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Xavier Hall CD, Bundy C, Foran JE, Newcomb ME, Carrillo H, Watkins-Hayes C, Mustanski B. Identifying Strategies for Improving Pre-exposure Prophylaxis Adherence: Perspectives from a Sample of Highly Adherent Young Men Who have Sex with Men. AIDS Behav 2023; 27:506-517. [PMID: 35906443 PMCID: PMC9884315 DOI: 10.1007/s10461-022-03785-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
Most research on pre-exposure prophylaxis (PrEP) adherence and persistence uses a deficit-based approach to identify negative influences on PrEP adherence; however, an alternative set of approaches (such as resilience, asset-based, and positive variation) may identify equally important positive influences on PrEP adherence. Thus, the current study presents qualitative perspectives of PrEP adherence strategies from a sample of adherent YMSM. PrEP-using YMSM living in the Chicago area from a larger cohort study were recruited into a 90-day diary study that measured sexual health behaviors including PrEP use. A subset (n = 28) were then recruited for in-depth interviews between April and September 2020 covering topics of PrEP use and adherence. Thematic analysis was used to interpret patterns within the data. The analytic sample (n = 19) consistently reported high levels of adherence. Adherence strategies were organized into three broader categories: psychological (e.g. mindfulness, pill auditing), technical/instrumental (e.g. automated reminders, pill organizers), and social strategies (e.g. checking in with friends, or getting suggestions from friends). The majority of participants described using multiple strategies and changing strategies to respond to barriers to adherence. Other themes that were related to adherence included having a daily medication history and a generally positive outlook toward the PrEP regimen. Those who had medication histories were able to draw from experience to develop strategies for PrEP adherence. Findings suggest the need for pre-emptive counseling for PrEP-initiators on the use of multiple strategies, how to prepare for PrEP adherence, to adapt to challenges, and to adopt a range of potential strategies for adherence.
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Affiliation(s)
- Casey D. Xavier Hall
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - Camille Bundy
- grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - James E. Foran
- grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - Michael E. Newcomb
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - Héctor Carrillo
- grid.16753.360000 0001 2299 3507Department of Sociology, Northwestern University, Evanston, IL USA
| | - Celeste Watkins-Hayes
- grid.214458.e0000000086837370Ford School of Public Policy, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Sociology, University of Michigan, Ann Arbor, MI USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.
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Bundy C, Xavier Hall CD, Foran JE, Jozsa K, Newcomb ME, Mustanski B. Reassessing the Importance of PrEP Use Given Reduced Sex During the COVID-19 Pandemic: Perspectives From a Sample of Young Sexual Minority Men. AIDS Educ Prev 2022; 34:441-452. [PMID: 36454133 PMCID: PMC9979445 DOI: 10.1521/aeap.2022.34.6.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Research has begun to examine sexual behavior during the COVID-19 pandemic using quantitative methods, but less is known about the context surrounding these changes using qualitative methods, including corresponding changes in risk reduction methods. This qualitative study, guided by the Integrated Behavioral Model, examines the pandemic's impact on PrEP adherence among young men who have sex with men in Chicago. PrEP-using participants from a cohort study were recruited into a 90-day diary study measuring sexual behaviors and PrEP use. Between April and September 2020, a subset of participants was recruited for qualitative interviews (n = 28) exploring prevention strategies, including the impact of the pandemic. Although most were highly adherent pre-pandemic, many took fewer pills or discontinued during the pandemic due to decreased sex. Findings suggest the importance of counseling for PrEP reinitiation as "seasons of HIV risk" increase, as well as use of telehealth as a facilitator of PrEP use throughout the pandemic.
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Affiliation(s)
- Camille Bundy
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Casey D. Xavier Hall
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James E. Foran
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Kyle Jozsa
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
| | - Michael E. Newcomb
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian Mustanski
- Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Xavier Hall CD, Morgan E, Bundy C, Foran JE, Janulis P, Newcomb ME, Mustanski B. Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV. AIDS Behav 2021; 25:3303-3315. [PMID: 33582890 DOI: 10.1007/s10461-021-03179-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 12/23/2022]
Abstract
Retention in care and sustained viral suppression are integral outcomes in the care continuum for people living with HIV (PLWH) and HIV prevention; however, less is known about how substance use predicts sustained viral suppression over time. This study seeks to examine the predictive effects of substance use on sustained viral suppression in a sample of cisgender sexual minority men and gender minority PLWH (n = 163) drawn from a longitudinal sample in the Chicago area collected 2015-2019. Using data from 3 visits separated by 6 months, participants were coded persistently detectable, inconsistently virally suppressed, and consistently virally suppressed (< 40 copies/mL at all visits). Multinomial logistic regressions were utilized. About 40% of participants had sustained viral suppression. In multinomial logistic regressions, CUDIT-R predicted persistent detectable status and stimulant use was associated with inconsistent viral suppression. Substance use may create challenges in achieving sustained viral suppression, which has important implications for care and prevention.
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Affiliation(s)
- Casey D Xavier Hall
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Ethan Morgan
- Infectious Disease Institute, College of Nursing, Ohio State University, Columbus, OH, USA
| | - Camille Bundy
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - James E Foran
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
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