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Leonard A, Duroseau B. Overview of the Epidemiology and Clinical Care Considerations for Adolescents and Young Adults Living with or at Risk of Human Immunodeficiency Virus. Nurs Clin North Am 2024; 59:329-344. [PMID: 38670698 PMCID: PMC11058420 DOI: 10.1016/j.cnur.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
This article provides an updated examination of human immunodeficiency virus (HIV) epidemiologic trends among adolescents and young adults (AYAs) in the United States, highlighting the significant public health challenge posed by HIV within this demographic. Despite a notable decline in HIV diagnoses among AYAs, challenges remain, particularly due to 50% of AYAs living with HIV being unaware of their status. The article aims to evaluate current clinical recommendations, identify deficiencies, and propose evidence-based improvements for HIV prevention, diagnosis, and care, with the goal of enhancing health outcomes and reducing HIV prevalence among AYAs.
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Affiliation(s)
- Adam Leonard
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA; Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA.
| | - Brenice Duroseau
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA. https://twitter.com/thenpthatcares
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Downing MJ, Wiatrek SE, Zahn RJ, Mansergh G, Olansky E, Gelaude D, Sullivan PS, Stephenson R, Siegler AJ, Bauermeister J, Horvath KJ, Chiasson MA, Yoon IS, Houang ST, Hernandez AJ, Hirshfield S. Video selection and assessment for an app-based HIV prevention messaging intervention: formative research. Mhealth 2023; 9:2. [PMID: 36760783 PMCID: PMC9902231 DOI: 10.21037/mhealth-21-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) continue to be overrepresented in human immunodeficiency virus (HIV) infection in the United States. HIV prevention and care interventions that are tailored to an individual's serostatus have the potential to lower the rate of new infections among GBMSM. Mobile technology is a critical tool for disseminating targeted messaging and increasing uptake of basic prevention services including HIV testing, sexually transmitted infection (STI) testing, and pre-exposure prophylaxis (PrEP). Mobile Messaging for Men (M-Cubed) is a mobile health HIV prevention intervention designed to deliver video- and text-based prevention messages, provide STI and HIV information, and link GBMSM to prevention and healthcare resources. The current report describes an iterative process of identifying and selecting publicly available videos to be used as part of the M-Cubed intervention. We also conducted interviews with GBMSM to assess the acceptability, comprehension, and potential audience reach of the selected video messages. METHODS The selection of videos included balancing of specific criteria [e.g., accuracy of scientific information, video length, prevention domains: HIV/STI testing, antiretroviral therapy (ART), PrEP, engagement in care, and condom use] to ensure that they were intended for our GBMSM audiences: HIV-negative men who engage in condomless anal sex, HIV-negative men who do not engage in condomless anal sex, and men living with HIV. This formative study included in-person interviews with 26 GBMSM from three U.S. cities heavily impacted by the HIV epidemic-New York City, Detroit, and Atlanta. RESULTS Following a qualitative content analysis, the study team identified five themes across the interviews: participant reactions to the video messages, message comprehension, PrEP concerns, targeting of video messaging, and prompted action. CONCLUSIONS Study results informed a final selection of 12 video messages for inclusion in a randomized controlled trial of M-Cubed. Findings may serve as a guide for researchers who plan to develop HIV prevention interventions that utilize publicly available videos to promote behavioral change. Further, the findings presented here suggest the importance of developing videos with broad age and gender diversity for use in interventions such as M-Cubed, and in other health promotion settings.
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Affiliation(s)
| | - Sarah E. Wiatrek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ryan J. Zahn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Deborah Gelaude
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Population and Leadership, School of Nursing & The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Mary Ann Chiasson
- Department of Epidemiology, Columbia University Mailman School of Public Health and Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Steven T. Houang
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony Jimenez Hernandez
- Department of Natural Sciences and Mathematics, Eugene Lang College of Liberal Arts, New York, NY, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Azucar D, Rusow JA, Slay L, Taiwo M, Rodriguez A, Johnson A, Calvetti S, Wright D, Wu S, Bray B, Goldbach JT, Kipke MD. Combining the HYM (Healthy Young Men's) Cohort Study and the TRUTH (A Trans Youth of Color Study): Protocol for an Expanded Mixed Methods Study Renewal. JMIR Res Protoc 2022; 11:e39232. [PMID: 36326811 PMCID: PMC9672995 DOI: 10.2196/39232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND As we enter the fifth decade of the AIDS epidemic, health researchers and AIDS activists reflect both on the progress that has been made and the importance of continued prevention efforts for those most at risk. As HIV infection rates continue to fluctuate across communities, a trend has emerged with new HIV infections becoming increasingly concentrated-with cascading effects-among people aged <30 years, from marginalized racial and ethnic groups, and who are sexual or gender minorities. OBJECTIVE In this paper, we discuss the renewal of the Healthy Young Men's (HYM) Cohort Study and the addition of a subcohort-TRUTH: A Transgender Youth of Color Study. The overarching aim of our renewed study was to inform new intervention strategies; understand linkage to care; and examine changes over time with respect to minority-related stress and intersectional identities and their relationship with substance use, mental health, and HIV risk. Findings from this study will help to inform the development of new interventions designed to engage African American and Black and Latino young men who have sex with men (YMSM) and transgender and gender minority youth in the HIV prevention and care continua and to reduce risk by addressing pathways of minority-related stress and intersectional stigma. METHODS Longitudinal study (baseline and follow-up assessments every 6 months for a total of 8 waves of data collection) is ongoing with reconsented cohort from the last iteration of HYM Cohort Study. This study protocol includes self-report survey, collection of urine to assess recent use of illicit drugs, and collection of blood and rectal and throat swabs to test for current sexually transmitted infection and HIV infection. An additional sample of blood and plasma (10 mL for 4 aliquots and 1 pellet) is also collected and stored in the HYM Cohort Study biorepository for future studies. This mixed methods study design includes collection of triangulated analysis of quantitative, qualitative, and biological measures (ie, drug use, sexually transmitted infection and HIV testing, and adherence to antiretroviral therapy among participants who are HIV+) at baseline and every 6 months. RESULTS As of February 2022, participants from the past 4 years of the HYM Cohort Study and TRUTH: A Transgender Youth of Color Study Cohort have been reconsented and enrolled into the renewal period of longitudinal data collection, which is projected from summer of 2020 until summer of 2025. Recruitment is ongoing to reach our target enrollment goal of YMSM and transgender minority youth. CONCLUSIONS The findings from this study are being used to inform the development of new, and adaptation of existing, evidence-based HIV prevention interventions designed to engage populations of transgender and gender minority youth and YMSM in the HIV prevention and care continua. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39232.
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Affiliation(s)
- Danny Azucar
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Joshua A Rusow
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lindsay Slay
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Mariam Taiwo
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Aracely Rodriguez
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Ali Johnson
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sam Calvetti
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Deja Wright
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Su Wu
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Bethany Bray
- Institute for Health Research Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Jeremy T Goldbach
- Brown School of Social Work, Washington University in St. Louis, Missouri, MO, United States
| | - Michele D Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Lightfoot M, Jackson-Morgan J, Pollack L, Bennett A. Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis. JMIR Form Res 2022; 6:e32416. [PMID: 35686737 PMCID: PMC9227642 DOI: 10.2196/32416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/05/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons. Objective We examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services. Methods The intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model. Results Of the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size. Conclusions Given low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services.
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Affiliation(s)
- Marguerita Lightfoot
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | | | - Lance Pollack
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Ayanna Bennett
- 3rd Street Youth Center and Clinic, San Francisco, CA, United States
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Sullivan PS, Stephenson R, Hirshfield S, Mehta CC, Zahn R, Bauermeister JA, Horvath K, Chiasson MA, Gelaude D, Mullin S, Downing MJ, Olansky EJ, Wiatrek S, Rogers EQ, Rosenberg E, Siegler AJ, Mansergh G. Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men. J Med Internet Res 2022; 24:e34574. [PMID: 35025755 PMCID: PMC8851328 DOI: 10.2196/34574] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. OBJECTIVE This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. METHODS We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. RESULTS In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84%) were assigned to the intervention group and 608 (99.51%) were analyzed, while 615 (50.16%) were assigned to the control group and 612 (99.51%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. CONCLUSIONS Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. TRIAL REGISTRATION ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16439.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Sabina Hirshfield
- Special Treatment and Research Program, Department of Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Cyra Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, NY, United States
| | - Ryan Zahn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jose A Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennslyvania, Philadelphia, PA, United States
| | - Keith Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Mary Ann Chiasson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.,Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Deborah Gelaude
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shelby Mullin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Martin J Downing
- Department of Psychology, Lehman College, City University of New York, Bronx, NY, United States
| | - Evelyn Jolene Olansky
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Social & Scientific Systems, Inc, DLH Holdings Company, Atlanta, GA, United States
| | - Sarah Wiatrek
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Erin Q Rogers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.,Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Eli Rosenberg
- Department of Epidemiology, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Gordon Mansergh
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Patients, Social Workers, and Pharmacists' Perceptions of Barriers to Providing HIV Care in Community Pharmacies in the United States. PHARMACY 2021; 9:pharmacy9040178. [PMID: 34842829 PMCID: PMC8628938 DOI: 10.3390/pharmacy9040178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Retaining people living with HIV (PLWH) in clinical care is a global priority to end the HIV epidemic. Community pharmacies in the United States have structural influences on the success or failure of retention in HIV care by supporting patients’ complex needs. However, to date, barriers to retention in care in the community pharmacy setting have not been examined beyond pharmacy services of medication therapy management. We utilized the patient-centered medical home model to examine the barriers to HIV care in the community pharmacy setting. We utilized semi-structured interviews to collect data from 15 participants: five PLWH, five community pharmacists, and five social workers from a midwestern state. Interview data were transcribed and analyzed using directed content analysis. Four key themes emerged regarding the barriers that impact utilization of community pharmacy services by PLWH: the perception of the role of community pharmacists in HIV care, perceptions of pharmacists’ HIV knowledge, perceptions of pharmacy operation and services, and negative experiences within the community pharmacy space. Participants’ perceptions of solutions for improving HIV care in the community pharmacy focused on improving the relationship between pharmacists and patients, ensuring that the community pharmacy is a private and safe space for patients, and having a diverse pharmacy staff that is equipped to take care of the diverse and marginalized HIV population, such as transgender people.
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Hightow-Weidman L, Muessig KE, Egger JR, Vecchio A, Platt A. Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men. AIDS Behav 2021; 25:2599-2617. [PMID: 33740213 DOI: 10.1007/s10461-021-03222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/25/2022]
Abstract
HIV incidence among young men who have sex with men (YMSM) is disproportionally high. Youth living with HIV demonstrate low rates of sustained virologic suppression (VS). Epic Allies, a theory-based behavioral intervention mobile app, utilizes self-management tools, gamification, and social support to improve engagement in care and antiretroviral adherence among YMSM living with HIV. A two-arm individually randomized-controlled trial enrolled 146 participants aged 16 to 24 years old to test the efficacy of Epic Allies to achieve VS. Both study arms showed improved VS at 26-weeks (62.9% intervention; 73.5% control; ARR = 0.93 (95% CI 0.73, 1.18)) and antiretroviral adherence; intervention effects were amplified in regular app users. Issues with recruitment and app usage metrics limit the ability to definitively say that the app was effective in causing behavior changes resulting in improved health outcomes. (ClinicalTrials.gov Identifier: NCT02782130).
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