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Johnson C, Chidester A, Chandramohan D, Lin H, Ho NM, Taranova A, Nijhawan AE, Kools S, Ingersoll K, Dillingham R, Taylor BS. A Call for Youth Voice to Support Engagement in Care for 18- to 29-Year Olds Living with HIV in the US South. AIDS Patient Care STDS 2024; 38:238-248. [PMID: 38662471 PMCID: PMC11301709 DOI: 10.1089/apc.2024.0006] [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: 05/25/2024] Open
Abstract
Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH.
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Affiliation(s)
- Catherine Johnson
- Department of Public Health, Innovation and Equity, University Health, San Antonio, Texas, USA
| | - Autumn Chidester
- Department of Medicine, Division of Infectious Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Divya Chandramohan
- Department of Medicine, Division of Infectious Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Hueylie Lin
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Nhat Minh Ho
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Anna Taranova
- Department of Public Health, Innovation and Equity, University Health, San Antonio, Texas, USA
| | - Ank E. Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Susan Kools
- School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| | - Karen Ingersoll
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Barbara S. Taylor
- Department of Medicine, Division of Infectious Diseases, UT Health San Antonio, San Antonio, Texas, USA
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Thrul J, Yusuf H, Devkota J, Owczarzak J, Ohene-Kyei ET, Gebo K, Agwu A. Accuracy of Provider Predictions of Viral Suppression Among Adolescents and Young Adults With HIV in an HIV Clinical Program. J Int Assoc Provid AIDS Care 2024; 23:23259582241252587. [PMID: 38794860 PMCID: PMC11128167 DOI: 10.1177/23259582241252587] [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: 08/15/2023] [Revised: 02/09/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Providers caring for adolescents and young adults with HIV (AYA-HIV) mostly base their adherence counseling during clinical encounters on clinical judgment and expectations of patients' medication adherence. There is currently no data on provider predictions of viral suppression for AYA-HIV. We aimed to assess the accuracy of provider predictions of patients' viral suppression status compared to viral load results. METHODS Providers caring for AYA-HIV were asked to predict the likelihood of viral suppression of patients before a clinical encounter and give reasons for their predictions. Provider predictions were compared to actual viral load measurements of patients. Patient data were abstracted from electronic health records. The final analysis included 9 providers, 28 patients, and 34 observations of paired provider predictions and viral load results. RESULTS Provider prediction accuracy of viral suppression was low (59%, Cohen's Kappa = 0.16). Provider predictions of lack of viral suppression were based on nonadherence to medications, new patient status, or structural vulnerabilities (e.g., unstable housing). Anticipated viral suppression was based on medication adherence, history of viral suppression, and the presence of family or other social forms of support. CONCLUSIONS Providers have difficulty accurately predicting viral suppression among AYA-HIV and may base their counseling on incorrect assumptions. Rapid point-of-care viral load testing may provide opportunities to improve counseling provided during the clinical encounter.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Hasiya Yusuf
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Janardan Devkota
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kelly Gebo
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allison Agwu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Jackman KMP, Ohene-Kyei ET, Barfield A, Atanda F, Smith R, Huettner S, Agwu A, Trent M. Patient Portal Privacy: Perspectives of Adolescents and Emerging Adults Living with HIV and the Parental/Guardian Role in Supporting Their Care. Appl Clin Inform 2023; 14:752-762. [PMID: 37729944 PMCID: PMC10511274 DOI: 10.1055/s-0043-1772685] [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: 12/15/2022] [Accepted: 07/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Increasing the percentage of people living with human immunodeficiency virus (HIV), including youth, who are virally suppressed to 95% is an overall goal of the ending the HIV epidemic initiative. While patient portals have become ubiquitous, questions remain about how best to operationalize parental/guardian access to youth's patient portals in alignment with optimizing HIV care outcomes and patient preferences. This qualitative study focuses on understanding perspectives among youth with HIV (YHIV) about parental access to patient portals. METHODS Eligible participants were YHIV aged 13 to 25 years receiving care at an urban academic hospital. Semistructured individual/paired interviews were conducted between May 2022 and March 2023. Participants were asked to discuss thoughts on parental access to patient portals, and roles parents/guardians have in supporting their HIV care. Semistructured interviews were conducted with adolescent and emerging adult health care workers (HCWs) to gain perspectives on YHIV emergent themes. Audio-recorded interviews were transcribed verbatim, and we conducted thematic analysis using an inductive approach to identify codes and themes. RESULTS Sixteen YHIV and four HCWs participated in interviews. Parental roles in coordinating HIV care ranged from supporting YHIV needs for transportation, acquiring, and taking medications, to not having any role at all. Participants shared heterogeneous perspectives about their openness to share patient portal access with their parents/guardians. Perspectives were not strictly congruent along lines of participant age or parental roles in helping youth to manage HIV care. Sharing passwords emerged both as a pathway that YHIV grant access to their accounts and a source of confusion for clinicians when parents/guardians send messages using their child's account. CONCLUSION Findings suggest HCWs should initiate conversations with YHIV patients to determine preferences for parental/guardian access to their patient portal, educate on proxy access, and explain the extent of medical information that is shared with proxy accounts, regardless of age and perceived parental involvement in HIV care.
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Affiliation(s)
- Kevon-Mark P. Jackman
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Elise Tirza Ohene-Kyei
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ashle Barfield
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Fopefoluwa Atanda
- Department of Biology, School of Computer, Mathematical and Natural Sciences, Morgan State University, Baltimore, Maryland, United States
| | - Raina Smith
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Steven Huettner
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Allison Agwu
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Maria Trent
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Gurung S, Jones SS, Mehta K, Budhwani H, MacDonell K, Belzer M, Naar S. Examining Recruitment Strategies in the Enrollment Cascade of Youth Living With HIV: Descriptive Findings From a Nationwide Web-Based Adherence Protocol. JMIR Form Res 2023; 7:e40077. [PMID: 36745773 PMCID: PMC10131637 DOI: 10.2196/40077] [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: 06/04/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Digital strategies and broadened eligibility criteria may optimize the enrollment of youth living with HIV in mobile health adaptive interventions. Prior research suggests that digital recruitment strategies are more efficient than traditional methods for overcoming enrollment challenges of youth living with HIV in the United States. OBJECTIVE This study highlights the challenges and strategies that explain screening and enrollment milestones in a national web-based adherence protocol for youth living with HIV. METHODS Baseline data from a national web-based HIV adherence protocol for youth living with HIV, collected from July 2018 to February 2021, were analyzed. A centralized recruitment procedure was developed, which used web-based recruitment via Online Master Screener; paid targeted advertisements on social media platforms (eg, Facebook and Reddit) and geosocial networking dating apps (eg, Grindr and Jack'd); and site and provider referrals from Subject Recruitment Venues and other AIDS service organizations, website referrals, and text-in recruitment. RESULTS A total of 3 distinct cohorts of youth living with HIV were identified, marked by changes in recruitment strategies. Overall, 3270 individuals consented to screening, 2721 completed screening, 581 were eligible, and 83 completed enrollment. We examined sociodemographic and behavioral differences in completing milestones from eligibility to full enrollment (ie, submitting antiretroviral therapy and viral load data and completing the baseline web-based survey). Those with the most recent viral load tests >6 months ago were half as likely to enroll (odds ratio 0.45, 95% CI 0.21-0.94). Moreover, eligible participants with self-reported antiretroviral therapy adherence (SRA) between 50% and 80% were statistically significant (P<.001 to P=.03) and more likely to enroll than those with SRA >80%. CONCLUSIONS The findings add to our knowledge on the use of digital technologies for youth living with HIV before and during the COVID-19 pandemic and provide insight into the impact of expanding eligibility criteria on enrollment. As the COVID-19 pandemic continues and the use of and engagement with social media and dating apps among youth living with HIV changes, these platforms should continue to be investigated as potential recruitment tools. Using a wide variety of recruitment strategies such as using social media and dating apps as well as provider referral mechanisms, increasing compensation amounts, and including SRA in enrollment criteria should continue to be studied with respect to their ability to successfully recruit and enroll eligible participants. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11183.
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Affiliation(s)
- Sitaji Gurung
- Department of Health Sciences, New York City College of Technology, The City University of New York, Brooklyn, NY, United States
| | - Stephen Scott Jones
- Department of Psychology, Hunter College, The City University of New York, New York, NY, United States
| | - Kripa Mehta
- Department of Psychology, Hunter College, The City University of New York, New York, NY, United States
| | - Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Karen MacDonell
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavorial Science, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Marvin Belzer
- Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavorial Science, College of Medicine, Florida State University, Tallahassee, FL, United States
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Trent M, Perin J, Yusuf H, Agwu A, Barfield A, Spatafore L, Coleman JS, Matson P. Understanding Perceived Risks and Sexual Behavior Among Adolescents and Young Adults During the COVID-19 Pandemic. J Adolesc Health 2023; 72:815-818. [PMID: 36669959 PMCID: PMC9847213 DOI: 10.1016/j.jadohealth.2022.11.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE We sought to describe the relationship between COVID-19 risk perception and sexual behaviors among urban adolescents and young adults (AYA). METHODS Data were collected from 159 urban AYAs on COVID-19 risk perception, COVID-19 infections and deaths, romantic relationships, and sexual behavior during the stay-at-home order using a telephone survey. RESULTS Seventy-nine percent of the study participants engaged in sexual intercourse during the stay-at-home order. Only 38% of these used condoms during their last sexual encounter. Experiencing COVID-19 positivity within their social circle was not related to COVID-19 testing. Concern for COVID-19 infection or experiencing a COVID-19 diagnosis or death in one's social circles was not associated with sexual intercourse or condom use. DISCUSSION Urban AYA remained at risk for sexually transmitted infections, and COVID-19, given high baseline community rates of sexually transmitted infections and COVID-19, low condom use, and low COVID-19 risk perception at the time of the survey.
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Affiliation(s)
- Maria Trent
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jamie Perin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hasiya Yusuf
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allison Agwu
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashle Barfield
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leah Spatafore
- Department of Pediatrics, Navajo Area - Indian Health Service, St. Michael, Arizona
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela Matson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Woods C, Yusuf H, Matson P, Marcell AV, DiClemente R, Fields E, Trent M. Social Media Versus Traditional Clinic-Based Recruitment for a Dyadic Sexually Transmitted Infection Prevention Trial: Results From the Sexperience Study. J Adolesc Health 2021; 69:668-671. [PMID: 33867231 PMCID: PMC8429059 DOI: 10.1016/j.jadohealth.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The enrollment of youth in clinical trials has generally been achieved through conventional in-person recruitment but is evolving with the surge in the use of social media and presents an alternative resource for research recruitment for sexually transmitted infection (STI) prevention trials. PURPOSE To compare the direct costs and performance of social media recruitment versus clinic-based recruitment method for a dyadic behavioral intervention for STI among heterosexual couples. METHODS In the clinic-based recruitment arm spanning 60 weeks, patients aged 16-25 years were recruited through an adolescent/young adult clinic. Social media adverts targeting college students within the city were also posted online over 23 weeks, using Facebook ad software. We compared the direct costs and performance of both recruitment methods to assess feasibility. RESULTS Three hundred eighty-one individuals were approached, of which 21 completed the dyadic intervention (11 from social media-based recruitment and 10 from clinic-based recruitment). Clinic-based recruitment accounted for 91.0% of total recruitment cost and 9.9% of the total cost was spent on social media recruitment via Facebook ad. CONCLUSIONS Recruitment of adolescents and young adults for a dyadic behavioral STI intervention trial using social media is feasible, has lower direct costs, and results in similar outcomes compared to clinic-based recruitment.
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Affiliation(s)
- Colin Woods
- Department of Global Public Health, New York University, New York, NY, USA
| | - Hasiya Yusuf
- Department of Global Public Health, New York University, New York, NY, USA
| | - Pamela Matson
- Department of Global Public Health, New York University, New York, NY, USA
| | - Arik V. Marcell
- Department of Global Public Health, New York University, New York, NY, USA
| | - Ralph DiClemente
- Department of Global Public Health, New York University, New York, New York
| | - Errol Fields
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
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