strategy selection. The panel initially identified 25 potential strategies spread across three categories: improving communication between health centers and CBOs; using low-barrier PrEP options (e.g. telemedicine), and developing locally-relevant, culturally-sensitive outreach materials. Focus groups with CBO clients highlighted a desire for flexible options for PrEP-related care and emphasized trust in CBOs. The final package of strategies consisted of: (1) a web-based referral tool; (2) telemedicine appointments; (3) geographically-convenient options for lab specimen collection; (4) tailored print and social media; and (5) regular coaching sessions with CBO staff. Through a community-engaged process, we identified a package of PrEP delivery strategies that CBOs and health centers can implement in partnership, which have the potential to overcome barriers to PrEP for LMSM.
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Affiliation(s)
- Jonathan Ross
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA.
| | | | - Elí A Andrade
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
| | - Augustus Klein
- Hunter Alliance for Research and Translation, Hunter College, New York, NY, USA
| | | | | | | | - Dana L Watnick
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 3300 Kossuth Avenue, Bronx, NY, 10467, USA
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Lee JJ, Barry MP, Kerani RP, Sanchez TH, Katz DA. The Pre-exposure Prophylaxis (PrEP) Care Continuum Among English-Speaking Latino Sexual Minority Men in the United States (2014-2020). J Acquir Immune Defic Syndr 2023; 93:199-207. [PMID: 36927841 PMCID: PMC10272091 DOI: 10.1097/qai.0000000000003187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is limited understanding of the pre-exposure prophylaxis (PrEP) care continuum specific to Latino/x gay, bisexual, and other sexual minority men (SMM) that encompasses the population residing outside of large metropolitan or urban areas. SETTING We examined trends and characteristics associated with the PrEP care continuum with data from the 2014-2020 cycles of the American Men's Internet Survey, an annual online cross-sectional behavioral survey of cisgender SMM in the United States. METHODS We calculated PrEP continuum outcomes overall and by year among Hispanic/Latino SMM (n = 9010). We used generalized estimating equations with Poisson links to examine (1) temporal trends (2014-2020) in each step of the PrEP continuum and PrEP use in the past year stratified by PrEP eligibility and (2) correlates of each step of the PrEP continuum in 2020 using multivariable models. RESULTS Among 2283 Latino SMM in 2020, 84% reported PrEP awareness, 30% discussed PrEP with a provider, 15% used PrEP in the past year, and 12% were currently using PrEP. PrEP awareness increased from 52% in 2014 to 84% in 2020; and PrEP use in the past year increased from 4% in 2014 to 15% in 2020. In the multivariable models, age and PrEP eligibility were associated with PrEP use in the past year, and urban-rural classification was associated with current PrEP use. CONCLUSIONS While most of the Latino SMM are aware of PrEP, significant gaps remain in this population in discussing PrEP with a provider and using PrEP that require tailored strategies to enhance access to HIV prevention services.
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Affiliation(s)
- Jane J. Lee
- School of Social Work, University of Washington, Seattle, WA
| | - Michael P. Barry
- Department of Epidemiology, University of Washington, Seattle, WA
- Public Health – Seattle & King County, Seattle, WA
| | - Roxanne P. Kerani
- Department of Epidemiology, University of Washington, Seattle, WA
- Public Health – Seattle & King County, Seattle, WA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | | | - David A. Katz
- Department of Global Health, University of Washington, Seattle, WA
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Reid MM, Davis SP, Henry ON, Mathew AA, McCallister S, Nero TT, Rabheru SA, Sampson SH, Vanderslice TF, Williams DT. Demographic diversity of US-based participants in GSK-sponsored interventional clinical trials. Clin Trials 2023; 20:133-144. [PMID: 36744680 PMCID: PMC10021118 DOI: 10.1177/17407745221149118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Demographic diversity among clinical trials is required for representing the real-world populations intended for treatment and disease prevention. Moreover, genetic and environmental differences between ethnic and racial groups necessitate appropriately powered trials for relevant subgroups. We investigate the racial and ethnic demographic diversity of US-based participants in GSK-sponsored interventional trials. We also assess the evaluation of demographic diversity against US Census and epidemiologic data. METHODS GSK-sponsored interventional phase I-IV clinical trials conducted from 2002 to 2019 across three areas were analyzed: pharmaceutical (includes therapeutic medicines except for vaccines and human immunodeficiency virus (HIV)), vaccine (includes prophylactic and therapeutic vaccines), and ViiV (includes HIV therapies). A total of 1005 global trials encompassing 460,707 global participants were identified, of which 495 had US-based sites with a total of 108,261 (23.5% of global) US participants (pharmaceutical, n = 357 trials; vaccine, n = 45 trials; and ViiV, n = 93 trials). We evaluated how GSK US-based trial recruitment compares with US Census (in line with previously published studies from other groups) and with epidemiologic data. RESULTS GSK participant data for race and ethnicity combined across areas were generally similar to US Census levels (e.g. GSK versus census: White, 76.5% versus 76.3%; Black or African American, 15.1% versus 13.4%; Asian, 1.8% versus 5.9%; Hispanic or Latino, 14.0% versus 18.5%; Non-Hispanic White, 63.5% versus 60.1%). However, this was not the case for the individual pharmaceutical, vaccine, and ViiV data sets; least represented groups were Asian individuals for pharmaceutical and ViiV trials and American Indian or Alaskan Native individuals for vaccine trials (6.2%, 11.8%, and 11.1% of trials met/exceeded census level representation, respectively). The percentage of trials reaching/exceeding census levels also varied per trial phase for race and ethnicity. Furthermore, disparities in the percentage of trials reaching/exceeding census levels versus epidemiology-based prevalence levels have revealed opportunities to improve industry success metrics; in HIV trials, the proportion of Black or African American individuals (35.1%) exceeded census (13.4%) but not epidemiologic levels (55.3%). CONCLUSION Further work is required to achieve demographic diversity across clinical trials. We conclude that US Census data are an inappropriate universal benchmark. A shift to epidemiology benchmarking will enable the consideration of global participants into US analyses for highly intrinsic (i.e. influenced by ancestry) diseases and more firm requirements for US-based participants into US analyses for extrinsic (i.e. influenced by location or culture) diseases. Benchmarking in line with epidemiologic data will allow us to set better trial enrollment goals, with the aim of conducting more demographically balanced, diverse, and representative clinical trials and enabling a better understanding of drug safety and efficacy per demographic group.
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Affiliation(s)
| | | | - Ouzama N Henry
- GSK, Rockville, MD, USA.,Dynavax Technologies, Emeryville, CA, USA
| | | | | | | | | | - Shani H Sampson
- GSK, Collegeville, PA, USA.,Independent Project Management Consultant for the Pharmaceutical Industry, Philadelphia, PA, USA
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Wang G, Song W, Rao S, Heitgerd J, Mulatu MS, Karch D, Belcher L. HIV Positivity, Linkage to Medical Care, Interview for Partner Services, and Pre-Exposure Prophylaxis Awareness and Referral Among Men Who Have Sex With Men Tested in Non-healthcare Settings in the United States, 2019. J Acquir Immune Defic Syndr 2023; 92:34-41. [PMID: 36166309 PMCID: PMC10959101 DOI: 10.1097/qai.0000000000003106] [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: 06/15/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. This study reports data on HIV testing program outcomes among MSM tested for HIV in non-healthcare settings in the United States. METHODS We analyzed Centers for Disease Control and Prevention's National HIV Prevention Program Monitoring and Evaluation data collected in 2019. Descriptive and multivariate robust Poisson regression analyses were conducted to summarize the patterns of HIV testing program outcomes [ie, positivity, linkage to HIV medical care within 30 days of diagnosis, interview for partner services (PS), and pre-exposure prophylaxis (PrEP) awareness and referral] by demographic characteristics, HIV prevalence, and testing site type. RESULTS A total of 123,251 HIV tests were conducted among MSM; of these, 1773 (1.4%) were newly diagnosed with HIV. Among MSM newly diagnosed with HIV, 75% were linked to HIV medical care and 80% were interviewed for PS. Among MSM who tested HIV-negative, 63% were aware of PrEP and 47% of those who were eligible for PrEP were referred to PrEP providers. Referral or linkage to services varied by demographic characteristics or other factors. CONCLUSIONS Linkage to HIV medical care and interview for PS among MSM newly diagnosed with HIV in non-healthcare settings were below national or funding program targets. Most MSM with risk factors for HIV infection were not referred to PrEP providers. Expanded efforts to address barriers to equitable access to services may help improve HIV-related outcomes among MSM and contribute to ending the HIV epidemic in the United States.
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Affiliation(s)
- Guoshen Wang
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wei Song
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shubha Rao
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet Heitgerd
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mesfin S. Mulatu
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Debra Karch
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Belcher
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Campbell JT, Adams OR, Bennett-Brown M, Woodward B, Gesselman AN, Carter G. PrEP Familiarity, Interest, and Usage Among 364 Black and Hispanic Adults in Indiana. Front Public Health 2022; 10:810042. [PMID: 35602152 PMCID: PMC9120626 DOI: 10.3389/fpubh.2022.810042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Pre-exposure prophylaxis, or PrEP, is a once-daily preventative prescription pill against HIV for adults or adolescents who have sex or inject drugs. PrEP may be especially useful among Black and Hispanic Americans, who are particularly at risk for HIV in the United States. In spite of this vulnerability, rates of PrEP use in Black and Hispanic communities are low. Here, we examined familiarity with, prior usage of, and future interest in PrEP among 364 Black and Hispanic Indiana residents. Indiana is an important context for this work, due to severe HIV outbreaks in the area over the last 8 years. Around half of all participants had never heard of PrEP, with Hispanic participants being less familiar than Black participants. Prior PrEP use was low, at around 10%, and was lower for Hispanic than Black participants. Around 21% of all participants reported interest in PrEP after learning of it in our study. Further, participants identified strategies that would make discussions about PrEP with a medical provider more comfortable. Black and Hispanic participants reported feeling the most comfortable with addressing PrEP usage with providers if: (a) the provider was the one who brought up the subject of PrEP, (b) there was written information available to the patient (i.e., brochures), and (c) the patient already knew they qualified for the prescription in terms of personal eligibility and insurance coverage. Additional provider and patient education, as well as openness on the part of the provider, can help to lessen the disparities associated with PrEP need and actual PrEP usage.
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Affiliation(s)
- Jessica T. Campbell
- The Kinsey Institute, Indiana University, Bloomington, IN, United States
- *Correspondence: Jessica T. Campbell
| | - Olivia R. Adams
- The Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Gender Studies, Indiana University, Bloomington, IN, United States
- Department of Nursing, Indiana University, Bloomington, IN, United States
| | - Margaret Bennett-Brown
- The Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Communication Studies, Texas Tech University, Lubbock, TX, United States
| | - Brennan Woodward
- Department of Nursing, Indiana University, Bloomington, IN, United States
| | | | - Gregory Carter
- The Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Nursing, Indiana University, Bloomington, IN, United States
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Safety and efficacy of G2-S16 dendrimer as microbicide in healthy human vaginal tissue explants. J Nanobiotechnology 2022; 20:151. [PMID: 35307031 PMCID: PMC8935742 DOI: 10.1186/s12951-022-01350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The absence of an effective treatment and vaccine in HIV-1 pandemic place preventive strategies such as safety and effective microbicide development as a central therapeutic approach to control HIV-1 pandemic nowadays. RESULTS Studies of cytotoxicity, immune population status, inflammation or tissue damage and mainly prophylactic inhibition of HIV-1 infection in vaginal human explants demonstrate the biosafety and effectivity of G2-S16 dendrimer. Human explants treated with G2-S16 dendrimer or treated and HIV-1 infected do not presented signs of irritation, inflammation, immune activation or T cell populations deregulation. CONCLUSIONS Herein we conclude that G2-S16 dendrimer has demonstrated sufficient efficacy, biosafety, effectivity and behavior in the closest to the real-life condition model represented by the human healthy donor vaginal tissue explants, to raise G2-S16 dendrimer as a promising candidate to clinical trials to develop an effective microbicide against HIV-1 infection.
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