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Anderson KM, Blumenthal J, Jain S, Sun X, Amico KR, Landovitz R, Zachek CM, Morris S, Moore DJ, Stockman JK. The impact of intimate partner violence on PrEP adherence among U.S. Cisgender women at risk for HIV. BMC Public Health 2024; 24:1461. [PMID: 38822300 PMCID: PMC11140862 DOI: 10.1186/s12889-024-18946-4] [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: 08/31/2023] [Accepted: 05/23/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Cisgender women account for 1 in 5 new HIV infections in the United States, yet remain under-engaged in HIV prevention. Women experiencing violence face risk for HIV due to biological and behavioral mechanisms, and barriers to prevention, such as challenges to Pre-Exposure Prophylaxis for HIV Prevention (PrEP) adherence. In this analysis, we aim to characterize intimate partner violence (IPV) among cisgender heterosexual women enrolled in a PrEP demonstration project and assess the associations with PrEP adherence. METHODS Adherence Enhancement Guided by Individualized Texting and Drug Levels (AEGiS) was a 48-week single-arm open-label study of PrEP adherence in HIV-negative cisgender women in Southern California (N = 130) offered daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). From 6/2016 to 10/2018, women completed a survey reporting HIV risk behavior and experiences of any IPV (past 90-days) and IPV sub-types (past-year, lifetime) and biological testing for HIV/STIs at baseline, and concentrations of tenofovir-diphosphate (TFV-DP) in dried blood spots at weeks 4, 12, 24, 36, and 48. Outcomes were TFV-DP concentrations consistent with ≥ 4 or ≥ 6 doses/week at one or multiple visits. Multivariable logistic regression models were conducted to examine associations. RESULTS Past-90-day IPV was reported by 34.4% of participants, and past-year and lifetime subtypes reported by 11.5-41.5%, and 21.5-52.3%, respectively. Women who engaged in sex work and Black women were significantly more likely to report IPV than others. Lifetime physical IPV was negatively associated with adherence at ≥ 4 doses/week at ≥ 3 of 5 visits, while other relationships with any IPV and IPV sub-types were variable. CONCLUSION IPV is an indication for PrEP and important indicator of HIV risk; our findings suggest that physical IPV may also negatively impact long-term PrEP adherence. CLINICAL TRIALS REGISTRATION NCT02584140 (ClinicalTrials.gov), registered 15/10/2015.
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Grants
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- EI11-SD-005B California HIV/AIDS Research Program
- KL2TR001444 NIH HHS
- P30AI036214 Center for AIDS Research, University of California, San Diego
- P30AI036214 Center for AIDS Research, University of California, San Diego
- P30AI036214 Center for AIDS Research, University of California, San Diego
- P30AI036214 Center for AIDS Research, University of California, San Diego
- P30AI036214 Center for AIDS Research, University of California, San Diego
- National Institutes of Health
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Affiliation(s)
- Katherine M Anderson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA, 92093-0507, USA.
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Jill Blumenthal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA, 92093-0507, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA, 92093-0725, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA, 92093-0725, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Raphael Landovitz
- David Geffen School of Medicine, UCLA Center for Clinical AIDS Research & Education, University of California Los Angeles, Los Angeles, CA, 90024, USA
| | - Christine M Zachek
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego Health, 9300 Campus Point Drive, La Jolla, San Diego, CA, 92037, USA
| | - Sheldon Morris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA, 92093-0507, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA, 92103, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA, 92093-0507, USA
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MacPhail C, Manlik K, Dews H, Mao L, Rutherford A. Ending HIV Transmission in Australia: Expanding PrEP to Cisgender Women: A Scoping Review. AIDS Behav 2024:10.1007/s10461-024-04386-z. [PMID: 38806843 DOI: 10.1007/s10461-024-04386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
Pre-exposure prophylaxis (PrEP) availability through the Pharmaceutical Benefits Scheme provides real potential for the elimination of HIV transmission in Australia, as evidenced by a rapid decline in HIV incidence among gay and bisexual men (GBM). However, HIV elimination will not be possible without also extending PrEP to other populations, including cisgender women. We conducted a scoping review to examine the extent to which PrEP access for cisgender women has been considered in Australia. A comprehensive search across five databases, grey literature, and hand search of references was conducted. A single reviewer conducted title and abstract screening and two reviewers completed full-text screening and data extraction. Nineteen documents were included in the final review and included both peer-reviewed journal articles and guidelines and strategies. Focused discussion of cisgender women's use of PrEP was largely missing from the literature and, although their use of PrEP is supported in some relevant guidelines, little has been done to actively develop strategies to inform cisgender women about PrEP as a precursor to prescribing for HIV prevention. Healthcare providers' narrow view of PrEP as being the domain of GBM further limits cisgender women's potential access. If HIV elimination in Australia is to be a reality, we need to develop mechanisms to specifically engage with cisgender women about PrEP.
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Affiliation(s)
- Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, Australia.
| | - Kate Manlik
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Hannah Dews
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Alison Rutherford
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
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Nydegger LA, Kidane H, Benitez S, Yuan M, Claborn KR. A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:771-783. [PMID: 37796358 PMCID: PMC10844362 DOI: 10.1007/s10508-023-02712-5] [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: 01/04/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.
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Affiliation(s)
- Liesl A Nydegger
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Hampton House, 624 N. Broadway Street, Baltimore, MD, 21205, USA.
| | - Heran Kidane
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Sabrina Benitez
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - Mandy Yuan
- School of Human Ecology, University of Texas at Austin, Austin, TX, USA
| | - Kasey R Claborn
- School of Social Work, University of Texas at Austin, Austin, USA
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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:S0002-9378(24)00060-7. [PMID: 38290644 DOI: 10.1016/j.ajog.2024.01.019] [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: 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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Zack JL, Hull SJ, Coleman ME, Ye PP, Lotke PS, Visconti A, Beverley J, Brant A, Moriarty P, Scott RK. Age-related factors associated with intention to initiate pre-exposure prophylaxis among cisgender women in Washington D.C. Ther Adv Infect Dis 2024; 11:20499361241252351. [PMID: 38751758 PMCID: PMC11095193 DOI: 10.1177/20499361241252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) utilization among cisgender women (subsequently 'women') is low across age groups, relative to their risk of HIV acquisition. We hypothesize that age-related differences in psychosocial factors also influence women's intention to initiate oral PrEP in Washington, D.C. Methods A secondary analysis of a cross-sectional survey data was performed to evaluate factors influencing intention to initiate oral PrEP among women seen at a family planning and a sexual health clinic. A bivariate analysis was performed to identify differences by age group in demographic characteristics, indications for PrEP, and attitudes toward PrEP; we then performed additional bivariate analysis to assess these variables in relation to PrEP intention. Results Across age groups, perceived risk of HIV acquisition was not significantly different and was not associated with intention to initiate PrEP. Awareness of and attitude toward PrEP, injunctive norms, descriptive norms, and self-efficacy were not different across age, however there were significant age-associated differences in relation to PrEP intention. Specifically, among 18-24-year-olds, intention to start PrEP was associated with support from provider (p = 0.03), main sexual partner (p < 0.01), and peers (p < 0.01). For women 25-34 years old, having multiple sexual partners (p = 0.03) and support from casual sexual partners (p = 0.03) was also important. Among women 35-44 years old, prior awareness of PrEP (p = 0.02) and their children's support of PrEP uptake (p < 0.01) were associated with intention to initiate PrEP. Among 45-55 year-old women intention to initiate PrEP was positively associated with engaging in casual sex (p = 0.03) and negatively associated with stigma (p < 0.01). Conclusion Overall, there were more similarities than differences in factors influencing intention to initiate PrEP across age groups. Observed differences offer an opportunity to tailor PrEP delivery and HIV prevention interventions to increase awareness and uptake for cisgender women.
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Affiliation(s)
- Jennifer L. Zack
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA
| | - Shawnika J. Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Megan E. Coleman
- Whitman-Walker Health, Department of Clinical Investigations, Washington, DC, USA
| | - Peggy Peng Ye
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Pamela S. Lotke
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Adam Visconti
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Georgetown University Hospital, Department of Family Medicine, Washington, DC, USA
| | - Jason Beverley
- DC Health, DC Department of Health: HIV/AIDS, Hepatitis, STD & TB Administration (HAHSTA), Washington, DC, USA
| | - Ashley Brant
- Cleveland Clinic Foundation, Women’s Health Institute, Cleveland, OH, USA
| | - Patricia Moriarty
- MedStar Health Research Institute, Clinical Research, Hyattsville, MD, USA
| | - Rachel K. Scott
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
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Hull SJ, Duan X, Brant AR, Ye PP, Lotke PS, Huang JC, Coleman ME, Nalls P, Scott RK. Understanding Psychosocial Determinants of PrEP Uptake Among Cisgender Women Experiencing Heightened HIV Risk: Implications for Multi-Level Communication Intervention. HEALTH COMMUNICATION 2023; 38:3264-3275. [PMID: 36398676 PMCID: PMC10192462 DOI: 10.1080/10410236.2022.2145781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective daily pill that decreases the likelihood of HIV acquisition by up to 92% among individuals at risk for HIV. PrEP can be discretely used, autonomously controlled, and in place at the time of risk exposure, making it an especially promising method for HIV prevention for cisgender women (CGW). But, PrEP is underutilized by CGW relative to the demonstrable need. We apply the Integrative Model of Behavioral Prediction to identify the critical psychosocial factors that shape CGW's intentions to use PrEP and their relevant underlying beliefs. We surveyed (N = 294) community- and clinic-recruited PrEP eligible CGW to understand the relative importance of attitudes, norms, and efficacy in shaping PrEP intentions. We utilized structural equation modeling to identify the relevant paths. We inspected the summary statistics in relation to three message three selection criteria. We identified beliefs that demonstrated (1) an association with intention, (2) substantial room to move the population, (3) practicality as a target for change through communication intervention. Results show that PrEP awareness was low. When women learned about PrEP, they voiced positive intentions to use it. There were significant and positive direct effects of SE (0.316***), attitudes (0.201**), and subjective norms (0.249***) on intention to initiate PrEP. We illustrate the strategic identification of beliefs within the relevant paths using the 3 belief selection criteria. We also discuss implications for social and structural communication interventions to support women's HIV prevention.
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Affiliation(s)
| | - Xuejing Duan
- Department of Biostatistics and Bioinformatics, The George Washington University
| | | | - Peggy Peng Ye
- Women’s and Infants’ Services Department, MedStar Washington Hospital Center
- Obstetrics & Gynecology, Georgetown University School of Medicine
| | - Pamela S. Lotke
- Women’s and Infants’ Services Department, MedStar Washington Hospital Center
- Obstetrics & Gynecology, Georgetown University School of Medicine
| | - Jim C. Huang
- Department of Business Management, National Sun Yat-sen University
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Arnold T, Whiteley L, Elwy RA, Ward LM, Konkle-Parker DJ, Brock JB, Giorlando KK, Barnett AP, Sims-Gomillia C, Craker LK, Lockwood KR, Leigland A, Brown LK. Mapping Implementation Science with Expert Recommendations for Implementing Change (MIS-ERIC): Strategies to Improve PrEP Use among Black Cisgender Women Living in Mississippi. J Racial Ethn Health Disparities 2023; 10:2744-2761. [PMID: 36396922 PMCID: PMC9672575 DOI: 10.1007/s40615-022-01452-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are disproportionately affected by the HIV epidemic. Strategies to increase Black women's use of pre-exposure prophylaxis (PrEP) are needed. METHODS Interviews were conducted in Mississippi (MS) with Black, cisgender women at risk for HIV, and community healthcare clinic (CHC) staff who work directly with this population. Reflexive thematic analysis was used to identify barriers and select appropriate implementation strategies to increase PrEP care. RESULTS Twenty Black women and twelve CHC staff were interviewed. PrEP use barriers resulted from low HIV risk awareness, lack of PrEP knowledge, and structural and stigma-related barriers. Methods for PrEP education and motivation included normalizing PrEP in public communications, providing education at places where women congregate, and tailoring PrEP content with Black women as educators. The Expert Recommendations for Implementing Change (ERIC) project provides a way for implementation scientists to select strategies that are consistent within research and practice across studies. Strategies from the ERIC project were selected to address implementation barriers. CONCLUSIONS Tailoring PrEP implementation protocols to increase Black women's access, engagement, and adherence to PrEP is needed. This is one of the first implementation studies to incorporate these four implementation concepts into a single study: (1) implementation outcomes, (2) i-PARIHS, (3) ERIC's strategy list, and (4) operationalizing the strategies using the Proctor et al., guidelines. Results provide an in-depth comprehensive list of implementation strategies to increase PrEP uptake for Black women in MS.
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Affiliation(s)
- Trisha Arnold
- Brown University Warren Alpert Medical School, Providence, RI, USA.
- Department of Psychiatry, Rhode Island Hospital, Providence, USA.
| | - Laura Whiteley
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Rani A Elwy
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Lori M Ward
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Deborah J Konkle-Parker
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - James B Brock
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | | | - Andrew P Barnett
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Courtney Sims-Gomillia
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Lacey K Craker
- Division of Prevention Science and Community Health, University of Miami, Miami, USA
| | - Khadijra R Lockwood
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Larry K Brown
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
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Darlington CK, Lipsky RK, Teitelman AM, Koblin BA, Davis A, Walcott M, Compton PA, Tieu HV. HIV risk perception, pre-exposure prophylaxis (PrEP) awareness, and PrEP initiation intention among women who use drugs. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209119. [PMID: 37451517 PMCID: PMC10529693 DOI: 10.1016/j.josat.2023.209119] [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: 11/09/2022] [Revised: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Women who use drugs (WWUD) are prime candidates for pre-exposure prophylaxis (PrEP) due to their elevated risk of acquiring HIV through biological, behavioral, and contextual factors. However, PrEP uptake among WWUD remains low. The relationship between unhealthy drug use and correlates of PrEP uptake in this vulnerable population is not well defined. The purpose of this study is to characterize the relationships between specific types and routes of drug use and several precursors of PrEP uptake among WWUD. METHODS The study collected data via a computer-based survey from 233 women living in New York City and Philadelphia who participated in a study designed to develop and pilot a women-focused intervention for PrEP uptake. The sample of cisgender, HIV-negative women were not currently taking PrEP but considered PrEP eligible. This analysis is focused on women's HIV risk perception, PrEP awareness, PrEP initiation intention, and any use of the following drugs: barbiturates, benzodiazepines, crack cocaine, powder cocaine, hallucinogens, heroin, methamphetamines, and prescription opioids. RESULTS Within the three months prior to study enrollment, 63.1 % of participants reported any drug use; 42 % reported polydrug use; 19.8 % had injected drugs; 75 % reported getting high or drunk before sex; and 44 % had been enrolled in drug treatment. Of our total sample, 41.2 % perceived themselves at risk for HIV infection, 41.6 % were aware of PrEP prior to the study, and 62.7 % intended to initiate PrEP after they were informed. When compared to other PrEP-eligible women, women who reported prescription opioid use and polydrug use perceived themselves at higher risk for HIV infection and had higher intention to start PrEP. However, they and women who reported injecting drugs also reported lower awareness of PrEP. CONCLUSION These findings have implications for increasing education about PrEP and the various modes of HIV exposure to support PrEP uptake in this vulnerable population.
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Affiliation(s)
| | | | - Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Thomas Jefferson University, College of Nursing, Philadelphia, PA, USA
| | | | - Annet Davis
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Melonie Walcott
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | - Peggy A Compton
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Scott RK, Hull SJ, Huang JC, Ye PP, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Elion R, Visconti AJ, Coleman M. Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City. Womens Health Issues 2023; 33:541-550. [PMID: 37479630 PMCID: PMC10552685 DOI: 10.1016/j.whi.2023.05.009] [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: 10/27/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions. METHODS We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP. RESULTS A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13-2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02-1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33-2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20-4.75) on the institutional level. CONCLUSION Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.
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Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia.
| | - Shawnika J Hull
- Rutgers University, Department of Communications, New Brunswick, New Jersey
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Peggy P Ye
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Pamela Lotke
- MedStar Washington Hospital Center, Washington, District of Columbia
| | | | | | | | - Allison Ward
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Ashley R Brant
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Rick Elion
- DC Health, Washington, District of Columbia
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10
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Hamilton DT, Agutu C, Sirengo M, Chege W, Goodreau SM, Elder A, Sanders EJ, Graham SM. Modeling the impact of different PrEP targeting strategies combined with a clinic-based HIV-1 nucleic acid testing intervention in Kenya. Epidemics 2023; 44:100696. [PMID: 37390706 PMCID: PMC10529734 DOI: 10.1016/j.epidem.2023.100696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Up to 69% of adults who acquire HIV in Kenya seek care for acute retroviral symptoms, providing an important opportunity for early diagnosis and HIV care engagement. The Tambua Mapema Plus (TMP) trial tested a combined HIV-1 nucleic acid testing, linkage, treatment, and partner notification intervention for adults with symptoms of acute HIV infection presenting to health facilities in coastal Kenya. We estimated the potential impact on the Kenyan HIV epidemic of providing PrEP to individuals testing negative in TMP, if scaled up. METHODS We developed an agent-based simulation of HIV-1 transmission using TMP data and current Kenyan statistics. PrEP interventions were layered onto a model of TMP as standard of care, to estimate additional potential population-level impact of enrolling HIV-negative individuals identified through TMP on PrEP over 10 years. Four scenarios were modeled: PrEP for uninfected individuals in disclosed serodiscordant couples; PrEP for individuals with concurrent partnerships; PrEP for all uninfected individuals identified through TMP; and PrEP integrated into the enhanced partner services component of TMP. FINDINGS Providing PrEP to both individuals with concurrent partnerships and uninfected partners identified through enhanced partner services reduced new HIV infections and was efficient based on numbers needed to treat (NNT). The mean percent of infections averted was 2.79 (95%SI:-10.83, 15.24) and 4.62 (95%SI:-9.5, 16.82) when PrEP uptake was 50% and 100%, respectively, and median NNT was 22.54 (95%SI:not defined, 6.45) and 27.55 (95%SI:not defined, 11.0), respectively. Providing PrEP for all uninfected individuals identified through TMP averted up to 12.68% (95%SI:0.17, 25.19) of new infections but was not efficient based on the NNT: 200.24 (95%SI:523.81, 123.23). CONCLUSIONS Providing PrEP to individuals testing negative for HIV-1 nucleic acid after presenting to a health facility with symptoms compatible with acute HIV adds value to the TMP intervention, provided PrEP is targeted effectively and efficiently. FUNDING National Institutes of Health, Sub-Saharan African Network for TB/HIV Research Excellence.
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Affiliation(s)
- Deven T Hamilton
- Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, United States.
| | - Clara Agutu
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Wairimu Chege
- National Institutes of Allergy & Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Steven M Goodreau
- Departments of Anthropology and Epidemiology, University of Washington, Seattle, WA, United States
| | - Adam Elder
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Eduard J Sanders
- KEMRI - Wellcome Trust Research Programme, Kilifi, Kenya; University of Oxford, Headington, United Kingdom
| | - Susan M Graham
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA, United States
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Scott RK, Deyarmond M, Marwitz S, Huang JC, Moriarty P, Visconti AJ, Beverley J, Elion R, Coleman M, Hull SJ. Implementation of an Educational Intervention to Improve HIV Pre-Exposure Prophylaxis Services for Women in an Urban Sexual Health Clinic. AIDS Patient Care STDS 2023; 37:447-457. [PMID: 37713289 PMCID: PMC10623070 DOI: 10.1089/apc.2023.0107] [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: 09/17/2023] Open
Abstract
To test the hypothesis that implementation of a multicomponent, educational HIV pre-exposure prophylaxis (PrEP) intervention to promote universal PrEP services for cisgender women (subsequently "women") in sexual and reproductive health centers would improve the proportion of women screened, offered, and prescribed PrEP, we implemented a multicomponent, educational intervention in a Washington D.C. Department of Health-sponsored sexual health clinic. The clinic serves a patient population with high-potential exposure to HIV. The intervention included clinic-wide PrEP trainings, an electronic health record prompt for PrEP counseling by providers, and educational videos in the waiting room. We collected preimplementation data from March 22, 2018 to July 4, 2018, including 331 clinical encounters for 329 women. Between July 5, 2018 and July 1, 2019, there were 1733 clinical encounters for 1720 HIV-negative women. We used mixed methods to systematically assess intervention implementation using the Reach Effectiveness Adoption Implementation Maintenance framework. Additionally, we assessed the interventions' acceptability and feasibility among providers through semistructured interviews. The proportion of women screened by providers for PrEP (5.6% preimplementation to a mean of 89.2% of women during the implementation period, p < 0.01), offered (6.2 to 69.8%, p < 0.01), and prescribed PrEP (2.6 to 8.1%, p < 0.01) by providers increased significantly in the implementation period. Providers and clinic staff found the intervention both highly feasible and acceptable and demonstrated increased knowledge of PrEP and HIV prevention associated with the clinic-wide trainings. Our results demonstrate the effectiveness of a low-cost educational intervention to increase provision of integrated PrEP services in an urban sexual health clinic serving women with high-potential exposure to HIV. ClinicalTrials.gov ID NCT03705663.
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Affiliation(s)
- Rachel K. Scott
- Department of Women's and Infants' Services, MedStar Washington Hospital Center, Division of Women's Health Research, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Megan Deyarmond
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Shannon Marwitz
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jim C. Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Patricia Moriarty
- Division of Women's Health Research, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Adam J. Visconti
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Jason Beverley
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Rick Elion
- HIV/AIDS, Hepatitis, STD and TB Administration, DC Health, Washington, District of Columbia, USA
| | - Megan Coleman
- Whitman Walker Health, Washington, District of Columbia, USA
| | - Shawnika J. Hull
- Department of Prevention and Community Medicine, George Washington University, Washington, District of Columbia, USA
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12
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Ayangeakaa SD, Kerr J, Combs RM, Harris LM, Sears JS, Parker K, Sterrett-Hong E. Sociocultural and structural influences on HIV Pre-Exposure Prophylaxis (PrEP) Engagement and Uptake among African American Young adults. BMC Public Health 2023; 23:1427. [PMID: 37495954 PMCID: PMC10369814 DOI: 10.1186/s12889-023-16273-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) demonstrates effectiveness in decreasing new cases of HIV. However, few African Americans use PrEP, despite being disproportionately impacted by HIV. Understanding the influence of sociocultural and structural factors on PrEP use among multiple priority groups of African Americans, including but not limited to men who have sex with men, may improve PrEP engagement and uptake. The social ecological model (SEM) as a framework guided the understanding of how these factors operate on multiple levels to influence PrEP use among this population. METHODS This study derived data from the Afya PrEP study consisting of eleven focus groups (N = 63) with 18-29-year-old African American sexual and gender minority and heterosexual individuals at heightened behavioral vulnerability to HIV. We employed constructivist grounded theory processes to inductively analyze the data. A pooled kappa score of 0.90 indicated excellent inter-rater agreement. RESULTS Factors impacting PrEP engagement among African American young adults included: (1) Community/social network influences; (2) medical mistrust; (3) stigma; (4) PrEP availability and accessibility, which had two sub-categories: (a) cost and (b) where to obtain PrEP; and (5) PrEP engagement strategies, which had two sub-categories: (a) current AIDS service organizations' PrEP engagement practices and (b) recommended future PrEP engagement strategies. Categories one through three represent sociocultural factors, and categories four and five represent structural factors that influence perceptions and attitudes of African American young adults regarding PrEP. CONCLUSION Our study highlights sociocultural and structural factors that act as barriers and facilitators to PrEP engagement. The SEM guided the understanding of how these factors operated on multiple levels. One of the sociocultural factors, community/social network influences operated at the interpersonal level of the SEM; the other two, stigma and medical mistrust, operated at the community level. The structural factors (PrEP availability, accessibility, and engagement strategies) operated at the institutional/organizational level. Thus, multi-level interventions are warranted to improve PrEP engagement among various African American young adult priority groups.
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Affiliation(s)
- Suur D Ayangeakaa
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St. Durham, Durham, NC, 27701, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Ryan M Combs
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Lesley M Harris
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Jeanelle S Sears
- Department of Human Services, Bowling Green State University, Bowling Green, OH, USA
| | | | - Emma Sterrett-Hong
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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13
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Demart S, Gérard E. The Construction of Pre-exposure Prophylaxis (PrEP) by Prevention Professionals as a Tool for Black African Migrant Women … or Not? AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:496-511. [PMID: 36454134 DOI: 10.1521/aeap.2022.34.6.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
While sub-Saharan African migrants are recognized as a key population in the HIV epidemics, they are absent from the PrEP delivery system and in particular women. The central argument of this article is that PrEP for Black African migrant women is an ambivalent offer that makes it necessary to understand how migration, gender, sexuality, and origin interact. Bringing together a sociologist and a prevention project manager, this article looks at how Belgian prevention professionals navigate with this ambivalent offer. From semi-directive interviews we explore how PrEP is constructed as a prevention tool for this population. The results show that different causalities are attributed to their absence from PrEP delivery system. This pluralism leads us to argue that there is a real blurring in the definition of this public as a "priority" in terms not only of representations and practices but also of political agenda.
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Affiliation(s)
- Sarah Demart
- Observatoire du sida et des sexualités, Université Libre de Bruxelles, Bruxells, Belgium
| | - Emilie Gérard
- Prevention worker and project manager with Plateforme Prévention Sida, Bruxelles, Belgium
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14
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Ruderman LW, Ochwal P, Marcus N, Napierala S, Thirumurthy H, Agot K, Maman S. 'When I have these kits … I have confidence' - HIV self-testing provides agency for women in their sexual decision-making. Glob Public Health 2022; 17:3735-3746. [PMID: 35770697 PMCID: PMC9800639 DOI: 10.1080/17441692.2022.2092176] [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: 10/12/2021] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
Abstract
Oral fluid-based HIV self-testing (HIVST) has emerged as a promising approach to increasing HIV testing coverage, particularly among high-risk populations. Understanding the experiences of women using self-tests and offering them to their sexual partners (secondary distribution) is crucial for determining the potential of HIVST. Qualitative in-depth interviews were conducted among 32 women at high risk of HIV infection, including women who engage in transactional sex, who participated in a cluster randomised trial of a secondary distribution strategy in western Kenya. Interviews explored how women used self-tests within relationships and how this affected their sexual decision-making. Three key themes emerged: women used HIVST to assess risk prior to engaging in sex with partners; HIVST provided women with increased agency to engage in or end relationships; and women appreciated these benefits and urged expanded access to self-tests. HIVST has the potential to support HIV prevention objectives in settings with high prevalence of HIV.Trial registration: ClinicalTrials.gov identifier: NCT03135067.
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Affiliation(s)
- Lucy W. Ruderman
- Gillings School of Global Public Health Department of Health Behaviour, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Perez Ochwal
- Impact Research and Development Organization, Kisumu, Kenya
| | - Noora Marcus
- Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Sue Napierala
- Women’s Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Harsha Thirumurthy
- Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Suzanne Maman
- Gillings School of Global Public Health Department of Health Behaviour, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Hamilton DT, Agutu C, Babigumira JB, van der Elst E, Hassan A, Gichuru E, Mugo P, Farquhar C, Ndung'u T, Sirengo M, Chege W, Goodreau SM, Elder A, Sanders EJ, Graham SM. Modeling the Impact of HIV-1 Nucleic Acid Testing Among Symptomatic Adult Outpatients in Kenya. J Acquir Immune Defic Syndr 2022; 90:553-561. [PMID: 35510854 PMCID: PMC9259037 DOI: 10.1097/qai.0000000000003013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Up to 69% of adults who acquire HIV in Kenya seek care before seroconversion, providing an important opportunity for early diagnosis and treatment. The Tambua Mapema Plus (TMP) trial tested a combined HIV-1 nucleic acid testing, linkage, treatment, and partner notification intervention for adults aged 18-39 years with symptoms of acute HIV infection presenting to health facilities in coastal Kenya. We estimated the potential impact of TMP on the Kenyan HIV epidemic. METHODS We developed an agent-based network model of HIV-1 transmission using TMP data and Kenyan statistics to estimate potential population-level impact of targeted facility-based testing over 10 years. Three scenarios were modeled: standard care [current use of provider-initiated testing and counseling (PITC)], standard HIV rapid testing scaled to higher coverage obtained in TMP (scaled-up PITC), and the TMP intervention. RESULTS Standard care resulted in 90.7% of persons living with HIV (PLWH) knowing their status, with 67.5% of those diagnosed on treatment. Scaled-up PITC resulted in 94.4% of PLWH knowing their status and 70.4% of those diagnosed on treatment. The TMP intervention achieved 97.5% of PLWH knowing their status and 80.6% of those diagnosed on treatment. The percentage of infections averted was 1.0% (95% simulation intervals: -19.2% to 19.9%) for scaled-up PITC and 9.4% (95% simulation intervals: -8.1% to 24.5%) for TMP. CONCLUSION Our study suggests that leveraging new technologies to identify acute HIV infection among symptomatic outpatients is superior to scaled-up PITC in this population, resulting in >95% knowledge of HIV status, and would reduce new HIV infections in Kenya.
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Affiliation(s)
- Deven T. Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA
| | - Clara Agutu
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
| | | | | | - Amin Hassan
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
| | | | - Peter Mugo
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
| | - Carey Farquhar
- Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA
| | | | - Martin Sirengo
- National AIDS and STI Control Programme, Nairobi, Kenya;
| | - Wairimu Chege
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD
| | | | - Adam Elder
- Biostatistics, University of Washington, Seattle, WA; and
| | - Eduard J. Sanders
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
- University of Oxford, Headington, United Kingdom.
| | - Susan M. Graham
- Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA
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16
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Young AM, Fruhauf T, Okonkwo O, Gingher E, Coleman J. Developing Educational Animations on HIV Pre-exposure Prophylaxis (PrEP) for Women: Qualitative Study. JMIR Form Res 2022; 6:e33978. [PMID: 35802416 PMCID: PMC9308066 DOI: 10.2196/33978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/03/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite experiencing the second-highest rate of HIV incidence in the United States, pre-exposure prophylaxis (PrEP) use remains low among Black women due, in part, to a lack of patients’ awareness and providers’ knowledge. Objective Our goal was to design animated educational tools informed by patients and women’s health providers to address these barriers, specifically for women at risk for HIV. Methods Two animation storyboards about PrEP for women were created by academic stakeholders (eg, HIV clinical experts, educators, and HIV peer counselors), one for patients and one for providers. Four focus groups with community members from Baltimore, Maryland and four with women’s health providers (eg, obstetrician/gynecologists, midwives, nurse practitioners, and peer counselors) at an academic center were conducted to discuss the storyboards. Transcripts were analyzed using conventional content analysis, and themes were incorporated into the final versions of the animations. Results Academic stakeholders and 30 focus group participants (n=16 female community members and n=14 women’s health providers) described important themes regarding PrEP. The themes most commonly discussed about the patient animation were understandability of side effects, HIV risk factors, messaging, PrEP access, and use confidence. Provider animation themes were indications for PrEP, side effects, and prescribing confidence. Conclusions We created two PrEP animations focused on women. Stakeholder feedback highlighted the importance of ensuring the understandability and applicability of PrEP educational materials while including necessary information to facilitate use or prescribing confidence. Both community members and women’s health providers reported greater use confidence after viewing the animations.
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Affiliation(s)
- Anna Marie Young
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Timothee Fruhauf
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Obianuju Okonkwo
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin Gingher
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jenell Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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17
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Scott RK, Hull SJ, Huang JC, Coleman M, Ye P, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Cameron M, Elion R, Visconti A. Factors Associated with Intention to Initiate Pre-exposure Prophylaxis in Cisgender Women at High Behavioral Risk for HIV in Washington, D.C. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2613-2624. [PMID: 35622077 PMCID: PMC9308717 DOI: 10.1007/s10508-021-02274-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV prevention is underutilized by cisgender women at risk for HIV in the USA. Published research on PrEP initiation among cisgender women at risk for HIV focuses on identifying barriers and facilitators associated with intention to initiate, but few apply a behavioral theoretical lens to understand the relative importance of these diverse factors. This study provides a theoretically grounded view of the relative importance of factors associated with intention to initiate PrEP. We conducted an anonymous, cross-sectional survey of 1437 cisgender women seeking care at family planning and sexual health clinics to evaluate hypothesized barriers and facilitators of PrEP initiation. We categorized cisgender women with ≥ 3 behavioral risk-factors as "high-risk" for HIV acquisition; 26.9% (N = 387) met high-risk criterion. Among cisgender women in the high-risk sample, the majority were Black and single. Perceived risk of HIV acquisition was low and 13.7% reported intention to initiate PrEP. Positive attitudes toward PrEP, self-efficacy, perceived support from medical providers and social networks, and prior discussion about PrEP with medical providers were associated with intention to initiate PrEP; stigma was negatively associated. Background characteristics (other than age), risk factors for HIV acquisition, prior awareness of PrEP, and perceived risk of HIV were not associated with uptake intention. These findings support interventions that center on the role of providers in the provision of PrEP and on social networks in destigmatization of PrEP use.
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Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA.
- MedStar Washington Hospital Center, Washington, DC, USA.
| | - Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | - Peggy Ye
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Pam Lotke
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Patricia Moriarty
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Dhikshitha Balaji
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Allison Ward
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Jennifer Holiday
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Ashley R Brant
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Martha Cameron
- International Community of Women Living with HIV, Washington, DC, USA
| | | | - Adam Visconti
- MedStar Georgetown University, NW Washington, DC, USA
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18
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Demart S. « On n'arrive pas à les toucher » : la PrEP, les migrant.e.s africain.e.s et la production de l'ignorance. Glob Health Promot 2022. [PMID: 35259999 DOI: 10.1177/17579759211062133] [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: 11/15/2022]
Abstract
Quelques années après sa mise sur le marché, on réalise que la PrEP (la prophylaxie pré-exposition) touche peu de monde, y compris dans le Nord global qui est son lieu principal de distribution. Les migrant.e.s africain.e.s, le groupe le plus touché par l'épidémie après les hommes ayant des rapports sexuels entre hommes (HSH), ne l'utilisent quasiment pas et ne le connaissent généralement pas. Cet article invite à considérer la non-utilisation de la PrEP par les migrant.e.s africain.e.s non pas comme un problème tributaire du public cible, mais comme un effet de l'ignorance produite par « l'industrie du sida » à l'endroit de ce public. L'ignorance est ici comprise comme une production active à l'articulation d'enjeux pharmaceutiques, politiques et épistémiques donnant à voir des choix de non-recherche, là où des connaissances pourraient être utiles pour le public concerné.
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Affiliation(s)
- Sarah Demart
- Observatoire du sida et des sexualités, Université libre de Bruxelles, Bruxelles, Belgium
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19
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Bond KT, Gunn A, Williams P, Leonard NR. Using an Intersectional Framework to Understand the Challenges of Adopting Pre-exposure Prophylaxis (PrEP) Among Young Adult Black Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:180-193. [PMID: 35401855 PMCID: PMC8992539 DOI: 10.1007/s13178-021-00533-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION There is limited functional knowledge and utilization of pre-exposure prophylaxis (PrEP) among young adult Black cisgender women (YBW). METHODS We conducted four focus groups with YBW using an intersectional framework to explore multiple levels of factors that impede YBW awareness, interest, and utilization of PrEP in conjunction with their sexual and reproductive healthcare needs. RESULTS Influences at the cultural-environmental level included a lack of information and resources to access to PrEP and medical mistrust in the healthcare system. At the social normative level, influences included attitudes towards the long-term effects on sexual and reproductive health and self-efficacy to follow the PrEP regimen. At the proximal intrapersonal level, influences included anticipated HIV stigma from family and peers along with the fear of rejection from their main partners. CONCLUSIONS Translation of these results indicated that interventions to increase PrEP utilization and adherence among YBW will require multi-level strategies to address barriers to integrating HIV prevention into sexual and reproductive healthcare.
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Affiliation(s)
- Keosha T. Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, New York, United States
| | - Alana Gunn
- Department of Criminology, Law, and Justice, University of Illinois At Chicago, Chicago, Illinois, United States
| | - Porche Williams
- CUNY Lehman College, Bronx, New York, New York, United States
| | - Noelle R. Leonard
- Silver School of Social Work, New York University, New York, New York, United States
- Center for Drug Use and HIV Research, NYU School of Global Public Health, New York, New York, United States
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20
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Blumenthal J, Landovitz R, Jain S, He F, Kofron R, Ellorin E, Ntim GM, Stockman JK, Corado K, Rivet Amico K, Moore DJ, Morris S. Pre-Exposure Prophylaxis Perspectives, Sociodemographic Characteristics, and HIV Risk Profiles of Cisgender Women Seeking and Initiating PrEP in a US Demonstration Project. AIDS Patient Care STDS 2021; 35:481-487. [PMID: 34851726 PMCID: PMC8905235 DOI: 10.1089/apc.2021.0114] [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: 11/13/2022] Open
Abstract
Little information is known about the cisgender women who seek and initiate pre-exposure prophylaxis (PrEP) for HIV prevention in the United States. Adherence Enhancement Guided by Individualized Texting and Drug Levels was a 48-week single-arm open-label demonstration study of daily oral tenofovir disoproxil fumaratel emtricitabine (TDF/FTC) in cisgender women ≥ 18 years old at risk for HIV. Participants were surveyed at screening and enrollment about sociodemographics, HIV risk perception and behaviors, and PrEP perspectives and aggregated into three risk groups according to HIV sexual risk behavior: being in a serodiscordant partnership (SD), engaging in sex work (SW), and having partners with unknown HIV status at risk for HIV (UP). One hundred sixty-seven women presented for screening with n = 31 screen failures. Of the 162 women completing enrollment, mean age was 40 (standard deviation 11), with 41% non-Hispanic Black, 22% non-Hispanic White, and 19% Latina. Compared with those who screened ineligible, enrolled participants were more likely to have heard of PrEP, had higher HIV risk perception, and reported higher perceived PrEP efficacy. Sixty-four women (47%) were categorized as SD, 21 (15%) as SW, and 51 (38%) as UP. The SW were more likely to report higher levels of drinking and drug use (p = 0.002) and history of intimate partner violence in the past year (p < 0.001) compared with SD and UP. Among cisgender women enrolled, there were significant differences between the three risk groups by demographics, HIV risk behavior, and PrEP perspectives, suggesting that interventions to successfully implement PrEP in US women may need to be tailored by HIV risk group. Clinical Trial Registration number: NCT02584140.
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Affiliation(s)
- Jill Blumenthal
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Raphael Landovitz
- Department of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Feng He
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Ryan Kofron
- Department of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Eric Ellorin
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Gifty M. Ntim
- Department of Medicine, Ronald Reagan UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Jamila K. Stockman
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Katya Corado
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Sheldon Morris
- Department of Medicine, University of California San Diego, San Diego, California, USA
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Hull SJ, Tessema H, Thuku J, Scott RK. Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services. J Acquir Immune Defic Syndr 2021; 88:165-172. [PMID: 34506359 PMCID: PMC8577287 DOI: 10.1097/qai.0000000000002750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice. SETTING We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties. METHOD Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her. RESULTS We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors. CONCLUSIONS Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.
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Affiliation(s)
- Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Hanna Tessema
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Jeri Thuku
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Rachel K Scott
- Center for AIDS Prevention Studies, Prevention Research Center, Division of Prevention Science, University of California, California, San Francisco
- Women's and Infants' Services Department, MedStar Washington Hospital Center, Washington, DC; and
- Georgetown University School of Medicine, Washington, DC
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22
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Rouhani S, Allen ST, Whaley S, White RH, O'Rourke A, Schneider KE, Kilkenny ME, Weir BW, Sherman SG. Food access among people who inject drugs in West Virginia. Harm Reduct J 2021; 18:90. [PMID: 34419045 PMCID: PMC8379557 DOI: 10.1186/s12954-021-00536-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/13/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community. METHODS Cross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting 'never' going to bed hungry at night in the past six months. Pearson's χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access. RESULTS Only 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035). CONCLUSIONS We found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.
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Affiliation(s)
- Saba Rouhani
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA. .,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Sean T Allen
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Sara Whaley
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychology, George Washington University, Washington, DC, USA
| | - Kristin E Schneider
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Brian W Weir
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
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23
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Craddock JB, Mangum LC, Aidoo-Frimpong G, Whitfield DL. The Associations of HIV Pre-Exposure Prophylaxis Interest and Sexual Risk Behaviors Among Young Black Women. AIDS Patient Care STDS 2021; 35:263-270. [PMID: 34242088 DOI: 10.1089/apc.2020.0259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The uptake of pre-exposure prophylaxis (PrEP) is low among young Black cisgender heterosexual women, although this subgroup faces a higher burden of new HIV diagnoses. This study explored the association between sexual risk and prevention behaviors, and oral PrEP and vaginal PrEP ring interest among young Black women (YBW). A sample of YBW (N = 208) 18-25 years of age completed a self-administered questionnaire assessing sexual risk and prevention behaviors, HIV and sexually transmitted infection (STI) testing, and PrEP interest from June to December 2018. Results revealed that 103 YBW were interested in taking oral or vaginal PrEP, with 43% interested in oral PrEP use only, 28% interested in vaginal PrEP use only, and 29% interested in both oral and vaginal PrEP use. Logistic regressions revealed that YBW who had sex in the last 1-4 weeks or 3-6 months had lower odds of being interested in oral PrEP and YBW who had sex in the last 1-4 weeks had lower odds of being interested in vaginal PrEP compared with those whose last sexual encounter occurred in the last week. A large percentage of our sample was unaware of PrEP at the time of survey administration, but after learning about PrEP became more interested in potential PrEP use. This indicates that more education about the benefits of PrEP coupled with harm reduction counseling to lower their risk of STI and HIV infections is necessary to increase PrEP interest among YBW.
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Affiliation(s)
- Jaih B. Craddock
- School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Laurenia C. Mangum
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gloria Aidoo-Frimpong
- School of Public Health and Health Professions, University of Buffalo, Buffalo, New York, USA
| | - Darren L. Whitfield
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Pollock L, Warren M, Levison J. Missed Opportunities for HIV Prevention in Perinatal Care Settings in the United States. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:680046. [PMID: 36304042 PMCID: PMC9580717 DOI: 10.3389/frph.2021.680046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Universal opt-out HIV screening in pregnancy is an essential intervention toward eliminating perinatal HIV transmission in the US. However, it fails to identify pregnant people who are HIV negative at the time of testing but are at ongoing risk for HIV acquisition. Those of us involved in caring for women living with HIV are acutely aware of the many diagnoses of HIV that might have been prevented if only a partner had been tested for HIV or preexposure prophylaxis (PrEP) had been offered to a patient. This perspective article will review current recommendations and evidence-based interventions to evaluate missed opportunities for HIV prevention in US perinatal care settings. We identified three barriers to implementation of HIV prevention strategies during pregnancy and breastfeeding: (1) HIV risk for women is underestimated and poorly defined in clinical practice; (2) Partner testing is challenging and implementation studies in the US are lacking; and (3) PrEP remains underutilized. In March 2020, the National Perinatal HIV Hotline convened a group of clinicians and researchers specializing in perinatal HIV care to a case-based discussion of missed opportunities in perinatal HIV prevention. From our review of the literature via PubMed search as well as expert opinions gathered in this discussion, we make recommendations for addressing these barriers.
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Affiliation(s)
- Lealah Pollock
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Lealah Pollock
| | - Marliese Warren
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Judy Levison
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
- Judy Levison
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Qin Y, Price C, Rutledge R, Puglisi L, Madden LM, Meyer JP. Women's Decision-Making about PrEP for HIV Prevention in Drug Treatment Contexts. J Int Assoc Provid AIDS Care 2021; 19:2325958219900091. [PMID: 31918605 PMCID: PMC7099671 DOI: 10.1177/2325958219900091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite pre-exposure prophylaxis’s (PrEP) efficacy for HIV prevention, uptake has been
low among women with substance use disorders (SUDs) and attributed to women’s lack of
awareness. In semistructured interviews with 20 women with SUD and 15 key stakeholders at
drug treatment centers, we assessed PrEP awareness and health-related decision-making.
Women often misestimated their own HIV risk and were not aware of PrEP as a personally
relevant option. Although women possessed key decision-making skills, behavior was
ultimately shaped by their level of motivation to engage in HIV prevention. Motivation was
challenged by competing priorities, minimization of perceived risk, and anticipated
stigma. Providers were familiar but lacked experience with PrEP and were concerned about
women’s abilities to action plan in early recovery. HIV prevention for women with SUD
should focus on immediately intervenable targets such as making PrEP meaningful to women
and pursuing long-term systemic changes in policy and culture. Efforts can be facilitated
by partnering with drug treatment centers to reach women and implement PrEP
interventions.
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Affiliation(s)
- Yilu Qin
- Internal Medicine Primary Care Residency Program, HIV Training Track, Yale School of Medicine, New Haven, CT, USA
| | - Carolina Price
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
| | - Ronnye Rutledge
- AIDS Program, Yale School of Medicine, New Haven, CT, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Lisa Puglisi
- Department of Medicine, Section of General Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynn M Madden
- AIDS Program, Yale School of Medicine, New Haven, CT, USA.,APT Foundation Inc, New Haven, CT, USA
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, CT, USA
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Bond KT, Chandler R, Chapman-Lambert C, Jemmott LS, Lanier Y, Cao J, Nikpour J, Randolph SD. Applying a Nursing Perspective to Address the Challenges Experienced by Cisgender Women in the HIV Status Neutral Care Continuum: A Review of the Literature. J Assoc Nurses AIDS Care 2021; 32:283-305. [PMID: 33929979 PMCID: PMC10688540 DOI: 10.1097/jnc.0000000000000243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The field of HIV research has grown over the past 40 years, but there remains an urgent need to address challenges that cisgender women living in the United States experience in the HIV neutral status care continuum, particularly among women such as Black women, who continue to be disproportionately burdened by HIV due to multiple levels of systemic oppression. We used a social ecological framework to provide a detailed review of the risk factors that drive the women's HIV epidemic. By presenting examples of effective approaches, best clinical practices, and identifying existing research gaps in three major categories (behavioral, biomedical, and structural), we provide an overview of the current state of research on HIV prevention among women. To illustrate a nursing viewpoint and take into account the diverse life experiences of women, we provide guidance to strengthen current HIV prevention programs. Future research should examine combined approaches for HIV prevention, and policies should be tailored to ensure that women receive effective services that are evidence-based and which they perceive as important to their lives.
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Affiliation(s)
- Keosha T Bond
- Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Rasheeta Chandler, PhD, RN, FNP-BC, FAANP, FAAN, is an Assistant Professor, School of Nursing, Emory University, Atlanta, Georgia, USA. Crystal Chapman-Lambert, PhD, CRNP, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Loretta Sweet Jemmott, PhD, RN, is Vice President, Health and Health Equity, and Professor, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA. Yzette Lanier, PhD, is an Assistant Professor, School of Nursing, New York University, New York, New York, USA. Jiepin Cao, MS, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Jacqueline Nikpour, BSN, RN, is a Graduate Student, School of Nursing, Duke University, Durham, North Carolina, USA. Schenita D. Randolph, PhD, MPH, RN, CNE, is an Assistant Professor, School of Nursing, and Co-director, Community Engagement Core, Duke Center for Research to Advance Healthcare Equity (REACH Equity), Duke University, Durham, North Carolina, USA
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Black Cisgender Women's PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago. J Acquir Immune Defic Syndr 2021; 84:497-507. [PMID: 32692108 DOI: 10.1097/qai.0000000000002377] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although black cisgender women in Chicago continue to disproportionally account for new HIV diagnoses, few are on pre-exposure prophylaxis (PrEP). We used concurrent mixed-methods to understand women's PrEP knowledge, attitudes, experience, and preferences in Chicago. SETTING AND METHODS We surveyed 370 HIV(-) cisgender women visiting a sexually transmitted infection clinic (n = 120) or emergency department (n = 250). Two focus groups were conducted with PrEP-naive women, and interviews were conducted with 7 PrEP-experienced women. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, and qualitative data using thematic analysis. RESULTS Majority of women identified as black (83.0%) and had a regular source of health care (70.0%). In the past 6 months, 84.1% had vaginal or anal sex, most with inconsistent condom use (94.2%). Only 30.3% had heard of PrEP, but once explained, one-quarter considered starting PrEP, with protecting health (76.4%) and reducing HIV worry (58.1%) the most common reasons. Factors associated with considering PrEP included being Latina [adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): (1.21 to 8.99)], recent sexually transmitted infection [aOR: 2.39, 95% CI: (1.25 to 4.59)], and higher belief in PrEP effectiveness [aOR: 1.85, 95% CI: (1.22 to 2.82)]. Most (81.1%) had concerns about taking PrEP with side effects a common concern. Qualitative themes aligned with survey results, revealing a disconnection from current PrEP marketing, need for community-level PrEP education/outreach, and importance of provider trust. LESSONS LEARNED Despite significant PrEP implementation work in Chicago, less than one-third of women in our study had heard of PrEP. Once informed, PrEP attitudes and interest were positive. Translating these results into interventions reflecting women's preferences and barriers is critical to increase PrEP uptake by cisgender women in Chicago and elsewhere.
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Delabre RM, Bernier A, Sánchez F, Vilotitch A, Chanos S, Cosmaro ML, Langanke H, Mey C, James C, Duken SB, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. "Yes, I'm interested in taking PrEP!": PrEP interest among women respondents to the European community-based survey "Flash! PrEP in Europe". PLoS One 2021; 16:e0246037. [PMID: 33596225 PMCID: PMC7888674 DOI: 10.1371/journal.pone.0246037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection, including women. However, data regarding PrEP interest among women is lacking, particularly in Europe. Factors associated with interest in using PrEP were assessed among women respondents to the Flash! PrEP in Europe (FPIE) survey. This community-based cross-sectional study, conducted in 12 European countries, aimed to assess PrEP knowledge and interest. “High objective risk” (HOR) was assessed using established risk criteria following EACS and CDC guidelines. Factors associated with interest in using PrEP were assessed in univariable and multivariable logistic regression models. Among 678 women, 12.5% (n = 85) were considered at HOR, 46.8% (n = 317) indicated prior PrEP knowledge and 18.0% (n = 122) reported interest in using PrEP. Among women at HOR, 40.0% (n = 34) were interested in PrEP. Factors significantly associated with PrEP interest in the final multivariable model were: younger age (18–29 years) (aOR 1.91[95CI: 1.07; 3.41]), bad self-perceived financial status (1.84[1.09; 3.11]), migrant status (south to north) (2.87[1.05; 7.89]), single or dating relationship status (1.93[1.23; 3.03]), sexual abuse history (1.86[1.17; 2.97]), “rather high”/ “high” self-perceived HIV risk (3.21[1.32; 7.81]), and HOR (2.49[1.42; 4.35]). These results show that women at HOR and those who perceived themselves to be at high risk are interested in using PrEP. There is a critical need for targeted information and improved access to PrEP to increase uptake of this HIV prevention tool to meet PrEP interest among women.
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Affiliation(s)
- Rosemary M. Delabre
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- * E-mail:
| | - Adeline Bernier
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
| | - Flor Sánchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | | | - Harriet Langanke
- GSSG–Gemeinnützige Stiftung Sexualität und Gesundheit, Cologne, Germany
| | | | - Cary James
- Terrence Higgins Trust, London, United Kingdom
| | | | | | | | - Kai J. Jonas
- Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- AIDES, Pantin, France
| | - Daniela Rojas Castro
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
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Jani N, Mathur S, Kahabuka C, Makyao N, Pilgrim N. Relationship dynamics and anticipated stigma: Key considerations for PrEP use among Tanzanian adolescent girls and young women and male partners. PLoS One 2021; 16:e0246717. [PMID: 33596216 PMCID: PMC7888654 DOI: 10.1371/journal.pone.0246717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/25/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES We examined key gender, interpersonal and community dynamics influencing PrEP acceptability among adolescent girls and young women (AGYW) and their male partners. METHODS We administered 12 in-depth interviews (IDI) to partnered, or married AGYW aged 15-24 years living without HIV, and 16 IDIs to male partners living without HIV aged 18 or older, partnered or married to an AGYW in Tanzania. Card sorting, a participatory qualitative method for facilitating systematic discussion, was used to identify attitudes, values, and desires that would influence PrEP acceptability. RESULTS Relationship distrust, partner communication about HIV risk, and need to control HIV risk were highly influential considerations for PrEP use. AGYW and male partners both wanted to discuss PrEP use amidst relationship distrust, while most male partners encouraged AGYW PrEP use for shared protective benefit. Anticipated stigma of being perceived as a person living with HIV, as a result of PrEP use, was a deterrent for both AGYW and male partners while AGYW also feared additional stigma of being considered sexually promiscuous. CONCLUSIONS Couples counseling for PrEP uptake and adherence might be a well-placed strategy for couples who are living without HIV to educate one another about the relationship benefits of using PrEP, thereby increasing its acceptance and adherence, addressing unequal power dynamics, and reducing associated relationship distrust. Community awareness and education about PrEP can help curb persistent PrEP stigma, including intersectional stigma.
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Affiliation(s)
- Nrupa Jani
- Population Council, Washington, DC, United States of America
- * E-mail:
| | - Sanyukta Mathur
- Population Council, Washington, DC, United States of America
| | | | - Neema Makyao
- National AIDS Control Programme, Dar es Salaam, Tanzania
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Moseholm E, Gilleece Y, Collins B, Kowalska JD, Vasylyev M, Pérez Elía MJ, Cairns G, Aebi-Popp K. Achievements and gaps to provide pre-exposure prophylaxis (PrEP) for women across the European Region - Results from a European survey study. J Virus Erad 2020; 7:100026. [PMID: 33489306 PMCID: PMC7809379 DOI: 10.1016/j.jve.2020.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The use of pre-exposure prophylaxis (PrEP) is a safe and effective prevention option to all people at substantial risk of HIV acquisition, irrespective of gender. However, in most European countries PrEP services focus on key populations, in particular men who have sex with men (MSM). This study aims to explore PrEP availability and implementation for women across the European region. Methods An online survey was sent to all members of Women Against Viruses in Europe (WAVE) from 50 countries in September 2019. It consisted of 19 questions, including both multiple choice and free text answers. Results In total, responses from 34 countries were included in the study (Western Europe n = 12, Central Europe = 12, Eastern Europe n = 6). PrEP was accessible in 30 WHO European countries. More than half of them stated that PrEP was available for all groups at-risk of HIV acquisition (n = 18), while in many countries PrEP was only available to MSM and transgender persons. Two-thirds of country respondents confirmed the availability of a national guideline for PrEP (n = 23), of which six countries had specific recommendations for PrEP in women. The most cited obstacles for PrEP access were lack of information about PrEP, lack of political support, and high cost for the individual. Fifteen country respondents stated that there were specific obstacles for PrEP access for women, such as guidelines prioritizing MSM, women not being seen as a target population for PrEP, and lack of knowledge about which subgroup of women would benefit most from PrEP. Seven countries had made efforts to encourage women’s access to PrEP, most of which were individually based or initiated by local NGOs. Conclusions PrEP is an important addition to HIV combination prevention. Women’s access to PrEP in Europe remains limited. Women are often not included in the guidelines or targeted with education or information, resulting in a general lack of information about the use of PrEP for women.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Yvonne Gilleece
- Department of HIV Medicine, Brighton & Sussex University Hospitals NHS Trust and Brighton & Sussex Medical School, University Hospital, Brighton, UK
| | | | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland
| | | | | | - Gus Cairns
- Aidsmap / PrEP in Europe, NAM Publications, London, UK
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, University Hospital Bern, Switzerland
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Chandler R, Hull S, Ross H, Guillaume D, Paul S, Dera N, Hernandez N. The pre-exposure prophylaxis (PrEP) consciousness of black college women and the perceived hesitancy of public health institutions to curtail HIV in black women. BMC Public Health 2020; 20:1172. [PMID: 32723313 PMCID: PMC7385954 DOI: 10.1186/s12889-020-09248-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 07/13/2020] [Indexed: 11/25/2022] Open
Abstract
Background Consistent use of Pre-Exposure Prophylaxis (PrEP), a biomedical intervention for HIV seronegative persons, has been shown to significantly decrease HIV acquisition. Black women are a viable population segment to consider for PrEP use as their HIV incidence is overwhelmingly higher than all other women groups. Methods We developed and piloted a cultural- and age- appropriate PrEP education intervention to determine Black college women’s: 1) perceptions of and receptivity to PrEP use; and 2) preferences for PrEP information delivery. Results We recruited N = 43 Black college women. Most of our sample were sophomore and Juniors of whom identified as heterosexual (83%) and single (67%). Over 50% of young women had never been HIV tested and only 28% had been tested in the last 6 months; however, 100% of the women believed their HIV status was negative. Prior to participating in the study, most Black college women (67%) had not heard about PrEP and were unsure or apprehensive (72%) to initiate PrEP. The Black college women indicated that our educational intervention was extremely helpful (67%) for understanding and learning about PrEP. Post participating in our PrEP education module, regardless of delivery modality, participants reported being likely (62.55–70%) to initiate PrEP in the future. Conclusions Results indicate that Black college women would strongly consider PrEP when provided with basic knowledge, regardless of delivery modality. Participants also showed greater appreciation for in-person delivery and found it to be significantly more helpful and of greater quality for learning about PrEP; comprehension or perceived usefulness of PrEP-related content was relatively the same between groups. PrEP content delivery -- via in-person or online methods – is contingent on learning style and presentation. Trial registration This study has been registered under the ISRCTN Registry as of July 6, 2020. The trial registration number is ISRCTN14792715. This study was retrospectively registered.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA.
| | - Shawnika Hull
- George Washington University, Prevention and Community Health, 1918 F Street NW, Washington, D.C, 20052, USA
| | - Henry Ross
- University of Rochester, Center for Community Practice, 601 Elmwood Ave, Rochester, NY, 14627, USA
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing (NHWSON), Emory University, 1520 Clifton Rd., NE, Atlanta, GA, 30322-4027, USA
| | - Nikita Dera
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
| | - Natalie Hernandez
- Morehouse School of Medicine, Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA
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Pathways to HIV Pre-exposure Prophylaxis Among Women Prescribed PrEP at an Urban Sexual Health Clinic. J Assoc Nurses AIDS Care 2020; 30:321-329. [PMID: 30958408 DOI: 10.1097/jnc.0000000000000070] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about real-world facilitators of and barriers to pre-exposure prophylaxis (PrEP) uptake among women prescribed PrEP. We sought to characterize the pathway to PrEP uptake and continuation in women prescribed PrEP at an urban sexual health-focused clinic. We conducted semi-structured individual interviews with 14 women from October 2016 to May 2017. Using grounded theory and the constant comparative method, we found that self-perceived HIV risk, learning about PrEP through trusted sources, having positive interactions with PrEP providers, and insurance coverage were facilitators of PrEP uptake and continuation. Concerns about PrEP safety, misinformation about PrEP eligibility and appropriateness, lack of insurance coverage, and pharmacy impediments were key barriers. The confluence of these issues led to PrEP rumination, a process of ongoing deliberation about the benefits and risks of PrEP. These findings provide important insights about how to increase PrEP uptake among women at high risk of HIV infection.
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Olilo WA, Petersen ML, Koss CA, Wafula E, Kwarisiima D, Kadede K, Clark TD, Cohen CR, Bukusi EA, Kamya MR, Charlebois ED, Havlir DV, Ayieko J. Pre-exposure Prophylaxis (PrEP) Uptake Among Older Individuals in Rural Western Kenya. J Acquir Immune Defic Syndr 2020; 82:e50-e53. [PMID: 31490343 PMCID: PMC6831040 DOI: 10.1097/qai.0000000000002150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Winter A Olilo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Eric Wafula
- University of California, San Francisco, San Francisco, CA
| | | | - Kevin Kadede
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Tamara D Clark
- University of California, San Francisco, San Francisco, CA
| | - Craig R Cohen
- University of California, San Francisco, San Francisco, CA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Diane V Havlir
- University of California, San Francisco, San Francisco, CA
| | - James Ayieko
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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Mayer KH, Agwu A, Malebranche D. Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review. Adv Ther 2020; 37:1778-1811. [PMID: 32232664 PMCID: PMC7467490 DOI: 10.1007/s12325-020-01295-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Indexed: 01/01/2023]
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, MA, USA.
| | - Allison Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Using Motivational Interviewing to Increase PrEP Uptake Among Black Women at Risk for HIV: an Open Pilot Trial of MI-PrEP. J Racial Ethn Health Disparities 2020; 7:913-927. [PMID: 32078743 DOI: 10.1007/s40615-020-00715-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
Black women in the USA are at the highest risk among women for HIV. Pre-exposure prophylaxis (PrEP) prevents HIV transmission, but uptake among Black women remains low. An open pilot trial was conducted on MI-PrEP, a brief culturally tailored intervention incorporating motivational interviewing (MI) strategies to improve PrEP uptake and motivation. MI-PrEP is the first behavioral intervention developed to promote PrEP uptake among women in the USA. In Miami, FL, ten Black women who met eligibility criteria (e.g., sexual partner with HIV) were enrolled. These women participated in the two sessions of MI-PrEP and a 1-month follow-up. Participants completed measures on PrEP (motivation, uptake [verified via medical records], adherence, and barriers), medical mistrust, and an exit interview. These preliminary findings showed acceptability and feasibility with high satisfaction ratings; increases in PrEP uptake, knowledge, and motivation to use; and decreases in PrEP barriers and medical mistrust. Greater attention is needed on the psychosocial and structural factors among Black women who may benefit from PrEP.
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Pitisuttithum P, Marovich MA. Prophylactic HIV vaccine: vaccine regimens in clinical trials and potential challenges. Expert Rev Vaccines 2020; 19:133-142. [PMID: 31951766 DOI: 10.1080/14760584.2020.1718497] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Ending the HIV epidemic will likely require an efficacious preventative HIV vaccine. As vaccine development progresses, new challenges emerge in the context of an evolving prevention landscape.Areas covered: The progress in HIV vaccine development including trial regimens, results, and impact of pre-exposure prophylaxis (PrEP) including trial design.Expert opinion: Building upon the modest RV144 efficacy results, a follow-up study was launched in South Africa using modified vaccine constructs, ALVAC-HIV vector and gp120 protein boosts (Clade C strains). An adjuvant, MF59, was used to improve durability. Another Phase 2b regimen using an Adenovirus-26 vector with multivalent mosaic antigen inserts and a Clade C gp140 boost advanced into efficacy testing. Current vaccine efficacy studies enroll participants at risk for HIV, offer robust prevention packages, and notably do not restrict PrEP usage. With increasingly efficacious prevention options, future clinical trial designs become more complex. While formally requiring PrEP in HIV vaccine trials (e.g. PrEP ± Vaccine) may maximize protection, it raises both ethical and incremental efficacy over PrEP. Increasing vaccine complexity may lead to persistent vaccine-induced seropositivity, which presents different challenges. Discussion with the community and broader stakeholder engagement will help create solutions to these challenges.
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Affiliation(s)
- Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mary Anne Marovich
- Vaccine Research Program, National Institute of Allergy and Infectious Diseases (NIAID, NIH), Bethesda, Maryland, United States
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Kanamori M, De La Rosa M, Shrader CH, Munayco C, Doblecki-Lewis S, Prado G, Safren S, Trepka MJ, Fujimoto K. Progreso en Salud: Findings from Two Adapted Social Network HIV Risk Reduction Interventions for Latina Seasonal Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4530. [PMID: 31731821 PMCID: PMC6888294 DOI: 10.3390/ijerph16224530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Miami-Dade County, where many Latina seasonal workers reside and work, has the highest incidence of the human immunodeficiency virus (HIV) in the US: a rate four times the national average. Despite this disproportionate risk for HIV, there are no HIV prevention interventions that aim to decrease HIV among Latina seasonal workers. METHODS The PROGRESO EN SALUD study compared the outcomes of two interventions adapted to include a social network component (VOICES and HEALTHY). Recruitment used a social network respondent-driven sampling design in which each seed was asked to recruit three friends, and those friends were asked to recruit three friends, for a total of twenty groups of 13 friends. We collected data at baseline, and 6 months and 12 months post intervention completion. We used generalized estimating equation models, properly adjusted for non-independent contributions of both social network interventions, to estimate the effects. Gaussian family multivariate models were calculated, addressing exchangeable working correlations, including both individual-level and cluster-level covariates in these models. RESULTS A total of 261 Latina seasonal workers participated in either the HEALTHY or the VOICES intervention. There were significant changes over time in cognitive factors (HIV knowledge, condom use self-efficacy, and adequate knowledge of condom use), behavioral factors (condom use, female condom use, and HIV testing), and communication factors (talking with friends about HIV prevention and intention to negotiate safe sex with male partners). DISCUSSION This study supports the literature suggesting that interventions incorporating social networks can have positive effects on HIV prevention and treatment outcomes, including sustained benefits beyond study periods.
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Affiliation(s)
- Mariano Kanamori
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL 33136, USA; (C.-H.S.); (G.P.)
| | - Mario De La Rosa
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; (M.D.L.R.); (M.J.T.)
| | - Cho-Hee Shrader
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL 33136, USA; (C.-H.S.); (G.P.)
| | - Cesar Munayco
- Centro Nacional De Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Lima 15072, PERU;
| | | | - Guillermo Prado
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL 33136, USA; (C.-H.S.); (G.P.)
| | - Steven Safren
- Department of Psychology, University of Miami School of Medicine, Miami, FL 33136, USA;
| | - Mary Jo Trepka
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; (M.D.L.R.); (M.J.T.)
| | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
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Tolley EE, Li S, Zangeneh SZ, Atujuna M, Musara P, Justman J, Pathak S, Bekker L, Swaminathan S, Stanton J, Farrior J, Sista N. Acceptability of a long-acting injectable HIV prevention product among US and African women: findings from a phase 2 clinical Trial (HPTN 076). J Int AIDS Soc 2019; 22:e25408. [PMID: 31651098 PMCID: PMC6813716 DOI: 10.1002/jia2.25408] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION High HIV incidence and low adherence to daily oral PrEP among women underscore the need for more acceptable and easier to use HIV prevention products. Global demand for injectable contraception suggests that new, long-acting, injectable formulations could meet this need. We examine acceptability of a long-acting injectable PrEP among HIV-uninfected women in Zimbabwe, South Africa and two United States phase 2 trial sites. METHODS Quantitative surveys were administered at the first, fourth and sixth injection visits. Focus group discussions (FGD) were conducted after the sixth injection visit. We compared the acceptability of injectable product attributes, prevention preferences and future interest in injectable PrEP by site and arm and ran longitudinal ordinal logistic regression models to identify determinants of future interest in injectable PrEP. RESULTS Between April 2015 and February 2017, the trial enrolled 136 (100 African, 36 US) women with a median age of 31 years. Most participants (>75%) rated injectable attributes as very acceptable. While few reported rash or other side effects, 56% to 67% reported injection pain, with nonsignificant differences over time and between arms. During FGDs, participants described initial fear of the injectable and variable experiences with pain. Most US and African participants preferred injectable PrEP to daily oral pills (56% to 96% vs. 4% to 25%). Future interest in using injectable PrEP was associated with acceptability of product attributes and was higher in African than US sites. In FGDs, participants described multiple reasons for trial participation, including a combination of monetary, health-related and altruistic motivations. While associated with future interest in use in univariate models, neither altruistic nor personal motivations remained significant in the multivariate model. CONCLUSIONS This study found that long-acting injectable PrEP is acceptable among African and US women experiencing product use. Acceptability of product attributes better predicted future interest in injectable use than experience of pain. This is reassuring as a single-dose regimen of a different product has advanced to phase 3 trials. Finally, the study suggests that future demand for an injectable PrEP by women may be greater in African than US settings, where the risk of HIV is highest.
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Affiliation(s)
| | - Sue Li
- Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
| | | | | | | | | | - Subash Pathak
- Vaccine and Infectious Disease DivisionFred HutchSeattleWAUSA
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Bond KT, Ramos SR. Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey. JMIR Form Res 2019; 3:e9995. [PMID: 31144667 PMCID: PMC6658301 DOI: 10.2196/formative.9995] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 04/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.
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Affiliation(s)
- Keosha T Bond
- Department of Public Health, New York Medical College, Valhalla, NY, United States
| | - S Raquel Ramos
- Rory Meyers College of Nursing, New York University, New York, NY, United States
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Anne Crock E. HIV and AIDS: An overview of the current issues, treatment and prevention. Nurs Stand 2017; 32:51-63. [PMID: 29210536 DOI: 10.7748/ns.2017.e11045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 11/09/2022]
Abstract
The theme of World AIDS Day 2017 is 'let's end it'. After almost 40 years since the first occurrences of human immunodeficiency virus (HIV), it is possible to envision an end to the HIV epidemic, one of the most serious health and development challenges humanity has faced. This article provides an overview of the current approaches to the treatment, care and support of people living with HIV and acquired immune deficiency syndrome (AIDS). It also discusses the challenges associated with HIV and AIDS that remain, HIV prevention strategies, and the nurse's role in caring for people living with HIV. It outlines the Australian partnership approach to HIV, which provides a background for reflection on the response to HIV and AIDS in the UK and worldwide.
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