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Merle JL, Zapata JP, Quieroz A, Zamantakis A, Sanuade O, Mustanski B, Smith JD. Pre-exposure prophylaxis (PrEP) among people who use drugs: a qualitative scoping review of implementation determinants and change methods. Addict Sci Clin Pract 2024; 19:46. [PMID: 38816889 PMCID: PMC11138081 DOI: 10.1186/s13722-024-00478-2] [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: 09/20/2023] [Accepted: 05/24/2024] [Indexed: 06/01/2024] Open
Abstract
Implementation of pre-exposure prophylaxis (PrEP) to prevent HIV transmission is suboptimal in the United States, particularly among people who use drugs (PWUD). PrEP research among PWUD is scarce, and the factors that impact implementation are largely unknown. Therefore, we conducted a scoping review of implementation determinants (i.e., barriers and facilitators), as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to increase PrEP implementation and use among PWUD. We identified 32 peer-reviewed articles assessing determinants and five that evaluated change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR), which is an established framework to understand the multilevel barriers and facilitators associated with implementation. Findings indicate that most research was conducted among PrEP recipients (i.e., patients), focusing on awareness and willingness to use PrEP, with less focus on factors impacting clinicians and service delivery systems. Moreover, very few change methods have been evaluated to improve clinician adoption and adherence to CDC guidelines for PrEP provision and/or recipient uptake and adherence to PrEP. Future research is needed that focuses on factors impacting implementation from a clinician standpoint as well as innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence to guidelines. Implementation Science offers a wealth of knowledge to speed up the effort to end the HIV epidemic in the United States.
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Affiliation(s)
- James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Juan P Zapata
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Artur Quieroz
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Alithia Zamantakis
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Olutobi Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Medical Social Sciences Department, Northwestern University, Chicago, IL, USA
- Department of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Chan K, Mitchell MM, Casselle E, Bender AA. Facilitators and Barriers to PrEP Acceptability and Initiation Among Opioid Treatment Program Patients and Staff. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:60-72. [PMID: 38349350 DOI: 10.1521/aeap.2024.36.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The Centers for Disease Control and Prevention recommends PrEP (pre-exposure prophylaxis) for people who use drugs, yet uptake remains low. This study explores the acceptability and potential uptake of PrEP among participants in an opioid treatment program (OTP). We conducted 26 in-depth, semistructured interviews with staff and patients at an OTP in Baltimore, Maryland. Overall, participants felt that providing PrEP within the program would be beneficial, but they noted competing priorities among populations engaging in high-risk behaviors and lack of willingness among groups with lower risk behaviors. Participants reported several barriers to PrEP use among people who use drugs and who use medications for opioid use, including cost, competing priorities, stigma, and misconceptions about who should use PrEP. Facilitators to PrEP use were described as health benefits, trusted relationships with providers, and existing resources in the opioid treatment program. Practitioners should consider addressing barriers to access and stigma within an OTP setting for HIV prevention tools.
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Affiliation(s)
- Kiera Chan
- Department of Medicine, Emory University, Atlanta, Georgia
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Jaiswal J, Griffin M, LoSchiavo C, Cox A, Hascher K, Dunlap K, Walters S, Burton WM, Grin B, Mumba M, Eaton E. Challenges to Providing Integrated HIV Prevention in Substance Use Treatment Settings: Frontline Staff Perspectives on HIV and Sex-Related, Education, Communication and Stigma. Subst Use Misuse 2023; 58:1866-1873. [PMID: 37818832 PMCID: PMC10873058 DOI: 10.1080/10826084.2023.2257308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Substance use treatment settings can play a critical role in ending the HIV epidemic. Community-based methadone clinics are potentially useful sites to offer biomedical HIV prevention, but little is known about how clinicians and other clinic staff communicate with patients about sexual behavior and HIV-related topics. METHODS Thirty semi-structured interviews were conducted at two methadone clinics in Northern New Jersey. Participants included medical providers (physicians, RNs, DNPs), methadone counselors, intake coordinators, lab technicians, and other auxiliary staff members. Results: Three major themes were identified: (1) HIV education is primarily provided by external organizations, (2) there is limited staff-patient communication around HIV and sexual behaviors, and (3) HIV stigma is prevalent among staff and patients. CONCLUSION To implement PrEP in methadone treatment settings, clinic staff must be able to engage in non-judgmental communication about HIV and sex with patients. Additionally, federal and state funding for HIV prevention in substance use treatment settings must be prioritized to enable clinics to access the necessary training and resources.
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Affiliation(s)
- Jessica Jaiswal
- Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Caleb LoSchiavo
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Amanda Cox
- Institute of Data and Analytics, University of Alabama, Tuscaloosa, AL, USA
| | | | - Kandyce Dunlap
- Department of Health Science, University of Alabama, Tuscaloosa, AL, USA
| | | | - Wanda M Burton
- Department of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Benjamin Grin
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Mercy Mumba
- Department of Nursing, University of Alabama, Tuscaloosa, AL, USA
| | - Ellen Eaton
- Division of Infectious Diseases, University of Alabama-Birmingham, Birmingham, AL, USA
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Paulus K, Kelly PJ, Brajuha J, D’Avanzo P, Dauria EF, Trainor A, Alrez A, Bass SB. The relationship of PrEP beliefs to perceived personal, interpersonal and structural benefits and barriers to PrEP use in women who inject drugs. BMC Womens Health 2023; 23:303. [PMID: 37291563 PMCID: PMC10251529 DOI: 10.1186/s12905-023-02452-7] [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: 09/15/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Women who inject drugs (WWID) have significant biological, behavioral, and gender-based barriers to accessing HIV prevention services, including Pre-Exposure Prophylaxis (PrEP) medication. Little is known about how beliefs about PrEP impact both perceived barriers and benefits of PrEP use and how they may be related to the decision-making process. METHODS Surveys were conducted with 100 female clients of a large syringe services program in Philadelphia, Pennsylvania. The sample was categorized into three groups based on mean PrEP beliefs scores using terciles: accurate beliefs, moderately accurate beliefs, and inaccurate beliefs. Oneway ANOVA tests were used to compare groups by perceived benefits and barriers to PrEP, drug use stigma, healthcare beliefs, patient self-advocacy, and intention to use PrEP. RESULTS Participants had a mean age of 39 years (SD 9.00), 66% reported being White, 74% finished high school, and 80% reported having been homeless within the past 6 months. Those with the most accurate PrEP beliefs reported highest intent to use PrEP and were more likely to agree that benefits of PrEP included it preventing HIV and helping them "feel in charge". Those with inaccurate beliefs were more likely to strongly agree that barriers, such as fear of reprisal from a partner, potential theft, or feeling they "might get HIV anyway", were reasons not to use PrEP. CONCLUSIONS Results indicate perceived personal, interpersonal and structural barriers to PrEP use are associated with accuracy of beliefs is, pointing to important intervention targets to increase uptake among WWID.
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Affiliation(s)
- Kirsten Paulus
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Patrick J.A. Kelly
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, USA
| | - Jesse Brajuha
- Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, USA
| | - Paul D’Avanzo
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Emily F. Dauria
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, 130 De Soto Street, Pittsburgh, 15261 USA
| | - Aurora Trainor
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Annabelle Alrez
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University College of Public Health, 1301 Cecil B. Moore Ave., Room 945, Philadelphia, 19064 USA
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Logistical Facilitators and Barriers to PrEP Implementation in Methadone Clinic Settings: Provider and Staff Perspectives. J Addict Med 2022; 16:e278-e283. [PMID: 35165229 PMCID: PMC9375804 DOI: 10.1097/adm.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the feasibility of implementing pre-exposure prophylaxis (PrEP), a daily oral medication for human immunodeficiency virus (HIV) prevention, in methadone clinics. METHODS Medical and nonmedical staff (n = 30) at 2 methadone clinics in Northern New Jersey were qualitatively interviewed about various aspects of substance use treatment, clinical operations, and HIV risk and prevention among their patient populations. Audio-recorded interviews were professionally transcribed, then coded and analyzed by the research team. RESULTS Themes surrounding the viability of PrEP implementation emerged for both logistical facilitators and barriers. Facilitators included availability of prescribing clinicians, ability to conduct lab testing on-site, and availability of existing hepatitis C programs as a blueprint for PrEP management. Barriers included increased provider burden, financial concerns, and perceptions that PrEP provision is outside the clinic's treatment scope. CONCLUSIONS Although staff expressed willingness and potential ability to provide PrEP, they identified barriers regarding insurance reimbursement, limited funding, and concerns that PrEP would extend the clinic's treatment scope. However, given the enabling factors such as availability of providers and existing clinical infrastructure, providing PrEP could increase clinic revenue through insurance reimbursement and federal funding for PrEP-related services. Clinic-level education is needed for clinical and nonclinical staff to better understand the logistics of implementing PrEP, particularly regarding prescribing practices, billing and insurance concerns, and the essential nature of HIV prevention as a critical component of substance use treatment.
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Hardy C, Fairley CK, Ong JJ, Vodstrcil LA, Bradshaw CS, Snow A, Chow EPF. Drug and Alcohol Use with Condomless Anal Sex among Men Who Have Sex with Men in Melbourne, Australia: A Retrospective Data Analysis from 2011 to 2017. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2497-2507. [PMID: 34757603 DOI: 10.1007/s10508-021-01966-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
Rises in condomless anal sex among men who have sex with men (MSM) have been reported over the last decade but there is less certainty about the role that drugs, alcohol, play in this change. We examined the changes in drug and alcohol use among 22,255 MSM reporting condomless anal sex at Melbourne Sexual Health Centre in 2011-2017. There was a 7% annual increase in using drugs before and/or during condomless anal sex but a 3% annual reduction in condomless anal sex while drunk. MSM taking PrEP were more likely to report condomless anal sex with drug use (AOR: 1.21; 95%CI: 1.07-1.37) and alcohol use (AOR: 1.29; 95%CI: 1.14-1.46) compared with MSM not taking PrEP.
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Affiliation(s)
- Christopher Hardy
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Lenka A Vodstrcil
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Anthony Snow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, VIC, 3053, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3053, Australia.
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Calabrese SK, Kalwicz DA, Modrakovic D, Earnshaw VA, Edelman EJ, Bunting SR, Del Río-González AM, Magnus M, Mayer KH, Hansen NB, Kershaw TS, Rosenberger JG, Krakower DS, Dovidio JF. An Experimental Study of the Effects of Patient Race, Sexual Orientation, and Injection Drug Use on Providers' PrEP-Related Clinical Judgments. AIDS Behav 2022; 26:1393-1421. [PMID: 34750695 PMCID: PMC9434708 DOI: 10.1007/s10461-021-03495-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/16/2023]
Abstract
Social biases may influence providers' judgments related to pre-exposure prophylaxis (PrEP) and patients' consequent PrEP access. US primary and HIV care providers (n = 370) completed an experimental survey. Each provider reviewed one fictitious medical record of a patient seeking PrEP. Records varied by patient race (Black or White) and risk behavior (man who has sex with men [MSM], has sex with women [MSW], or injects drugs [MID]). Providers reported clinical judgments and completed measures of prejudice. Minimal evidence of racially biased judgments emerged. Providers expressing low-to-moderate sexual prejudice judged the MSM as more likely than the MSW to adhere to PrEP, which was associated with greater PrEP prescribing intention; sexual prejudice was negatively associated with anticipated MSM adherence. Providers judged the MID to be at higher risk, less likely to adhere, less safety-conscious, and less responsible than both the MSM and MSW; adverse adherence and responsibility judgments were associated with lower prescribing intention.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Djordje Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - E Jennifer Edelman
- Department of General Internal Medicine, Yale University, New Haven, CT, USA
| | - Samuel R Bunting
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ana María Del Río-González
- Department of Psychological and Brain Sciences, George Washington University, 2125 G Street NW, Washington, DC, 20052, USA
| | - Manya Magnus
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - John F Dovidio
- Department of Social and Behavioral Sciences, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Silva-Brandao RRD, Ianni AMZ. Othering discourse and stigma amidst the identity formation process among gays, bisexuals and other men who have sex with men on HIV pre-exposure prophylaxis (PrEP). CIENCIA & SAUDE COLETIVA 2022; 27:1965-1974. [PMID: 35544823 DOI: 10.1590/1413-81232022275.12692021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
With the global emergence of the HIV pre-exposure prophylaxis (PrEP), questions have emerged on which ways the social identity formation process among gays, bisexuals and other men who have sex with men on PrEP arise and constitute beyond exclusive sexual orientation expressions. We conducted a content analysis with thematic categories in a PrEP online group guided by group-web affiliation and individualization approaches. Individuals identify themselves as PrEPsters as part of a PrEP club, while dealing with conflicts on serosorting sexual partners and stigmatizing reactions towards people living with HIV/AIDS (PLWH). Self-worth and othering discourses towards PLWH emerged as complex themes in men's production of identity processes across four overlapping domains: (1) self-worth as a strategy to challenge individual HIV-acquisition-related anxiety and fear, (2) group-worth and group empowerment, (3) body control and reclaiming power on sexual health, and (4) othering discourses, HIV/AIDS stigma and criminalization of PLWH. Paradoxically, internal and external discourses to the group constitute and challenge identity differentiation; individuals on PrEP claim to fight against the HIV/AIDS stigma, while this reverberates alongst HIV-related discriminatory expressions in their discourses.
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Affiliation(s)
- Roberto Rubem da Silva-Brandao
- Faculdade de Saúde Pública, Universidade de São Paulo (USP). Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
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GLICK JL, RUSSO RG, HUANG AKH, JIVAPONG B, RAMASAMY V, ROSMAN LM, PELAEZ DL, SHERMAN SG. ART uptake and adherence among female sex workers (FSW) globally: A scoping review. Glob Public Health 2022; 17:254-284. [PMID: 33301704 PMCID: PMC8190161 DOI: 10.1080/17441692.2020.1858137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted the first scoping literature review on ART uptake and adherence among Female Sex Workers (FSW), following PRISMA-ScR guidelines. Searches were conducted in PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting an ART uptake or adherence result among FSW aged 18 or older; peer-reviewed; published in English between 1996 and 2018. Our search identified 6,735 studies; 30 met eligibility requirements. ART uptake ranges from 0 to 100% and adherence ranges from 50-90%, depending on measurement methods. Uptake and adherence influencing factors are mapped onto a social ecological model (SEM). Knowledge and beliefs, substance use, food insecurity and sex-work engagement were negatively associated, while older age, relationships and social support were positively associated with ART uptake and adherence. Standardised methods to measure uptake and adherence prevalence must be established for data comparison. Evidence regarding ART uptake and adherence barriers and facilitators span multiple SEM levels, although more research is needed regarding structural and occupational level influencers. Results suggest that the multi-level ART uptake and adherence barriers faced by FSW require complex multi-level evidence-based interventions. Study findings can inform ART interventions, future research, and offer guidance to other support services with FSW, such as PrEP interventions.
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Affiliation(s)
- Jennifer L. GLICK
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Rienna G. RUSSO
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Aimee Kao-Hsuan HUANG
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Belinda JIVAPONG
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Lori M. ROSMAN
- Welch Medical Library, Johns Hopkins University, Baltimore MD, USA
| | - Danielle L PELAEZ
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Susan G. SHERMAN
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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Glasner S, Patrick K, Ybarra M, Reback CJ, Ang A, Kalichman S, Bachrach K, Garneau HC, Venegas A, Rawson RA. Promising outcomes from a cognitive behavioral therapy text-messaging intervention targeting drug use, antiretroviral therapy adherence, and HIV risk behaviors among adults living with HIV and substance use disorders. Drug Alcohol Depend 2022; 231:109229. [PMID: 34979421 DOI: 10.1016/j.drugalcdep.2021.109229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND To date, no studies have reported the use of text messaging to deliver cognitive behavioral therapy (CBT) to people living with HIV and substance use disorders. OBJECTIVE We developed and evaluated a 12-week, CBT-based text-messaging intervention (TXT-CBT) targeting drug use and adherence to antiretroviral therapy (ART) for adults with HIV and comorbid opioid and stimulant use disorders. MATERIALS AND METHODS Participants were randomly assigned to receive either TXT-CBT (n = 25) or an informational pamphlet (INFO) discussing substance use and medication adherence (n = 25). ART adherence, drug use, and HIV-risk behaviors were assessed at baseline, monthly during treatment, and treatment-end, and were compared between groups using a mixed-model repeated-measures analysis. Injection drug use was examined as a moderator of outcomes. RESULTS Relative to the INFO group, TXT-CBT participants evidenced increased ART adherence, measured by phone-based unannounced pill counts and biochemically by viral load and CD4 count. TXT-CBT participation was also associated with reductions in opioid use and HIV risk behaviors. While reductions in cocaine use were observed in the TXT-CBT group, relative to the INFO group, other stimulant use did not change. Among people who inject drugs, TXT-CBT produced increases in ART adherence and corresponding changes in viral load, relative to injection drug users in the control condition. CONCLUSIONS Findings demonstrated promising preliminary evidence for the efficacy of TXT-CBT in improving ART adherence and reducing drug use and HIV-risk behaviors among people with HIV infection and comorbid opioid and stimulant use disorders.
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Affiliation(s)
- Suzette Glasner
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; UCLA School of Nursing, Los Angeles, USA.
| | - Kevin Patrick
- University of California at San Diego, San Diego, USA
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, USA
| | - Cathy J Reback
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; Friends Research Institute, West Hollywood, USA
| | - Alfonso Ang
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; UCLA School of Nursing, Los Angeles, USA
| | - Seth Kalichman
- University of Connecticut, Department of Psychology, Storrs, USA
| | | | - Hélène Chokron Garneau
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA
| | - Alexandra Venegas
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA
| | - Richard A Rawson
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Los Angeles, USA; University of Vermont, Department of Psychiatry, Burlington, USA
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Pleuhs B, Mistler CB, Quinn KG, Dickson-Gomez J, Walsh JL, Petroll AE, John SA. Evidence of Potential Discriminatory HIV Pre-Exposure Prophylaxis (PrEP) Prescribing Practices for People Who Inject Drugs Among a Small Percentage of Providers in the U.S. J Prim Care Community Health 2022; 13:21501319211063999. [PMID: 35068243 PMCID: PMC8796077 DOI: 10.1177/21501319211063999] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION A large percentage of people who inject drugs (PWID) are living with HIV. Yet, rates of HIV pre-exposure prophylaxis (PrEP) use among PWID remain low. Stigma surrounding substance use and PWID have been identified as potential barriers to PrEP. This study examined healthcare providers' concerns regarding PWID and willingness to prescribe PrEP to PWID. METHODS An online, cross-sectional survey of a diverse group of healthcare providers in the 10 U.S. cities with the greatest HIV prevalence was conducted between July 2014 and May 2015. Participants responded to a patient vignette of a PWID and asked to indicate whether the patient would be a candidate for PrEP and why via free-response text. Descriptive statistics are reported using frequency measures. Bivariate analyses were conducted using chi-squared comparisons and logistical regression. RESULTS Survey data from 480 providers were included in analyses. Of the 480 responses, 85.5% were classified as PrEP aware, while 14.2% were PrEP unaware. Additionally, 82.6% indicated the patient would be a good candidate for PrEP, 4.4% believed the patient was not a good candidate for PrEP, and 13% were unsure. Among those who were unsure or would not prescribe PrEP (n = 84), open-ended responses indicated lack of knowledge (42.9%), concern about adherence (27.4%), concern about cost (4.8%), and bias (7.1%) as the primary reasons. CONCLUSIONS Although the majority of providers in this study did not demonstrate bias against PWID, our study found that limited PrEP knowledge and bias are barriers to PrEP prescription among PWID for some providers. Interventions are needed that increase PrEP awareness of CDC guidelines and reduce implicit bias among providers.
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Affiliation(s)
| | | | | | | | | | | | - Steven A. John
- Medical College of Wisconsin, Milwaukee, WI, USA
- Steven A. John, Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202, USA.
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Pre-exposure prophylaxis (PrEP) indication and uptake among people receiving buprenorphine for the treatment of opioid use disorder. J Subst Abuse Treat 2022; 132:108506. [PMID: 34098202 PMCID: PMC8630078 DOI: 10.1016/j.jsat.2021.108506] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with opioid use disorder (OUD) are disproportionately burdened by HIV. The United States' Centers for Disease Control and Prevention (CDC) has issued guidelines for pre-exposure prophylaxis (PrEP) indication. We know little about PrEP for people receiving medication for OUD. The objective of this study is to report PrEP indication, awareness, and uptake in patients engaged in outpatient OUD treatment with buprenorphine. METHODS Adult patients (n = 137) receiving buprenorphine for OUD at an outpatient substance use disorder treatment clinic completed a cross-sectional survey between July and September 2019. The study determined PrEP indication by 2017 CDC criteria. PrEP awareness and uptake were self-reported. The study assessed statistical differences in PrEP indicators by Pearson's χ2 and Fisher's exact. RESULTS Nearly three-quarters (73.7%, n = 101) of the study sample met CDC criteria for PrEP-indication based on past-year risk behaviors. Ninety-five percent of these participants reported inconsistent condom use, 21.0% engaged in commercial sex, 9.0% shared injection equipment, 8.9% reported a recent bacterial STI, and 4.0% had an HIV+ sexual partner. Of PrEP indicated participants (n = 101), 19 had heard of PrEP prior to the survey, but only 1 participant reported past-year PrEP use. CONCLUSIONS Among a clinical population of people receiving buprenorphine for OUD, HIV risk behaviors were common, yet PrEP awareness and uptake were low. People engaged in treatment for OUD remain at high risk for HIV and are a priority population for PrEP. In light of the current opioid crisis, more research is needed to guide the integration of comprehensive HIV prevention into outpatient opioid treatment centers.
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Brokus C, Kattakuzhy S, Gayle B, Narayanan S, Davis A, Cover A, Eyasu R, Ebah E, Ogbumbadiugha-Weekes O, Hoffmann J, Silk R, Stevens J, Mount J, Gannon C, Nussdorf L, Mathur P, Bijole P, Jones M, Kier R, Sternberg D, Greenblatt A, Weintraub E, Masur H, Kottilil S, Rosenthal E. Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment. Open Forum Infect Dis 2021; 9:ofab658. [PMID: 35187191 PMCID: PMC8849288 DOI: 10.1093/ofid/ofab658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background Daily oral preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) prevents human immunodeficiency (HIV) among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use (IDU), PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. Methods The ANCHOR investigation evaluated a community-based care model collocating hepatitis C virus (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC, and Baltimore, Maryland. PrEP counseling was conducted from HCV treatment day 0 until week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried blood spot TDF analysis. Results One hundred ninety-eight participants were enrolled, of whom 185 (93%) were HIV negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. One hundred sixteen participants (62.7%) met 2014 Centers for Disease Control and Prevention (CDC) PrEP criteria due to IDU (82 [44.3%]), sex (9 [4.9%]), or both practices (25 [13.5%]). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (interquartile range, 28–276 days), with 8 participants retained through week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Conclusions This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.
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Affiliation(s)
- C Brokus
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - S Kattakuzhy
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - B Gayle
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - S Narayanan
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A Davis
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A Cover
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - R Eyasu
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E Ebah
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - O Ogbumbadiugha-Weekes
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - J Hoffmann
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - R Silk
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - J Stevens
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - J Mount
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - C Gannon
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - L Nussdorf
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
| | - P Mathur
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - P Bijole
- HIPS, org, Washington, DC, United States
| | - M Jones
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - R Kier
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - D Sternberg
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - A Greenblatt
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E Weintraub
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - H Masur
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - S Kottilil
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - E Rosenthal
- DC Partnership for HIV/AIDS Progress, Washington, DC, United States
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
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Care of Individuals Who Identify as Lesbian, Gay, Bisexual, Transgender, Questioning and/or Queer, Intersex, or Asexual: A Position Paper. J Addict Nurs 2021; 32:220-224. [PMID: 34855320 DOI: 10.1097/jan.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Zhou X, Altice FL, Chandra D, Didomizio E, Copenhaver MM, Shrestha R. Use of Pre-exposure Prophylaxis Among People Who Inject Drugs: Exploratory Findings of the Interaction Between Race, Homelessness, and Trust. AIDS Behav 2021; 25:3743-3753. [PMID: 33751313 DOI: 10.1007/s10461-021-03227-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Scale-up of pre-exposure prophylaxis (PrEP) in people who inject drugs (PWID) remains suboptimal. Patient-level factors are often complex and may contribute to scale-up. Using cross-sectional data from 234 opioid-dependent patients on methadone who met eligibility criteria for PrEP, we conducted logistic regression analyses to assess potential moderators associated with being on PrEP (n = 60). Mean provider trust was significantly higher among Blacks vs Whites (39.4 vs 34.9; p = 0.002) and non-homeless vs homeless participants (37.5 vs 34.8; p = 0.008). Though race/ethnicity was not a significant moderator on provider trust and PrEP use, increased provider trust was marginally associated with increased PrEP use among Blacks (p = 0.058). Additionally, homelessness significantly moderated provider trust and PrEP use (p = 0.024). Provider trust among non-homeless participants was positively correlated with PrEP use (p = 0.013) but not among homeless participants. Strategies that promote provider trust in Blacks and non-homeless PWID on methadone may improve PrEP scale-up.
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Mistler CB, Copenhaver MM, Shrestha R. The Pre-exposure Prophylaxis (PrEP) Care Cascade in People Who Inject Drugs: A Systematic Review. AIDS Behav 2021; 25:1490-1506. [PMID: 32749627 PMCID: PMC7858689 DOI: 10.1007/s10461-020-02988-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Injection drug use is a key risk factor for the transmission of HIV. Prevention strategies, such as the use of pre-exposure prophylaxis (PrEP), are effective at reducing the risk of HIV transmission in people who inject drugs (PWID). Following PRISMA guidelines, a literature search was conducted to identify the current state of the PrEP care cascade in PWID. Twenty-three articles were evaluated in this systematic review. A decline in engagement throughout the stages of the PrEP care cascade was found. High awareness and willingness to use PrEP was found, yet PrEP uptake was relatively low (0-3%). There is a lack of research on interventions to increase engagement of PrEP across all levels of the care cascade in PWID. Implications from the interventions that have been published provide insight into practice and public policy on efficacious strategies to reduce HIV incidence in PWID. Our findings suggest that more efforts are needed to identify and screen PWID for PrEP eligibility and to link and maintain them with appropriate PrEP care.
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Affiliation(s)
- Colleen B Mistler
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA.
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
| | - Michael M Copenhaver
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269-1101, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Roman Shrestha
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Towe SL, Sullivan CA, McKellar MS, Meade CS. Examining the Potential of Pre-exposure Prophylaxis (PrEP) for HIV Prevention in a Community Sample of Persons Who Use Stimulants Living in the Southern United States. AIDS Behav 2021; 25:1480-1489. [PMID: 32757101 DOI: 10.1007/s10461-020-02987-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pre-exposure prophylaxis (PrEP), a highly effective HIV prevention strategy, is currently underutilized by several at-risk groups, including both persons who inject drugs and those who use drugs via other routes. Stimulant use is associated with increased HIV risk due to both sexual and injection risk behaviors. In this study, we examined PrEP awareness and acceptability in persons with biologically confirmed HIV-negative status who use stimulant drugs. We also examined HIV risk behaviors to identify how many participants met behavioral eligibility for PrEP. The sample of 352 participants was 46% female, 87% African American, and 45.69 years old on average. Over half the sample (n = 213) met criteria for PrEP candidacy, but less than 20% had heard of PrEP. Ratings for willingness to take PrEP were high. PrEP candidates reported more frequent and problematic stimulant use relative to non-candidates. Our results show that persons who use stimulants are a high-risk population that could benefit significantly from PrEP. Efforts to increase PrEP awareness among high-risk populations are critical for facilitating PrEP implementation and ensuring effective HIV prevention within these communities.
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Affiliation(s)
- Sheri L Towe
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA.
| | - Catherine A Sullivan
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
| | - Mehri S McKellar
- Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Christina S Meade
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 102848, Durham, NC, 27710, USA
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Pre-exposure prophylaxis awareness, acceptability and potential stigma among medical and non-medical clinic staff in methadone treatment settings in northern New Jersey: The key role of non-medical staff in enhancing HIV prevention. J Subst Abuse Treat 2021; 129:108371. [PMID: 34080542 DOI: 10.1016/j.jsat.2021.108371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/06/2021] [Accepted: 03/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND HIV prevention is needed among people who use drugs (PWUD) due to mixing sex and drugs, selling/trading sex, and/or injecting drugs. Pre-exposure prophylaxis (PrEP) is an extremely effective biomedical HIV prevention strategy, but uptake remains low among communities most in need of HIV prevention, including PWUD. Previous studies have found that providers are less willing to prescribe PrEP to PWUD, yet PWUD express high levels of PrEP acceptance. More research is needed to understand how people who provide substance use treatment services think about PrEP to maximize this biomedical prevention strategy. METHODS The study conducted semistructured interviews with 29 staff members in two methadone clinic settings in urban northern New Jersey. Staff members included medical providers, methadone counselors, intake coordinators, front desk staff, lab technicians, security guards, and administrative/leadership personnel. RESULTS All staff recognized the need for HIV prevention among their patient populations, but most were either unaware of PrEP or unfamiliar with its purpose and how it works. Medical providers were more likely to have some PrEP knowledge in comparison to counselors and other staff, but the former largely did not have in-depth knowledge. Among those familiar with PrEP, many confused PrEP with HIV medication, as Truvada was the only FDA-approved PrEP at the time of the study. About half of participants expressed clear support for PrEP, while the other half expressed mixed or negative attitudes related to HIV, sexual behavior, and mistrust of the medication. Both the positive and negative perceptions entailed stigmatizing elements. RECOMMENDATIONS Due to patients' frequent interactions with non-medical staff (e.g., front desk staff, lab technicians, etc.), all staff, not only medical personnel, should be aware of PrEP and comfortable discussing it to foster well-informed, nonjudgmental conversations about HIV prevention with patients. PrEP education should specifically address HIV and sexual-related stigma, as even positive perceptions of PrEP may entail stigmatizing elements.
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19
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Ni Z, Altice FL, Wickersham JA, Copenhaver MM, DiDomizio EE, Nelson LE, Shrestha R. Willingness to initiate pre-exposure prophylaxis (PrEP) and its use among opioid-dependent individuals in drug treatment. Drug Alcohol Depend 2021; 219:108477. [PMID: 33422864 PMCID: PMC7946167 DOI: 10.1016/j.drugalcdep.2020.108477] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/28/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND People who use drugs (PWUD) continue to experience a disproportionate HIV burden due to drug- and sex-related risk behaviors. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, but very little is known about PrEP use among PWUD and their willingness to initiate PrEP. METHODS We conducted a cross-sectional survey among 234 HIV-negative, opioid-dependent individuals recruited from an urban methadone clinic. Participants were assessed using an audio-computer assisted self-interview technique. Bivariate and multiple logistic regressions were used to explore independent correlates of actual PrEP use and willingness to initiate PrEP. RESULTS One-fourth (25.6 %) of participants had previously used PrEP. Over two-thirds (67.1 %) of participants had previously heard of PrEP, and 65.0 % were willing to take it. In multivariable logistic regression analyses, the number of times participants engaged in HIV testing (aOR = 1.66, p < 0.01) and whether they visited a healthcare provider (aOR=20.81, p = 0.02) were associated with a higher likelihood of PrEP use, while perceived HIV risk (aOR=2.71, p < 0.01) and previous use of PrEP (aOR=3.57, p < 0.01) were significantly associated with willingness to initiate PrEP. CONCLUSION PrEP use was low among PWUD, but their willingness to initiate PrEP was moderate, which indicated a significant discrepancy between actual PrEP use and willingness to use it. Our findings highlight the importance of healthcare providers engaging opioid-dependent individuals in discussions about PrEP and the need for innovative strategies to increase their awareness of PrEP and modify their perceptions of HIV risk.
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Affiliation(s)
- Zhao Ni
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | - Frederick L. Altice
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA,Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA,Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
| | - Jeffrey A. Wickersham
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA,Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Michael M. Copenhaver
- Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA,Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | | | - Roman Shrestha
- Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA,Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
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Tran NK, Felsher M, Pol BVD, Bellamy SL, McKnight J, Roth AM. Intention to initiate and uptake of PrEP among women who injects drugs in a demonstration project: an application of the theory of planned behavior. AIDS Care 2021; 33:746-753. [PMID: 33486981 DOI: 10.1080/09540121.2021.1874267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Some women who inject drugs (WWID) would benefit from pre-exposure prophylaxis (PrEP), yet there are few studies of issues related to uptake in real-world settings. In this study, participants (n = 95) were offered PrEP and responded to items measuring PrEP-related attitudes, norms, and perceived behavioral control based on the Theory of Planned Behavior. We tested associations with intention to initiate PrEP and uptake. Most WWID (88%) intended to initiate PrEP and 78% accepted a prescription. Compared to WWID who did not express PrEP intentions, those who did were less concerned about attitudinal and perceived behavioral control constructs such as temporary (75% vs. 36%, p = 0.01) and long-term (63% vs. 27%, p = 0.05) side effects, negative interactions with their birth control (93% vs. 38%, p < 0.01), their ability to take a daily pill (80% vs. 36%, p < 0.01), and the cost of PrEP (87% vs. 36%, p < 0.01). WWID who went on to take PrEP had fewer concerns with subjective norms constructs such as talking to health care providers about sex (91% vs. 65%, p < 0.01) and drug use (88% vs. 55%, p < 0.01) compared to those who did not. Attitudes and perceived behavioral control influenced intention while subjective norms had a greater impact on actual uptake.
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Affiliation(s)
- Nguyen K Tran
- Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Marisa Felsher
- Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Barbara Van Der Pol
- Division of Infectious Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Scarlett L Bellamy
- Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jade McKnight
- Prevention Point Philadelphia, Philadelphia, PA, USA
| | - Alexis M Roth
- Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Felsher M, Koku E, Lankenau S, Brady K, Bellamy S, Roth AM. Motivations for PrEP-Related Interpersonal Communication Among Women Who Inject Drugs: A Qualitative Egocentric Network Study. QUALITATIVE HEALTH RESEARCH 2021; 31:86-99. [PMID: 32869694 PMCID: PMC7864555 DOI: 10.1177/1049732320952740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A qualitative egocentric social network approach was taken to explore motivations for pre-exposure prophylaxis (PrEP)-related communication between women who inject drugs and network members. Eligible participants were HIV-negative, 18 years or older, and participating in a PrEP demonstration project in Philadelphia, PA, USA. The study employed content analysis of in-depth interviews to identify themes related to contextual and relational factors impacting PrEP communication within networks. Participants (n = 20) named on average three network members, resulting in a total of 57 unique relationships. PrEP conversations occurred within 30 of the 57 relationships, and motivations were to benefit others, to benefit themselves, and due to a sense of obligation. Some conversations also occurred when a peer unexpectedly found their pills. Taking a qualitative approach to network analysis provided a nuanced understanding of how interpersonal characteristics motivated PrEP conversations. Network interventions that facilitate information diffusion and social support may increase PrEP uptake and adherence among women who inject drugs.
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Affiliation(s)
| | | | | | - Kathleen Brady
- Philadelphia Department of Public Health, Philadelphia, PA, USA
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Walters SM, Kral AH, Simpson KA, Wenger L, Bluthenthal RN. HIV Pre-Exposure Prophylaxis Prevention Awareness, Willingness, and Perceived Barriers among People Who Inject Drugs in Los Angeles and San Francisco, CA, 2016-2018. Subst Use Misuse 2020; 55:2409-2419. [PMID: 32962490 PMCID: PMC7665852 DOI: 10.1080/10826084.2020.1823419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV prevention is indicated for people who inject drugs (PWID), yet most studies do not focus on PWID. This study examines factors associated with PrEP awareness and willingness, and identifies perceived barriers to PrEP among PWID. Methods: PWID were interviewed in Los Angeles and San Francisco, CA from 2016 to 2018. We analyzed data from self-reported HIV-negative participants who had injected drugs within the past 6 months (n = 469). Questions on PrEP included awareness, willingness, barriers, and uptake. Multiple logistic regression models of factors associated with awareness of, and willingness to, take PrEP were developed. Descriptive statistics on perceived PrEP barriers are reported. Results: Among HIV-negative PWID, 40% were aware of PrEP, 59% reported willingness to take PrEP, and 2% were currently taking PrEP. In multivariable analysis, PrEP awareness was associated with study site and sexual minority status, higher educational attainment, and HIV testing in the last 6 months. Willingness to take PrEP was associated with self-reported risk (paying sex partner in the last 6 months, sharing drug paraphernalia, and being injected by another PWID) and perceived HIV risk. The most common perceived barriers to PrEP were copays, concerns about increased HIV or sexually transmitted risk with PrEP, and concerns about reduction of medication efficacy without daily use. Conclusion: PrEP awareness among PWID remains inadequate. Willingness to take PrEP was moderate and was most desired by PWID who engaged in high-risk behaviors. Interventions to increase PrEP awareness and willingness, and to facilitate PrEP uptake among PWID are needed.
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Affiliation(s)
- Suzan M Walters
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, San Francisco, California, USA
| | - Kelsey A Simpson
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, San Francisco, California, USA
| | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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24
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Picard J, Jacka B, Høj S, Laverdière É, Cox J, Roy É, Bruneau J. Real-World Eligibility for HIV Pre-exposure Prophylaxis Among People Who Inject Drugs. AIDS Behav 2020; 24:2400-2408. [PMID: 31997057 PMCID: PMC10710293 DOI: 10.1007/s10461-020-02800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent studies have highlighted the efficacy of and willingness to use pre-exposure prophylaxis (PrEP) to prevent HIV infection among people who inject drugs (PWID), however knowledge of real-world applicability is limited. We aimed to quantify the real-world eligibility for HIV-PrEP among HIV-negative PWID in Montreal, Canada (n = 718). Eligibility was calculated according to US Centers for Disease Control and Prevention (CDC) guidelines and compared to risk of HIV acquisition according to the assessing the risk of contracting HIV (ARCH-IDU) risk screening tool. Over one-third of participants (37%) were eligible for HIV PrEP, with 1/3 of these eligible due to sexual risk alone. Half of participants were considered high risk of HIV acquisition according to ARCH-IDU, but there was poor agreement between the two measures. Although a large proportion of PWID were eligible for HIV-PrEP, better tools that are context- and location-informed are needed to identify PWID at higher risk of HIV acquisition.
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Affiliation(s)
- Jonathan Picard
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Brendan Jacka
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Stine Høj
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Émélie Laverdière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Regional Public Health Department, CIUSSS du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Canada
| | - Élise Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
- Direction des risques biologiques et de sa santé au travail, Institut National de Santé Publique du Québec, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada.
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada.
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25
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Felsher M, Ziegler E, Smith LR, Sherman SG, Amico KR, Fox R, Madden K, Roth AM. An Exploration of Pre-exposure Prophylaxis (PrEP) Initiation Among Women Who Inject Drugs. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2205-2212. [PMID: 32274742 PMCID: PMC7773227 DOI: 10.1007/s10508-020-01684-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective but understudied tool for preventing HIV among women who inject drugs (WWID). This article is the first to explore WWID's rationale for PrEP initiation (or refusal) in a real-world setting. Purposive sampling was used to recruit 25 WWID, participating in a PrEP demonstration project operating within a syringe services program, based on whether they initiated or declined PrEP care. Content analysis of qualitative interviews was used to explore decisions to initiate PrEP (or not). We found that WWID view HIV as severe, perceive themselves to be susceptible to HIV, and believe PrEP is beneficial for HIV prevention. For some, however, real and perceived barriers outweighed benefits, leading to decisions not to initiate PrEP. Barriers included HIV stigma, fear of side effects, and needing assurance that PrEP care will be available long-term. Despite viewing PrEP as an important HIV prevention tool, not all WWID who were offered PrEP initiated it. For these women, supports to buffer perceived barriers to initiation and access to post-exposure prophylaxis may be warranted. For women who initiate, it is possible that adherence will wane if perceived risk does not remain high. Research to understand PrEP persistence is needed.
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Affiliation(s)
- Marisa Felsher
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Room 454, Philadelphia, PA, 19104, USA
| | - Eliza Ziegler
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Laramie R Smith
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Susan G Sherman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Fox
- Public Health Management Corporation Care Clinic, Philadelphia, PA, USA
| | - Kayla Madden
- Prevention Point Philadelphia, Philadelphia, PA, USA
| | - Alexis M Roth
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Room 454, Philadelphia, PA, 19104, USA.
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26
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Shrestha R, DiDomizio EE, Kim RS, Altice FL, Wickersham JA, Copenhaver MM. Awareness about and willingness to use long-acting injectable pre-exposure prophylaxis (LAI-PrEP) among people who use drugs. J Subst Abuse Treat 2020; 117:108058. [PMID: 32811633 DOI: 10.1016/j.jsat.2020.108058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/10/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
In the Bangkok Tenofovir Study of oral pre-exposure prophylaxis (PrEP; TDF/FTC), adherence was poor. Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) for HIV prevention may help overcome adherence challenges and is currently being tested in clinical trials, but not in people who use drugs (PWUD), an important key population that remains highly vulnerable to HIV. Since PWUD are not currently included in trials of LAI-PrEP, we sought to examine awareness about LAI-PrEP and factors associated with willingness to use LAI-PrEP in this understudied population. Participants included 234 HIV-negative people with opioid use disorder and self-reported HIV-risk behaviors recruited from Connecticut's largest addiction treatment program. We analyzed data from a standardized assessment using audio computer-assisted self-interview (ACASI) to assess the independent factors associated with willingness to use LAI-PrEP. While only 25.6% of participants were aware of LAI-PrEP (67.1% had heard of oral PrEP), after being given a description of it, 73.5% were willing to use it, if it were available. Participants were most commonly concerned about long-term side effects (76.9%) of LAI-PrEP. Independent correlates of willingness to use LAI-PrEP were female sex (aOR = 2.181, p = 0.018), recent visit to healthcare provider (aOR = 2.9, p = 0.023), high perceived risk of acquiring HIV (aOR = 3.3, p = 0.007), and having previously taken oral PrEP (aOR = 3.284, p = 0.017). Findings suggest that PWUD are highly interested in PrEP, especially in LAI-PrEP formulations. Our results indicate the potential for LAI-PrEP, as an alternative to oral daily PrEP, to be implemented into existing evidence-based HIV-based HIV prevention efforts that target high-risk PWUD.
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Affiliation(s)
- Roman Shrestha
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA.
| | - Elizabeth E DiDomizio
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Rayne S Kim
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Frederick L Altice
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Jeffrey A Wickersham
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
| | - Michael M Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
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27
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Glick JL, Russo R, Jivapong B, Rosman L, Pelaez D, Footer KHA, Sherman SG. The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review. AIDS Behav 2020; 24:1312-1333. [PMID: 31807973 DOI: 10.1007/s10461-019-02733-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HIV prevalence among cisgender female sex workers (FSW) and/or women who use drugs (WWUD) is substantially higher compared to similarly aged women. Consistent with PRISMA guidelines, we conducted the first systematic review on the pre-exposure prophylaxis (PrEP) continuum among FSW and/or WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting a PrEP related result among FSW and/or WWUD aged 18 + ; peer-reviewed; and published in English between 2012 and 2018. Our search identified 1365 studies; 26 met eligibility requirements, across the following groups: FSW (n = 14), WWUD (n = 9) and FSW-WWUD (n = 3). Studies report on at least one PrEP outcome: awareness (n = 12), acceptability (n = 16), uptake (n = 4), and adherence (n = 8). Specific barriers span individual and structural levels and include challenges to daily adherence, cost, and stigma. Combining health services and long-acting PrEP formulas may facilitate better PrEP uptake and adherence. The limited number of studies indicates a need for more research.
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28
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Ranjit YS, Shrestha R, Copenhaver M, Altice FL. Online HIV information seeking and pre-exposure prophylaxis awareness among people who use drugs. J Subst Abuse Treat 2019; 111:16-22. [PMID: 32087834 DOI: 10.1016/j.jsat.2019.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
People who use drugs (PWUD) remain at high risk for acquiring human immunodeficiency virus (HIV), both from injection and from sexual risk-taking. In 2016, 9% of 39,782 new HIV diagnoses occurred among people who inject drugs in the United States. Reaching PWUD with accurate information about and motivation for initiating pre-exposure prophylaxis (PrEP) remains challenging and remains the first crucial step in the knowledge-attitude-behavior change continuum. This study seeks to contribute to closing this information gap by examining the HIV information-seeking behaviors among PWUD who are not on PrEP, so as to identify potential strategies to increase adoption of HIV prevention such as PrEP as part of overall health and related to risk-taking behaviors. A cross-sectional survey was conducted in 2016 among HIV-negative PWUD (n = 400), 57.3% of whom reported injecting at least once in a week, chronically maintained on methadone treatment (MMT) at a large addiction treatment program. The study found that the number of hours spent online by people who use drugs was comparable to the general population. Awareness about PrEP and the seeking of HIV-related information was low in this population. Looking for sex partners online, perception of risk, having multiple partners were associated with seeking HIV information. Although using injection drugs was related to high perception of risk of acquiring HIV, it was not associated with seeking HIV information online. It is imperative to further understand the online HIV information seeking behavior of this population and provide targeted information in order to increase awareness and knowledge about HIV-related risk and methods of prevention, including information about PrEP.
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Affiliation(s)
- Yerina S Ranjit
- Department of Communication, University of Missouri, United States of America.
| | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University, United States of America
| | | | - Frederick L Altice
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine and Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, United States of America
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29
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Pinto RM, Chen Y, Park SE. A client-centered relational framework on barriers to the integration of HIV and substance use services: a systematic review. Harm Reduct J 2019; 16:71. [PMID: 31856845 PMCID: PMC6923912 DOI: 10.1186/s12954-019-0347-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023] Open
Abstract
Background Given the close connection between human immunodeficiency virus (HIV) infection and substance use disorder (SUD), access to integrated HIV and SUD services is critical for individuals experiencing both challenges and their biopsychosocial conditions. Method Adopting an integrative method, this systematic review included 23 empirical studies published between 2000 and 2018. Articles investigated providers’ and clients’ perspectives on barriers to accessing integrated HIV and SUD services in various service settings (e.g., HIV primary care, SUD treatment, pharmacy). Results Using a client-centered relational framework, we identified barriers in three relational domains with “the client” as the focus of each: client-provider, client-organization, and client-system. The review shows that (1) barriers to HIV and SUD services do not exist in isolation, but in the dynamics within and across three relational domains; (2) service providers and clients often have different perceptions about what constitutes a barrier and the origin of such barriers; and (3) interprofessional and interorganizational collaborations are crucial for integrating HIV and SUD services. Conclusion This review points out the limitations of the conventional paradigm grouping barriers to service integration into isolated domains (client, provider, organization, or system). Reforms in service arrangements and provider training are recommended to address barriers to integrated services.
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Affiliation(s)
- Rogério Meireles Pinto
- School of Social Work, University of Michigan-Ann Arbor, 1080 South University Avenue, Ann Arbor, MI, 48109, USA.
| | - Yun Chen
- School of Social Work, University of Michigan-Ann Arbor, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Sunggeun Ethan Park
- School of Social Work, University of Michigan-Ann Arbor, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
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30
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Zhang C, McMahon J, Simmons J, Brown LL, Nash R, Liu Y. Suboptimal HIV Pre-exposure Prophylaxis Awareness and Willingness to Use Among Women Who Use Drugs in the United States: A Systematic Review and Meta-analysis. AIDS Behav 2019; 23:2641-2653. [PMID: 31297684 DOI: 10.1007/s10461-019-02573-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In the United States (U.S.), more than 12 million women reported illicit drug use in the past month. Drug use has been linked to increased risk for HIV, but little is known about the uptake of HIV pre-exposure prophylaxis (PrEP) to prevent HIV among women who use drugs (WWUD). Following the PRISMA guideline, we conducted a multi-database literature search to assess engagement along the PrEP care continuum among WWUD in the U.S. Seven studies with a total of 755 women were included in the review: 370 (49%) Black, 126 (16.7%) Hispanics, and 259 (34.3%) Whites. Employing random-effect models, data indicate 20.6% (95% CI 8.7%, 32.4%) of WWUD were aware of PrEP, and 60.2% (95% CI 52.2%, 68.2%) of those aware were also willing to use PrEP. Notwithstanding study limitations, our findings suggest there may be potential to increase PrEP uptake among WWUD, but efforts must first concentrate on improving PrEP awareness among this population.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, NY, 14622, USA.
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd, Rochester, NY, 14622, USA
| | - Janie Simmons
- Department of Social & Behavioral Sciences, College of Global Public Health, New York University, New York City, NY, USA
| | - L Lauren Brown
- Nashville CARES, Nashville, TN, USA
- Infectious Diseases Division, Vanderbilt University Medical Center, Nashville, USA
| | - Robertson Nash
- Vanderbilt Comprehensive Care Clinic, Nashville, TN, USA
| | - Yu Liu
- Division of Epidemiology, Department of Public Health Science, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
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31
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Peterson M, Macmadu A, Truong AQ, Rich J, Pognon K, Lurie M, Clarke JG, Brinkley-Rubinstein L. Pre-exposure prophylaxis awareness and interest among participants in a medications for addiction treatment program in a unified jail and prison setting in Rhode Island. J Subst Abuse Treat 2019; 106:73-78. [PMID: 31540614 DOI: 10.1016/j.jsat.2019.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 01/12/2023]
Abstract
People who are incarcerated are at increased risk for HIV (human immunodeficiency virus) acquisition upon release, and one possible intervention for prevention is the use of pre-exposure prophylaxis (PrEP) upon release. The present study assessed HIV risk perceptions as well as PrEP awareness and interest among 39 people who were incarcerated and enrolled in a structured Medication for Addiction Treatment (MAT) program at the Rhode Island Department of Corrections using semi-structured, qualitative interviews. Analysis was conducted using a generalized, inductive method in NVivo 12. While PrEP awareness was low across the study sample, some participants were interested in PrEP uptake or learning more about PrEP after they were provided with an overview of it. PrEP interest strongly related to current perceived HIV risk. Potential barriers included side effects, adherence, and reluctance to take medications in general. MAT programs for people who are criminal justice (CJ) involved may serve as useful linkage spaces to PrEP information, access, and retention.
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Affiliation(s)
- Meghan Peterson
- School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America; Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America.
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America; Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America.
| | - Ashley Q Truong
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America.
| | - Josiah Rich
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America; Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, United States of America.
| | - Kimberly Pognon
- Center for Prisoner Health and Human Rights, 8 3rd Street, Providence, RI 02906, United States of America.
| | - Mark Lurie
- Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI 02903, United States of America.
| | - Jennifer G Clarke
- Rhode Island Department of Corrections, 40 Howard Ave, Cranston, RI 02920, United States of America; Departments of Medicine and Obstetrics and Gynecology, Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, United States of America.
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, 333 S Columbia St, Chapel Hill, NC 27516, United States of America; Center for Health Equity Research, University of North Carolina, 335 S Columbia St, Chapel Hill, NC 27516, United States of America.
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