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Sullivan PS, Castel A, Fenton K, Rodriguez-Diaz C, Reisner S, Dean HD. From equality to equity: Increasing the use and reporting of equity-based approaches in epidemiology. Ann Epidemiol 2024; 98:32-35. [PMID: 39146758 DOI: 10.1016/j.annepidem.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024]
Affiliation(s)
- Patrick S Sullivan
- Emory University Rollins School of Public Health, Atlanta, GA, United States.
| | - Amanda Castel
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kevin Fenton
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Sari Reisner
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Hazel D Dean
- Emory University Rollins School of Public Health, Atlanta, GA, United States
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2
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Larson R, Hussain S, Chau MM, Jones A, Vangeepuram N, Madden D, Berhane T, Shuman S, Islam N, Trinh-Shevrin C. The Power of Partnership: NYCEAL Collaborations With Health Agencies and Mobile Vaccination Vans. Am J Public Health 2024; 114:S92-S95. [PMID: 38207257 PMCID: PMC10785186 DOI: 10.2105/ajph.2023.307455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 01/13/2024]
Abstract
New York City experienced a high COVID-19 burden and striking disparities among racial and ethnic minoritized groups. The New York Community Engagement Alliance Against COVID-19 Disparities (NYCEAL) collaborated with health agencies and clinical providers to increase and facilitate COVID-19 vaccinations across New York City. NYCEAL partners and their network of hundreds of community health workers delivered vaccine education, fostered community trust, and supported vaccine uptake among low-income, limited‒English-proficient, and racial and ethnic minoritized communities. With funding from the National Institutes of Health (NIH), the objective of NYCEAL was to reduce COVID-19 disparities by increasing vaccine uptake and promoting trust in science. (Am J Public Health. 2024;114(S1):S92-S95. https://doi.org/10.2105/AJPH.2023.307455).
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Affiliation(s)
- Rita Larson
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Sarah Hussain
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Michelle M Chau
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Andrew Jones
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Nita Vangeepuram
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Devin Madden
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Timnit Berhane
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Saskia Shuman
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Nadia Islam
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
| | - Chau Trinh-Shevrin
- Rita Larson, Sarah Hussain, Michelle M. Chau, Nadia Islam, and Chau Trinh-Shevrin are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York. Andrew Jones is with the Arab-American Family Support Center in Brooklyn, NY. Nita Vangeepuram is with the Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY. Devin Madden and Timnit Berhane are with the Office of Gender Equity, Icahn School of Medicine at Mount Sinai. Saskia Shuman is with the Institute for Family Health, New York, NY
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3
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Bono RS, Pan Z, Dahman B, Deng Y, Kimmel AD. Urban-rural disparities in geographic accessibility to care for people living with HIV. AIDS Care 2023; 35:1844-1851. [PMID: 36369925 PMCID: PMC10175509 DOI: 10.1080/09540121.2022.2141186] [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: 05/03/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
In the United States, people living with HIV (PLWH) in rural areas fare worse along the HIV care continuum than their urban counterparts; this may be due in part to limited geographic access to care. We estimated drive time to care for PLWH, focusing on urban-rural differences. Adult Medicaid enrollees living with HIV and their usual care clinicians were identified using administrative claims data from 14 states (Medicaid Analytic eXtract, 2009-2012). We used geographic network analysis to calculate one-way drive time from the enrollee's ZIP code tabulation area centroid to their clinician's practice address, then examined urban-rural differences using bivariate statistics. Additional analyses included altering the definition of rurality; examining subsamples based on the state of residence, services received, and clinician specialty; and adjusting for individual and county characteristics. Across n = 49,596 PLWH, median drive time to care was 12.8 min (interquartile range 26.3). Median drive time for rural enrollees (43.6 (82.0)) was nearly four times longer than for urban enrollees (11.9 (20.6) minutes, p < 0.0001), and drive times exceeded one hour for 38% of rural enrollees (versus 12% of urban, p < 0.0001). Urban-rural disparities remained in all additional analyses. Sustained efforts to circumvent limited geographic access to care are critical for rural areas.
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Affiliation(s)
- Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Zhongzhe Pan
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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4
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Sharpe JD, Siegler AJ, Sanchez TH, Guest JL, Sullivan PS. Effects of mode of transportation on PrEP persistence among urban men who have sex with men. AIDS Care 2023; 35:1411-1419. [PMID: 37232114 PMCID: PMC11167718 DOI: 10.1080/09540121.2023.2217375] [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: 07/25/2022] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Little is known about the effect of travel-related factors, such as mode of transportation, on retention in PrEP care, or PrEP persistence. We used data from the 2020 American Men's Internet Survey and conducted multilevel logistic regression to estimate the association between mode of transportation used for healthcare access and PrEP persistence among urban gay, bisexual, and other men who have sex with men (MSM) in the U.S. MSM using public transportation were less likely to report PrEP persistence (aOR: 0.51; 95% CI: 0.28-0.95) than MSM using private transportation. There were no significant associations between PrEP persistence and using active transportation (aOR: 0.67; 95% CI: 0.35-1.29) or multimodal transportation (aOR: 0.85; 95% CI: 0.51-1.43) compared to using private transportation. Transportation-related interventions and policies are needed to address structural barriers to accessing PrEP services and to improve PrEP persistence in urban areas.
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Affiliation(s)
| | | | | | - Jodie L. Guest
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Wien S, Guest JL, Luisi N, Taussig J, Kramer MR, Stephenson R, Millett G, del Rio C, Sullivan PS. Racial differences in the association of undetectable HIV viral load and transportation to an HIV provider among men who have sex with men in Atlanta, Georgia: a health equity perspective. AIDS Care 2023; 35:1154-1163. [PMID: 36878481 PMCID: PMC10426396 DOI: 10.1080/09540121.2023.2182871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
There are inequities in HIV outcomes among Black gay, bisexual, and other sexual minority men who have sex with men (GBMSM) compared to GBMSM overall, including access to transportation to HIV care. It is unclear if the relationship between transportation and clinical outcomes extends to viral load. We assessed the relationship between transportation dependence to an HIV provider and undetectable viral load among Black and White GBMSM in Atlanta. We collected transportation and viral load information from GBMSM with HIV from 2016-2017 (n = 345). More Black than White GBMSM had a detectable viral load (25% vs. 15%) and took dependent (e.g. public) transportation (37% vs. 18%). Independent (e.g. car) transportation was associated with undetectable viral load for White GBMSM (cOR 3.61, 95% CI 1.45, 8.97) but was attenuated by income (aOR. 2.29, 95% CI 0.78, 6.71), and not associated for Black GBMSM (cOR 1.18, 95% CI 0.58, 2.24). One possible explanation for no association for Black GBMSM is that there are more competing barriers to HIV care for Black GBMSM than White GBMSM. Further investigation is needed to confirm whether 1) transportation is unimportant for Black GBMSM or 2) transportation interacts with additional factors not considered in this analysis.
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Affiliation(s)
- Simone Wien
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Greg Millett
- American Foundation for AIDS Research, Washington DC, USA
| | - Carlos del Rio
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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6
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Fogarty H, Jones MD, Moore SJ, Harper GW, Camacho-González A, del Rio C, Hussen SA. Examining HIV Organizational Structures and their Influence on Engagement with Young Black Gay, Bisexual, and other Men who have Sex with Men in Atlanta, Georgia. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2023; 36:58-79. [PMID: 38650676 PMCID: PMC11034743 DOI: 10.1080/10538720.2023.2184438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV. Structural influences on these disparities, including characteristics of the various organizations that serve YB-GBMSM living with HIV, remain understudied. We drew on Weick's model of organizing to conduct and analyze qualitative interviews with 28 HIV service providers representing healthcare and community-based organizations in Atlanta, Georgia. Enactment of HIV service provision was described as following simplified and standardized responses-defined as "rules", and/or more dynamic exchanges to formulate responses -otherwise known as "communication behavior cycles" (CBCs). Rules, including patient quotas and limited hours of operation, were viewed as rigid, out-of-touch, and inhibiting engagement with YB-GBMSM. CBCs, such as patient feedback loops and rejection of traditional hierarchies, fostered creative insights to combating the epidemic and increased levels of cultural awareness and community buy-in. Organizations should strive to enact CBCs, to foster culturally congruent approaches to service delivery for YB-GBMSM.
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Affiliation(s)
- Hannah Fogarty
- Hubert Department of Global Health, Emory University Rollins School of Public Health
| | - Marxavian D. Jones
- Hubert Department of Global Health, Emory University Rollins School of Public Health
| | - Shamia J. Moore
- Hubert Department of Global Health, Emory University Rollins School of Public Health
| | - Gary W. Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | - Andrés Camacho-González
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine
| | - Carlos del Rio
- Hubert Department of Global Health, Emory University Rollins School of Public Health
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
| | - Sophia A. Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
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Mansergh G, Sullivan PS, Kota KK, Daskalakis D. Pre-exposure prophylaxis in the era of emerging methods for men who have sex with men in the USA: the HIV Prevention Cycle of Care model. Lancet HIV 2023; 10:e134-e142. [PMID: 36525980 PMCID: PMC11283766 DOI: 10.1016/s2352-3018(22)00309-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
Expanding on previous work, we present an HIV Prevention Cycle of Care model to facilitate understanding of the complexity of issues involved in pre-exposure prophylaxis implementation for gay, bisexual, and other men who have sex with men (MSM) in the USA, including individual, client-provider, and overarching issues such as health equity, stigma, and prevention nomenclature. The HIV prevention cycle of care applies to MSM who test negative for HIV. The Prevention Cycle of Care model includes seven steps: prevention knowledge, prevention self-awareness and preferences, prevention motivation, health-care access and cost, provider issues, adherence and persistence, and periodic reassessment and adjustment. HIV prevention is complex in an era of emerging multiple modalities, and more research is needed to successfully implement pre-exposure prophylaxis options over time and across diverse communities of MSM who are sexually active.
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Affiliation(s)
- Gordon Mansergh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Patrick S Sullivan
- Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Krishna Kiran Kota
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Demetre Daskalakis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Dasgupta S, Tie Y, Beer L, Lyons SJ, Shouse RL, Harris N. Geographic Differences in Reaching Selected National HIV Strategic Targets Among People With Diagnosed HIV: 16 US States and Puerto Rico, 2017-2020. Am J Public Health 2022; 112:1059-1067. [PMID: 35653649 DOI: 10.2105/ajph.2022.306843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To assess geographic differences in reaching national targets for viral suppression, homelessness, and HIV-related stigma among people with HIV and key factors associated with these targets. Methods. We used data from the Medical Monitoring Project (2017-2020) and the National HIV Surveillance System (2019) to report estimates nationally and for 17 US jurisdictions. Results. Viral suppression (range = 55.3%-74.7%) and estimates for homelessness (range = 3.6%-11.9%) and HIV-related stigma (range for median score = 27.5-34.4) varied widely by jurisdiction. No jurisdiction met any of the national 2025 targets, except for Puerto Rico, which exceeded the target for homelessness (3.6% vs 4.6%). Viral suppression and antiretroviral therapy dose adherence were lowest, and certain social determinants of health (i.e., housing instability, HIV-related stigma, and HIV health care discrimination) were highest in Midwestern states. Conclusions. Jurisdictions have room for improvement in reaching the national 2025 targets for ending the HIV epidemic and in addressing other measures associated with adverse HIV outcomes-especially in the Midwest. Working with local partners will help jurisdictions determine a tailored approach for addressing barriers to meeting national targets. (Am J Public Health. Published online ahead of print June 2, 2022: e1-e9. https://doi.org/10.2105/AJPH.2022.306843).
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Affiliation(s)
- Sharoda Dasgupta
- All of the authors are with the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yunfeng Tie
- All of the authors are with the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda Beer
- All of the authors are with the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shacara Johnson Lyons
- All of the authors are with the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - R Luke Shouse
- All of the authors are with the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Norma Harris
- All of the authors are with the Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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9
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Sharpe JD, Guest JL, Siegler AJ, Sanchez TH, Sullivan PS. The spatiotemporal distribution of pre-exposure prophylaxis accessibility in the United States, 2016-2020. Ann Epidemiol 2021; 64:102-110. [PMID: 34563567 DOI: 10.1016/j.annepidem.2021.09.006] [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] [Received: 03/09/2021] [Revised: 07/21/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Residing in areas with little spatial accessibility to HIV pre-exposure prophylaxis (PrEP) providers, or PrEP deserts, contributes to low PrEP uptake. This study examines and characterizes the spatial distribution of PrEP accessibility in the United States over time. METHODS We conducted spatial network analyses and geographic mapping to explore the spatiotemporal distribution of persistent PrEP deserts (census tracts with suboptimal accessibility in 2016 and 2020), new PrEP deserts (tracts with suboptimal accessibility in 2020 but not 2016), new PrEP oases (tracts with suboptimal accessibility in 2016 but not 2020), and persistent PrEP oases (tracts with optimal accessibility in 2016 and 2020). We used polytomous logistic regression to determine area-level factors associated with these four spatiotemporal PrEP accessibility types. RESULTS There was a reduction of 52.8% in the prevalence of 30-minute PrEP deserts from 2016 (28,055 tracts) to 2020 (13,240 tracts) and an increase of 33.5% in 30-minute PrEP oases from 2016 (44,259 tracts) to 2020 (59,074 tracts). Of all tracts, 12,487 (17.3%) were persistent PrEP deserts, 753 (1.0%) were new PrEP deserts, 15,568 (21.5%) were new PrEP oases, and 43,506 (60.1%) were persistent PrEP oases. Overall, persistent PrEP oases were more likely to be of higher socioeconomic status, racially/ethnically diverse, located in urban areas, and located in the Northeast compared with other spatiotemporal PrEP accessibility types, with variation by urbanicity and U.S. Census region. CONCLUSIONS Efforts to improve PrEP accessibility should be especially focused in disadvantaged communities in nonurban areas and the South, Midwest, and West. Monitoring changes in the spatial accessibility of PrEP over time and determining the factors associated with such changes can help to evaluate progress made towards improving PrEP accessibility.
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Affiliation(s)
- J Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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10
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Phillips G, McCuskey D, Ruprecht MM, Curry CW, Felt D. Structural Interventions for HIV Prevention and Care Among US Men Who Have Sex with Men: A Systematic Review of Evidence, Gaps, and Future Priorities. AIDS Behav 2021; 25:2907-2919. [PMID: 33534056 PMCID: PMC7856612 DOI: 10.1007/s10461-021-03167-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/01/2022]
Abstract
The preponderance of HIV interventions have been behavioral, targeting individual, dyadic, or group dynamics. However, structural-level interventions are required to decrease HIV transmission and increase engagement in care, especially for men who have sex with men (MSM), particularly Black and Latinx MSM. A systematic literature review was conducted to assess the current state of structural interventions; only two studies detailing structural interventions related to HIV for Black and Latinx MSM in the US were identified. An additional 91 studies which discussed structural-level barriers to optimal HIV outcomes among MSM, yet which did not directly evaluate a structural intervention, were also identified. While this paucity of findings was discouraging, it was not unexpected. Results of the systematic review were used to inform guidelines for the implementation and evaluation of structural interventions to address HIV among MSM in the U.S. These include deploying specific interventions for multiply marginalized individuals, prioritizing the deconstruction of structural stigma, and expanding the capacity of researchers to evaluate “natural” policy-level structural interventions through a standardization of methods for rapid evaluative response, and through universal application of sex, sexual orientation, and gender identity demographic measures.
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Affiliation(s)
- Gregory Phillips
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - David McCuskey
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan M Ruprecht
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caleb W Curry
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Case Western Reserve University Undergraduate Studies, Cleveland, OH, USA
| | - Dylan Felt
- Evaluation, Data Integration, and Technical Assistance (EDIT) Program, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave #14-043, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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11
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Sullivan PS, Hightow-Weidman L. Mobile apps for HIV prevention: how do they contribute to our epidemic response for adolescents and young adults? Mhealth 2021; 7:36. [PMID: 33898605 PMCID: PMC8063022 DOI: 10.21037/mhealth-20-71] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/05/2020] [Indexed: 11/06/2022] Open
Abstract
Mobile health (mHealth) tools to address the HIV epidemic have proliferated in recent years. Yet when applied to the United States (US) epidemic, which is driven by new HIV infections among men who have sex with men (MSM), it is not clear how mHealth tools fit in the overall portfolio of biobehavioral prevention interventions and clinical services proven to be efficacious. Adolescent and young adult MSM are particularly vulnerable and reducing HIV incidence among this priority population will require substantial levels of uptake of multiple prevention strategies (i.e., HIV testing, condom use, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP), and treatment for those with HIV infection). Starting from the premise that adolescents are avid consumers of technology, this paper considers the particular strengths and opportunities of mHealth tools to address HIV prevention and provides examples of mHealth approaches that have been tested or are in development in these areas. Even after mHealth interventions are proven effective, there will be important intervening steps before such tools can be deployed and integrated into existing prevention programs given the diverse landscape of prevention service delivery. We anticipate some of the likely barriers to broad implementation of proven mHealth interventions in the context of the US public health funding and service delivery infrastructure and provide recommendations to increase efforts for future scale-up and dissemination.
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Affiliation(s)
- Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
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Phillips Ii G, McCuskey DJ, Felt D, Raman AB, Hayford CS, Pickett J, Shenkman J, Lindeman PT, Mustanski B. Geospatial perspectives on health: The PrEP4Love campaign and the role of local context in health promotion messaging. Soc Sci Med 2020; 265:113497. [PMID: 33187750 DOI: 10.1016/j.socscimed.2020.113497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/05/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP) remains one of the most effective biomedical interventions for the prevention of HIV transmission. However, uptake among populations most impacted by the HIV epidemic remains low. La rge-scale awareness and mobilization campaigns have sought to address gaps in knowledge and motivation in order to improve PrEP diffusion. Such campaigns must be cognizant of the historical, physical, and structural contexts in which they exist. In urban contexts, neighborhood segregation has the potential to impact health outcomes and amplify disparities. Therefore, we present novel geospatial approaches to the evaluation of a Chicago-based PrEP messaging campaign (PrEP4Love) in a 2018 cohort of men who have sex with men and transgender women, contextualizing results within the localized infrastructure and public health landscape, and examining associations between geographic location and campaign efficacy. Results revealed notable variance in rates of PrEP uptake associated with campaign exposure by Chicago planning area, which are likely explained by the historical and contemporary impacts of racist structures on physical environment and city infrastructure. Findings have important implications for the evaluation and implementation of future messaging campaigns, which should take the unique historical, structural, and geospatial factors of their particular settings into account in order to achieve maximum impact.
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Affiliation(s)
- Gregory Phillips Ii
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Third Coast Center for AIDS Research, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA.
| | - David J McCuskey
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Anand B Raman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Christina S Hayford
- Third Coast Center for AIDS Research, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA
| | - Jim Pickett
- AIDS Foundation of Chicago, 200 W. Monroe St., Suite 1150, Chicago, IL, 60606, USA
| | - Julia Shenkman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Peter T Lindeman
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA; Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA; Third Coast Center for AIDS Research, 625 N Michigan Ave., 14th Floor, Suite 1400, Chicago, IL, 60611, USA
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Tieu HV, Koblin BA, Latkin C, Curriero FC, Greene ER, Rundle A, Frye V. Neighborhood and Network Characteristics and the HIV Care Continuum among Gay, Bisexual, and Other Men Who Have Sex with Men. J Urban Health 2020; 97:592-608. [PMID: 29845586 PMCID: PMC7560681 DOI: 10.1007/s11524-018-0266-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order for treatment as prevention to work as a national strategy to contain the HIV/AIDS epidemic in the United States (US), the HIV care continuum must become more robust, retaining more individuals at each step. The majority of people living with HIV/AIDS (PLWHA) in the US are gay, bisexual, and other men who have sex with men (MSM). Within this population, there are distinct race- and ethnicity-based disparities in rates of HIV infection, engagement, and retention in HIV care, and viral suppression. Compared with White MSM, HIV-infected Black MSM are less likely to be on anti-retroviral therapy (ART), adhere to ART, and achieve viral suppression. Among MSM living in urban areas, falling off the continuum may be influenced by factors beyond the individual level, with new research identifying key roles for network- and neighborhood-level characteristics. To inform multi-level and multi-component interventions, particularly to support Black MSM living in urban areas, a clearer understanding of the pathways of influence among factors at various levels of the social ecology is required. Here, we review and apply the empirical literature and relevant theoretical perspectives to develop a series of potential pathways of influence that may be further evaluated. Results of research based on these pathways may provide insights into the design of interventions, urban planning efforts, and assessments of program implementation, resulting in increased retention in care, ART adherence, and viral suppression among urban-dwelling, HIV-infected MSM.
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Affiliation(s)
- Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Beryl A Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily R Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Victoria Frye
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, USA.
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Restar AJ, Jin H, Ogunbajo A, Adia A, Surace A, Hernandez L, Cu‐Uvin S, Operario D. Differences in HIV risk and healthcare engagement factors in Filipinx transgender women and cisgender men who have sex with men who reported being HIV negative, HIV positive or HIV unknown. J Int AIDS Soc 2020; 23:e25582. [PMID: 32844564 PMCID: PMC7448155 DOI: 10.1002/jia2.25582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Understanding HIV risk and healthcare engagement of at-risk individuals by HIV status is vital to informing HIV programmes in settings where the HIV epidemic is rapidly expanding like the Philippines. This study examined differences in HIV risk and healthcare engagement factors among Filipinx transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM respectively) who self-reported being HIV negative, HIV positive or HIV unknown. METHODS Between 2018 and 2019, we conducted Project #ParaSaAtin, an online cross-sectional survey that examined the structural, social and behavioural factors impacting HIV services among Filipinx trans-WSM and cis-MSM (n = 318). We performed multinomial regression procedures to determine factors associated with HIV status (with HIV-negative referent). Co-variates included participant demographics, experiences of social marginalization, HIV risk, healthcare engagement and alcohol and substance problems. RESULTS Self-reported HIV status of the sample was as follows: 38% HIV negative, 34% HIV positive and 28% HIV unknown. Relative to HIV-negative respondents, HIV-positive respondents were more likely to be older (25- to 29-year-old adjusted risk ratio [aRRR]=5.08, 95% Confidence Interval [95% CI] = 1.88 to 13.72; 30- to 34-year-old aRRR = 4.11, 95% CI = 1.34 to 12.58; and 35 + years old aRRR = 8.13, 95% CI = 2.40 to 27.54, vs. 18 to 25 years old respectively), to live in Manila (aRRR = 5.89, 95% CI = 2.20 to 15.72), exhibit hazardous drinking (aRRR = 2.87, 95% CI = 1.37 to 6.00) and problematic drug use (aRRR = 2.90, 95% CI = 1.21 to 7.13). HIV-positive respondents were less likely to identify as straight (aRRR = 0.13, 95% CI = 0.02 to 0.72), and were more likely to avoid HIV services due to lack of anti-lesbian, gay, bisexual and transgender (LGBT) discrimination policies (aRRR = 0.37, 95% CI = 0.14 to 0.90). Relative to HIV-negative respondents, HIV-unknown respondents were less educated (some college aRRR = 0.10, 95% CI = 0.02 to 0.37, beyond college aRRR = 0.31, 95% CI = 0.09 to 0.99, vs. high school or below respectively), had lower HIV knowledge (aRRR = 0.30, 95% CI = 0.20 to 0.71), and were less communicative about safer sex (ARR = 0.29, 95% CI = 0.09 to 0.92). Moreover, HIV-unknown respondents were also more likely to have avoided HIV services due to cost (aRRR = 4.46, 95% CI = 1.73 to 11.52). CONCLUSIONS This study highlights differences in HIV risks and healthcare engagement by HIV status. These findings show different barriers exist per HIV status group, and underscore the need to address Filipinx trans-WSM and cis-MSM's poor engagement in HIV services in the Philippines.
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Affiliation(s)
- Arjee J Restar
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
- amfARFoundation of AIDS ResearchWashingtonDCUSA
| | - Harry Jin
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | - Adedotun Ogunbajo
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Alexander Adia
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
| | - Anthony Surace
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Laufred Hernandez
- Department of Behavioral SciencesUniversity of Philippines ManilaManilaPhilippines
| | - Susan Cu‐Uvin
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
- Providence‐Boston Center for AIDS ResearchProvidenceRIUSA
- Department of MedicineMiriam HospitalProvidenceRIUSA
| | - Don Operario
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
- The Philippine Health Initiative for Research, Service, and TrainingBrown University Global Health InitiativeProvidenceRIUSA
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Crawford ND, Josma D, Morris J, Hopkins R, Young HN. Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with men. J Am Pharm Assoc (2003) 2020; 60:602-608. [PMID: 32007364 DOI: 10.1016/j.japh.2019.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To understand the perceptions and support for pharmacy-based pre-exposure prophylaxis (PrEP) delivery among pharmacists and men who have sex with men (MSM). DESIGN A qualitative study from April 2017 to December 2018. SETTING AND PARTICIPANTS The researchers used purposive sampling to identify MSM participants and AIDSVu to identify pharmacists in high-human immunodeficiency virus (HIV) zip codes in the metropolitan Atlanta area. Eight MSM and 6 pharmacists consented to participate in the study. OUTCOME MEASURES Perceptions and support for PrEP delivery in pharmacies. RESULTS Both MSM and pharmacists expressed strong support for in-pharmacy PrEP screening and dissemination. MSM reported that pharmacies were more convenient and accessible compared with physician's offices. However, they also noted that privacy and training of pharmacy staff were important for them to consider being screened for PrEP in a pharmacy. Pharmacists also believed training was important and felt comfortable counseling on HIV prevention for their current patients. CONCLUSION These data support early evidence that pharmacies are a promising venue to improve PrEP access for MSM. To implement PrEP screening in pharmacies, proper training of pharmacy staff and a designated space to ensure privacy are critical. Future studies should test the feasibility of screening for PrEP in pharmacies for black MSM.
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Rebeiro PF, Pettit AC, Sizemore L, Mathieson SA, Wester C, Kipp A, Shepherd BE, Sterling TR. Trends and Disparities in Mortality and Progression to AIDS in the Highly Active Antiretroviral Therapy Era: Tennessee, 1996-2016. Am J Public Health 2019; 109:1266-1272. [PMID: 31318589 PMCID: PMC6687251 DOI: 10.2105/ajph.2019.305180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To use statewide surveillance data to examine trends and disparities in mortality and progression from HIV to AIDS comprehensively in Tennessee over the past 20 years.Methods. Individuals diagnosed with HIV in Tennessee from 1996 to 2016 were identified through the Tennessee Department of Health Enhanced HIV/AIDS Reporting System. Clinical AIDS and all-cause mortality were the outcomes. Cox regression yielded adjusted hazard ratios (AHRs) for death and competing risk regression yielded adjusted subhazard ratios (SHRs) for AIDS, with death as the competing event.Results. Individuals with a history of heterosexual contact (AHR = 1.20; 95% confidence interval [CI] = 1.12, 1.29) and injection drug use (AHR = 1.27; 95% CI = 1.18, 1.38) had increased hazards of death relative to those with a history of male-to-male sexual contact. Hazards of death were lower among White (AHR = 0.79; 95% CI = 0.73, 0.85) and Hispanic (AHR = 0.50; 95% CI = 0.40, 0.63) individuals than among Black individuals. Those with heterosexual contact (SHR = 1.20; 95% CI = 1.12, 1.29) and injection drug use (SHR = 1.27; 95% CI = 1.18, 1.38) had a greater risk of AIDS than those with male-to-male sexual contact. White individuals (SHR = 0.85; 95% CI = 0.81, 0.90) had a lower risk of AIDS than Black individuals, and female individuals (SHR = 0.84; 95% CI = 0.79, 0.90) had a lower risk than male individuals.Conclusions. The trends, disparities, and outcomes assessed in our study will inform HIV testing and care linkage program design and implementation in Tennessee.
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Affiliation(s)
- Peter F Rebeiro
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - April C Pettit
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Lindsey Sizemore
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Samantha A Mathieson
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Carolyn Wester
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Aaron Kipp
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Bryan E Shepherd
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Timothy R Sterling
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
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Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Carr Melvin S, Draper C, Magee-Jackson V, Brewer R, Schneider JA. The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1922. [PMID: 31151275 PMCID: PMC6603520 DOI: 10.3390/ijerph16111922] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing 'Neighborhoods and Networks (N2) Cohort Study'. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - DeMarc A Hickson
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA.
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Denton Callander
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Brandon Brooks
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA.
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Aditya S Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
| | - Basile Chaix
- Pierre-Louis Institute of Epidemiology Public Health (UMR-S 1136), Faculté de Médecine Saint-Antoine, Sorbonne Universités, 75012 Paris, France.
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
| | - Sandra Carr Melvin
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | - Cordarian Draper
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | | | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA.
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Masiano SP, Martin EG, Bono RS, Dahman B, Sabik LM, Belgrave FZ, Adimora AA, Kimmel AD. Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban-rural differences. J Int AIDS Soc 2019; 22:e25286. [PMID: 31111684 PMCID: PMC6527947 DOI: 10.1002/jia2.25286] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/30/2019] [Indexed: 11/09/2022] Open
Abstract
Achieving US state and municipal benchmarks to end the HIV epidemic and promote health equity requires access to comprehensive HIV care. However, this care may not be geographically accessible for all people living with HIV (PLHIV). We estimated county-level drive time and suboptimal geographic accessibility to HIV care across the contiguous US, assessing regional and urban-rural differences. We integrated publicly available data from four federal databases to identify and geocode sites providing comprehensive HIV care in 2015, defined as the co-located provision of core HIV medical care and support services. Leveraging street network, US Census and HIV surveillance data (2014), we used geographic analysis to estimate the fastest one-way drive time between the population-weighted county centroid and the nearest site providing HIV care for counties reporting at least five diagnosed HIV cases. We summarized HIV care sites, county-level drive time, population-weighted drive time and suboptimal geographic accessibility to HIV care, by US region and county rurality (2013). Geographic accessibility to HIV care was suboptimal if drive time was >30 min, a common threshold for primary care accessibility in the general US population. Tests of statistical significance were not performed, since the analysis is population-based. We identified 671 HIV care sites across the US, with 95% in urban counties. Nationwide, the median county-level drive time to HIV care is 69 min (interquartile range (IQR) 66 min). The median county-level drive time to HIV care for rural counties (90 min, IQR 61) is over twice that of urban counties (40 min, IQR 48), with the greatest urban-rural differences in the West. Nationally, population-weighted drive time, an approximation of individual-level drive time, is over five times longer in rural counties than in urban counties. Geographic access to HIV care is suboptimal for over 170,000 people diagnosed with HIV (19%), with over half of these individuals from the South and disproportionately the rural South. Nationally, approximately 80,000 (9%) drive over an hour to receive HIV care. Suboptimal geographic accessibility to HIV care is an important structural barrier in the US, particularly for rural residents living with HIV in the South and West. Targeted policies and interventions to address this challenge should become a priority.
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Affiliation(s)
- Steven P Masiano
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Erika G Martin
- Department of Public Administration and PolicyUniversity at Albany‐State University of New YorkAlbanyNYUSA
| | - Rose S Bono
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Bassam Dahman
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Lindsay M Sabik
- Department of Health Policy and ManagementUniversity of PittsburghPittsburghPAUSA
| | - Faye Z Belgrave
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Adaora A Adimora
- Departments of Medicine and EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - April D Kimmel
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
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Dyar C, Taggart TC, Rodriguez-Seijas C, Thompson RG, Elliott JC, Hasin DS, Eaton NR. Physical Health Disparities Across Dimensions of Sexual Orientation, Race/Ethnicity, and Sex: Evidence for Increased Risk Among Bisexual Adults. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:225-242. [PMID: 29633061 PMCID: PMC6382069 DOI: 10.1007/s10508-018-1169-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/16/2017] [Accepted: 01/31/2018] [Indexed: 05/18/2023]
Abstract
Accumulating evidence suggests that sexual minority individuals are at increased risk for physical health conditions compared to heterosexual individuals. However, we know little about physical health disparities affecting bisexual individuals, a population at increased risk for psychiatric and substance use conditions compared to both heterosexual and lesbian/gay populations. Using a large, nationally representative sample, we examined physical health disparities for bisexual individuals. To advance research on sexual minority health disparities, we further: (1) compared prevalence rates of physical health conditions across three dimensions of sexual orientation (i.e., identity, attractions, behavior) and (2) examined whether disparities differed by sex and race/ethnicity. Results indicated that sexual minority individuals were at increased risk for many physical health conditions. Notably, individuals with bisexual identity, attractions, and/or behavior were at increased risk for more physical health conditions than other sexual minority groups. The number and types of physical health disparities affecting bisexually identified individuals and individuals with same- and opposite-sex attractions and/or sexual partners varied across sex and race/ethnicity, with the most consistent disparities emerging for individuals who reported same- and opposite-sex sexual partners. Our findings highlight the substantial physical health disparities affecting sexual minorities and the heightened risk conferred by all facets of bisexuality.
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Affiliation(s)
- Christina Dyar
- Department of Psychology, University of Cincinnati, Cincinnati, OH, 45221, USA.
| | - Tenille C Taggart
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | | | - Ronald G Thompson
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Kimmel AD, Masiano SP, Bono RS, Martin EG, Belgrave FZ, Adimora AA, Dahman B, Galadima H, Sabik LM. Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South. AIDS Care 2018. [DOI: http://doi.org.10.1080/09540121.2018.1476656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Steven P. Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Erika G. Martin
- Nelson A. Rockefeller Institute of Government, Albany, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs & Policy, University at Albany, Albany, USA
| | - Faye Z. Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adaora A. Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Hadiza Galadima
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, USA
| | - Lindsay M. Sabik
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
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Kimmel AD, Masiano SP, Bono RS, Martin EG, Belgrave FZ, Adimora AA, Dahman B, Galadima H, Sabik LM. Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South. AIDS Care 2018; 30:1459-1468. [PMID: 29845878 PMCID: PMC6150812 DOI: 10.1080/09540121.2018.1476656] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Structural barriers to HIV care are particularly challenging in the US South, which has higher HIV diagnosis rates, poverty, uninsurance, HIV stigma, and rurality, and fewer comprehensive public health programs versus other US regions. Focusing on one structural barrier, we examined geographic accessibility to comprehensive, coordinated HIV care (HIVCCC) in the US South. We integrated publicly available data to study travel time to HIVCCC in 16 Southern states and District of Columbia. We geocoded HIVCCC service locations and estimated drive time between the population-weighted county centroid and closest HIVCCC facility. We evaluated drive time in aggregate, and by county-level HIV prevalence quintile, urbanicity, and race/ethnicity. Optimal drive time was ≤30 min, a common primary care accessibility threshold. We identified 228 service locations providing HIVCCC across 1422 Southern counties, with median drive time to care of 70 min (IQR 64 min). For 368 counties in the top HIV prevalence quintile, median drive time is 50 min (IQR 61 min), exceeding 60 min in over one-third of these counties. Among counties in the top HIV prevalence quintile, drive time to care is six-folder higher for rural versus super-urban counties. Counties in the top HIV prevalence quintiles for non-Hispanic Blacks and for Hispanics have >50% longer drive time to care versus for non-Hispanic Whites. Including another potential care source-publicly-funded health centers serving low-income populations-could double the number of high-HIV burden counties with drive time ≤30 min, representing nearly 35,000 additional people living with HIV with accessible HIVCCC. Geographic accessibility to HIVCCC is inadequate in the US South, even in high HIV burden areas, and geographic and racial/ethnic disparities exist. Structural factors, such as geographic accessibility to care, may drive disparities in health outcomes. Further research on programmatic policies, and evidence-based alternative HIV care delivery models improving access to care, is critical.
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Affiliation(s)
- April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Steven P. Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Erika G. Martin
- Nelson A. Rockefeller Institute of Government, Albany, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs & Policy, University at Albany, Albany, USA
| | - Faye Z. Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adaora A. Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Hadiza Galadima
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, USA
| | - Lindsay M. Sabik
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
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Madkins K, Greene GJ, Hall E, Jimenez R, Parsons JT, Sullivan PS, Mustanski B. Attrition and HIV Risk Behaviors: A Comparison of Young Men Who Have Sex with Men Recruited from Online and Offline Venues for an Online HIV Prevention Program. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2135-2148. [PMID: 30069614 PMCID: PMC6197065 DOI: 10.1007/s10508-018-1253-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/29/2018] [Accepted: 06/02/2018] [Indexed: 06/08/2023]
Abstract
In addition to offline venue-based and time-space sampling, recruitment of young men who have sex with men (YMSM) into HIV surveillance and prevention studies has expanded over time to include Internet-based approaches. Despite broadening recruitment strategies, enrolling racially and ethnically diverse YMSM who are disproportionately impacted by HIV continues to be challenging. Additionally, there is little literature on the impact of recruitment venue on participant characteristics and likelihood to enroll YMSM into online randomized control trials (RCT). This study used data from the multisite RCT, Keep It Up! 2.0, to examine the impact of recruitment venue on participant demographics, behavioral HIV risks, and enrollment. A total of 2984 participants were screened for eligibility from community-based organizations, Facebook, dating apps, and outreach events. There were significant differences by venue in age (χ2[3] = 54.38, p < .001), race/ethnicity (χ2[9] = 110.78, p < .001), sexual orientation (χ2[3] = 7.85, p < .05), relationship status (χ2[6] = 27.71, p < .001), and region of recruitment (χ2[6] = 1480.51, p < .001). There were no significant differences by venue in attrition during the enrollment process. The only difference in attrition was by race/ethnicity. Compared to White participants, eligible Black (OR: 0.35, p < .01) and Latino (OR: 0.46, p < .05) participants were significantly less likely to enroll in the intervention. There were also no significant differences by recruitment venue in sexual risk behaviors among enrolled participants. These findings suggest that recruitment into online HIV interventions from a variety of venues is feasible for diverse YMSM who are at similar risk for HIV infection.
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Affiliation(s)
- Krystal Madkins
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA
| | - Eric Hall
- Programs, Research and Innovation in Sexual Minority Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Ruben Jimenez
- Center for HIV Educational Studies and Training, Hunter College and the Graduate Center of the City University of New York, New York, NY, USA
| | - Jeffrey T Parsons
- Center for HIV Educational Studies and Training, Hunter College and the Graduate Center of the City University of New York, New York, NY, USA
| | - Patrick S Sullivan
- Programs, Research and Innovation in Sexual Minority Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14th Floor, Chicago, IL, 60611, USA.
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23
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Janulis P, Feinstein BA, Phillips G, Newcomb ME, Birkett M, Mustanski B. Sexual Partner Typologies and the Association Between Drug Use and Sexual Risk Behavior Among Young Men Who Have Sex With Men. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:259-271. [PMID: 28194606 PMCID: PMC5554732 DOI: 10.1007/s10508-016-0909-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 05/12/2023]
Abstract
Numerous partner and relationship characteristics are associated with sexual risk behavior among young men who have sex with men (YMSM), including being in a serious relationship and having older partners. However, most research in this area is limited by its reliance on variable-centered approaches. Using multilevel latent class analysis, this study identified subgroups of sexual partner types with a particular emphasis on examining whether partner type moderated the association between drug use and condomless anal sex (CAS). Data were utilized from an ongoing cohort study of YMSM (ages 16-29) recruited from previous studies as well as peers and serious partners of existing cohort members. A total of 469 participants reported on 1596 sexual partners in the past 6 months. We identified four distinct sexual partner typologies, which we refer to as: casual, older-online, much older, and serious. Results indicated that rates of CAS were highest for older-online and serious partners. Additionally, there was a positive association between drug use and CAS among a predominantly marijuana using sample, but only for serious partners. While previous research has found that CAS is highest in serious relationships, findings suggest that there may be another type of partnership in which CAS is likely to occur (older partners met online). If confirmed, these results suggest interventions focused on the intersection of marijuana use and CAS may be particularly important among YMSM with serious partners.
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Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
| | - Brian A Feinstein
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
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Yu SWY, Hill C, Ricks ML, Bennet J, Oriol NE. The scope and impact of mobile health clinics in the United States: a literature review. Int J Equity Health 2017; 16:178. [PMID: 28982362 PMCID: PMC5629787 DOI: 10.1186/s12939-017-0671-2] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/24/2017] [Indexed: 11/24/2022] Open
Abstract
As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation's overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population. This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics MobileHealthMap.org , the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there are limitations and challenges to this healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into our healthcare system.
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Affiliation(s)
- Stephanie W. Y. Yu
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Caterina Hill
- Department of Global Health and Social Medicine, Harvard Medical School, c/o The Family Van, 1542 Tremont St, Roxbury, MA 02120 USA
| | - Mariesa L. Ricks
- Harvard Business School, Soldiers Field, Boston, MA 02163 USA
- Harvard University T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Jennifer Bennet
- The Family Van: Harvard Medical School, 1542 Tremont St, Roxbury, MA 02120 USA
| | - Nancy E. Oriol
- Harvard Medical School, 260 Longwood Ave, Suite 244, Boston, MA 02115 USA
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
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Abdulrahman SA, Rampal L, Othman N, Ibrahim F, Hayati KS, Radhakrishnan AP. Sociodemographic profile and predictors of outpatient clinic attendance among HIV-positive patients initiating antiretroviral therapy in Selangor, Malaysia. Patient Prefer Adherence 2017; 11:1273-1284. [PMID: 28794617 PMCID: PMC5538701 DOI: 10.2147/ppa.s141609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Inconsistent literature evidence suggests that sociodemographic, economic, and system- and patient-related factors are associated with clinic attendance among the HIV-positive population receiving antiretroviral therapy (ART) around the world. We examined the factors that predict outpatient clinic attendance among a cohort of HIV-positive patients initiating ART in Selangor, Malaysia. PATIENTS AND METHODS This cross-sectional study analyzed secondary data on outpatient clinic attendance and sociodemographic, economic, psychosocial, and patient-related factors among 242 adult Malaysian patients initiating ART in Selangor, Malaysia. Study cohort was enrolled in a parent randomized controlled trial (RCT) in Hospital Sungai Buloh Malaysia between January and December 2014, during which peer counseling, medication, and clinic appointment reminders were provided to the intervention group through short message service (SMS) and telephone calls for 24 consecutive weeks. Data on outpatient clinic attendance were extracted from the hospital electronic medical records system, while other patient-level data were extracted from pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires in which primary data were collected. Outpatient clinic attendance was categorized into binary outcome - regular attendee and defaulter categories - based on the number of missed scheduled outpatient clinic appointments within a 6-month period. Multivariate regression models were fitted to examine predictors of outpatient clinic attendance using SPSS version 22 and R software. RESULTS A total of 224 (93%) patients who completed 6-month assessment were included in the model. Out of those, 42 (18.7%) defaulted scheduled clinic attendance at least once. Missed appointments were significantly more prevalent among females (n=10, 37.0%), rural residents (n=10, 38.5%), and bisexual respondents (n=8, 47.1%). Multivariate binary logistic regression analysis showed that Indian ethnicity (adjusted odds ratio [AOR] =0.235; 95% CI [0.063-0.869]; P=0.030) and heterosexual orientation (AOR =4.199; 95% CI [1.040-16.957]; P=0.044) were significant predictors of outpatient clinic attendance among HIV-positive patients receiving ART in Malaysia. CONCLUSION Ethnicity and sexual orientation of Malaysian patients may play a significant role in their level of adherence to scheduled clinic appointments. These factors should be considered during collaborative adherence strategy planning at ART initiation.
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Affiliation(s)
- Surajudeen Abiola Abdulrahman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
- Department of Public Health Medicine, Penang Medical College, George Town, Penang
| | - Lekhraj Rampal
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
| | - Norlijah Othman
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
| | - Faisal Ibrahim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
| | - Kadir Shahar Hayati
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor
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Vaughan AS, Kramer MR, Cooper HLF, Rosenberg ES, Sullivan PS. Activity spaces of men who have sex with men: An initial exploration of geographic variation in locations of routine, potential sexual risk, and prevention behaviors. Soc Sci Med 2016; 175:1-10. [PMID: 28040577 DOI: 10.1016/j.socscimed.2016.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/17/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
Theory and research on HIV and among men who have sex with men (MSM) have long suggested the importance of non-residential locations in defining structural exposures. Despite this, most studies within these fields define place as a residential context, neglecting the potential influence of non-residential locations on HIV-related outcomes. The concept of activity spaces, defined as a set of locations to which an individual is routinely exposed, represents one theoretical basis for addressing this potential imbalance. Using a one-time online survey to collect demographic, behavioral, and spatial data from MSM, this paper describes activity spaces and examines correlates of this spatial variation. We used latent class analysis to identify categories of activity spaces using spatial data on home, routine, potential sexual risk, and HIV prevention locations. We then assessed individual and area-level covariates for their associations with these categories. Classes were distinguished by the degree of spatial variation in routine and prevention behaviors (which were the same within each class) and in sexual risk behaviors (i.e., sex locations and locations of meeting sex partners). Partner type (e.g. casual or main) represented a key correlate of the activity space. In this early examination of activity spaces in an online sample of MSM, patterns of spatial behavior represent further evidence of significant spatial variation in locations of routine, potential HIV sexual risk, and HIV prevention behaviors among MSM. Although prevention behaviors tend to have similar geographic variation as routine behaviors, locations where men engage in potentially high-risk behaviors may be more spatially focused for some MSM than for others.
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Affiliation(s)
- Adam S Vaughan
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA 30322, USA; Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA 30322, USA; Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Hannah L F Cooper
- Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA; Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA 30322, USA.
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA 30322, USA; Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, 1518 Clifton Rd NE, Emory University, Atlanta, GA 30322, USA; Laney Graduate School, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
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27
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Grov C, Rendina HJ, Ventuneac A, Parsons JT. Sexual Behavior Varies Between Same-Race and Different-Race Partnerships: A Daily Diary Study of Highly Sexually Active Black, Latino, and White Gay and Bisexual Men. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1453-62. [PMID: 26696407 PMCID: PMC4917476 DOI: 10.1007/s10508-015-0677-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 11/23/2015] [Accepted: 12/01/2015] [Indexed: 05/11/2023]
Abstract
Racial homophily (partnering with those of the same race) has been suggested as contributing to racial disparities in HIV among gay and bisexual men (GBM). Using a daily diary study, we examined racial homophily and its role in anal sexual behaviors in a sample of highly sexually active Black, White, and Latino GBM (N = 294, n = 3107 sexual events). In general, (1) men tended to partner with others of the same race, (2) HIV was more prevalent among men of color, and (3) race acted independent of whether one would engage in behaviors that would put them at highest risk for transmitting HIV (i.e., no main or interaction effects for insertive condomless anal sex (CAS) among HIV-positive men, and no main or interaction effects for receptive CAS among HIV-negative men). There were some main and interactive effects observed for lower risk behaviors (receptive CAS among HIV-positive men and insertive CAS among HIV-negative). Our findings suggest that racial disparities in HIV may be due to a higher exposure frequency (i.e., the frequency with which one comes into contact with a partner where a transmission could occur). However, men were also less likely to have anal sex when having sex with someone of the same race-a finding that works against the premise of higher exposure frequency. Future researchers should examine both racial homophily as well as variation in sexual behavior based on same-race or different-race partnerships.
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Affiliation(s)
- Christian Grov
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York (CUNY), Brooklyn, NY, USA
- CUNY School of Public Health, New York, NY, USA
| | - H Jonathon Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
| | - Ana Ventuneac
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
| | - Jeffrey T Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA.
- CUNY School of Public Health, New York, NY, USA.
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY, 10065, USA.
- Health Psychology and Clinical Science Doctoral Program, The Graduate Center of CUNY, New York, NY, USA.
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Dasgupta S, Kramer MR, Rosenberg ES, Sanchez TH, Sullivan PS. Development of a comprehensive measure of spatial access to HIV provider services, with application to Atlanta, Georgia. SPRINGERPLUS 2016; 5:984. [PMID: 27429893 PMCID: PMC4932000 DOI: 10.1186/s40064-016-2515-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND No existing measures of HIV care access consider both spatial proximity to services and provider-related characteristics in a single measure. We developed and applied a tool to: (1) quantify spatial access to HIV care services (supply) and (2) identify underserved areas with respect to HIV cases (demand), by travel mode, in Atlanta. METHODS Building on a study of HIV care engagement, data from an HIV care provider database, and HIV case counts by zip code tabulation area (ZCTA) from AIDSVu.org, we fit a discrete choice model to estimate practice characteristics most salient in defining patient care access. Modified spatial gravity modeling quantified supply access based on discrete choice model results separately for travel by car and by public transportation. Relative access scores were calculated by ZCTA, and underserved areas (defined as having low supply access and high HIV case count) were identified for each travel mode. RESULTS Characteristics retained in the final model included: travel distance, available provider-hours, availability of ancillary services, and whether Ryan White patients were accepted. HIV provider supply was higher in urban versus suburban/rural areas for both travel modes, with lower supply access if traveling by public transportation. Underserved areas were concentrated in south and east Atlanta if traveling by public transportation, overlapping with many areas of high poverty. Approximately 7.7 %, if traveling by car, and 64.3 %, if traveling by public transportation, of Atlanta-based persons with diagnosed HIV infection resided in underserved areas. CONCLUSION These findings highlight underserved areas in south and east Atlanta if traveling by public transit. Conceptualizing access to medical services spatially and by travel mode may help bridge gaps between patient needs and service availability and improve HIV outcomes.
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Affiliation(s)
- Sharoda Dasgupta
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Michael R. Kramer
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Eli S. Rosenberg
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Travis H. Sanchez
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
| | - Patrick S. Sullivan
- />Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA
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Grov C, Cain D, Whitfield THF, Rendina HJ, Pawson M, Ventuneac A, Parsons JT. Recruiting a U.S. national sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: Challenges and Opportunities. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2016; 13:1-21. [PMID: 26858776 PMCID: PMC4743043 DOI: 10.1007/s13178-015-0212-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We describe enrollment for the One Thousand Strong panel, present characteristics of the panel relative to other large U.S. national studies of gay and bisexual men (GBM), and examine demographic and behavioral characteristics that were associated with passing enrollment milestones. A U.S. national sample of HIV-negative men were enrolled via an established online panel of over 22,000 GBM. Participants (n = 1071) passed three milestones to join our panel. Milestone 1 was screening eligible and providing informed consent. Milestone 2 involved completing an hour-long at-home computer-assisted self-interview (CASI) survey. Milestone 3 involved completing at-home self-administered rapid HIV testing and collecting/returning urine and rectal samples for gonorrhea and chlamydia testing. Compared to those who completed milestones: those not passing milestone 1 were more likely to be non-White and older; those not passing milestone 2 were less likely to have insurance or a primary care physician; and those not passing milestone 3 were less educated, more likely to be bisexual as opposed to gay, more likely to live in the Midwest, had fewer male partners in the past year, and less likely to have tested for HIV in the past year. Effect sizes for significant findings were small. We successfully enrolled a national sample of HIV-negative GBM who completed at-home CASI assessments and at-home self-administered HIV and urine and rectal STI testing. This indicates high feasibility and acceptability of incorporating self-administered biological assays into otherwise fully online studies. Differences in completion of study milestones indicate a need for further investigation into the reasons for lower engagement by certain groups.
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