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Tanner AE, Hall MA, Aguilar-Palma SK, Mann-Jackson L, Alonzo J, Bertoni AG, McCoy TP, Garcia M, Sucaldito AD, Turner MJ, Robles Arvizu J, Russell LP, Rhodes SD. Understanding uptake of COVID-19 testing, vaccination, and boosters among Spanish-speaking Latines in the United States: Qualitative insights from Spanish speakers and key informants. PLoS One 2024; 19:e0296812. [PMID: 38452119 PMCID: PMC10919869 DOI: 10.1371/journal.pone.0296812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Latine communities in the United States have been disproportionately affected by COVID-19. It is critical to gain a better understanding of the sociocultural determinants that challenge and facilitate COVID-19 testing, vaccination, and booster uptake within these vulnerable communities to inform culturally congruent strategies and interventions. METHODS In summer 2022, our community-based participatory research partnership conducted 30 key informant interviews and 7 focus groups with 64 Spanish-speaking Latine participants in North Carolina. Interviewees consisted of representatives from health and service organizations, most of whom were engaged with direct service to Spanish speakers. Interviews were conducted in either English or Spanish, depending on the preference of the participant; all focus groups were conducted in Spanish. Interviews and focus groups were conducted in person or by videoconference. RESULTS Twenty themes emerged that we organize into four domains: general perceptions about COVID-19; barriers to COVID-19 testing, vaccination, and booster uptake; facilitators to COVID-19 testing, vaccination, and booster uptake; and recommendations to promote testing, vaccination, and booster uptake. DISCUSSION Results underscore important sociocultural determinants of ongoing COVID-19 testing, vaccination, and booster uptake to consider in developing interventions for Spanish-speaking Latines in the United States. Based on this formative work, our partnership developed Nuestra Comunidad Saludable (Our Healthy Community). We are implementing the intervention to test whether trained peer navigators can increase COVID-19 testing, vaccination, and booster uptake among Spanish-speaking Latines through blending in-person interactions and mHealth (mobile health) strategies using social media.
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Affiliation(s)
- Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Mark A. Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest University School of Law, Winston-Salem, NC, United States of America
| | | | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest Clinical and Translational Sciences Institute Program in Community-Engaged Research, Winston-Salem, NC, United States of America
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Thomas P. McCoy
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, United States of America
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Ana D. Sucaldito
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest Clinical and Translational Sciences Institute Program in Community-Engaged Research, Winston-Salem, NC, United States of America
| | - Mari Jo Turner
- Hispanic League, Inc, Winston-Salem, NC, United States of America
| | - Jose Robles Arvizu
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Laurie P. Russell
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
- Wake Forest Clinical and Translational Sciences Institute Program in Community-Engaged Research, Winston-Salem, NC, United States of America
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Rhodes SD, Alonzo J, Mann-Jackson L, Aviles LR, Tanner AE, Galindo CA, Bessler PA, Courtenay-Quirk C, Garcia M, Sucaldito AD, Smart BD, Goldenberg T, Reboussin BA. Preexposure Prophylaxis Uptake Among Spanish-Speaking Transgender Women: A Randomized Controlled Trial in North and South Carolina, 2019-2022. Am J Public Health 2024; 114:68-78. [PMID: 38091558 PMCID: PMC10726943 DOI: 10.2105/ajph.2023.307444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 12/18/2023]
Abstract
Objectives. To evaluate Chicas Creando Acceso a la Salud (Girls Creating Access to Health; ChiCAS), a Spanish-language, small-group intervention designed to increase preexposure prophylaxis (PrEP) use, consistent condom use, and medically supervised gender-affirming hormone therapy use among Spanish-speaking transgender Latinas who have sex with men. Methods. Participants were 144 HIV-negative Spanish-speaking transgender Latinas, aged 18 to 59 years, living in North and South Carolina. From July 2019 to July 2021, we screened, recruited, and randomized them to the 2-session ChiCAS intervention or the delayed-intervention waitlist control. Participants completed assessments at baseline and 6-month follow-up. Follow-up retention was 94.4%. Results. At follow-up, relative to control participants, ChiCAS participants reported increased PrEP use (adjusted odds ratio [AOR] = 4.64; 95% confidence interval [CI] = 1.57, 13.7; P < .006). However, ChiCAS participants did not report increased use of condoms or medically supervised gender-affirming hormone therapy. ChiCAS participants reported increases in knowledge of HIV (P < .001), sexually transmitted infections (P < .001), and gender-affirming hormone therapy (P = .01); PrEP awareness (P < .001), knowledge (P < .001), and readiness (P < .001); condom use skills (P < .001); and community attachment (P < .001). Conclusions. The ChiCAS intervention was efficacious in increasing PrEP use among Spanish-speaking, transgender Latinas in this trial. (Am J Public Health. 2024;114(1):68-78. https://doi.org/10.2105/AJPH.2023.307444).
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Affiliation(s)
- Scott D Rhodes
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Jorge Alonzo
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Lilli Mann-Jackson
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Lucero Refugio Aviles
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Amanda E Tanner
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Carla A Galindo
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Patricia A Bessler
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Cari Courtenay-Quirk
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Manuel Garcia
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Ana D Sucaldito
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Benjamin D Smart
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Tamar Goldenberg
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
| | - Beth A Reboussin
- Scott D. Rhodes, Jorge Alonzo, Lilli Mann-Jackson, and Manuel Garcia are with the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC. At trial initiation, Lucero Refugio Aviles was with the Triad Health Project, Greensboro, NC; she completed the study while at the Department of Social Sciences and Health Policy, Wake Forest University School of Medicine. Amanda E. Tanner and Tamar Goldenberg are with the Department of Public Health Education, University of North Carolina, Greensboro. Carla A. Galindo, Patricia A. Bessler, and Cari Courtenay-Quirk are with the US Centers for Disease Control and Prevention, Atlanta, GA. Ana D. Sucaldito is with the Clinical and Translational Science Institute, Wake Forest University School of Medicine. Benjamin D. Smart is with the Karolinska Institutet, Stockholm, Sweden. Beth A. Reboussin is with the Department of Biostatistics and Data Sciences, Wake Forest University School of Medicine
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Sucaldito AD, Tanner AE, Mann-Jackson L, Alonzo J, Garcia M, Chaffin JW, Faller R, McGuire T, Jibriel M, Mertus S, Kline DM, Russell L, Stafford J, Aviles LR, Weil PH, Wilkin AM, Rhodes SD. Exploring Individual and Contextual Factors Associated With Sexual Risk and Substance Use Among Underserved GBQMSM and Transgender and Nonbinary Persons in South Central Appalachia. AIDS Educ Prev 2023; 35:495-506. [PMID: 38096454 PMCID: PMC11075819 DOI: 10.1521/aeap.2023.35.6.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/18/2023]
Abstract
Gay, bisexual, queer, and other men who have sex with men (GBQMSM) and transgender and nonbinary persons are at elevated risk for HIV, sexually transmitted infections (STIs), and hepatitis C (HCV); in Appalachia, these communities experience more disease burden. However, little is known about the factors influencing risk. Sixteen semistructured in-depth interviews were conducted examining factors influencing prevention and care. Data were analyzed using constant comparison methodology. Fifteen themes emerged within four domains: social environment (e.g., microaggressions across gender, sexual orientation, and racial identities), substance use (e.g., high prevalence, use as coping mechanism), sexual health (e.g., misinformation and denial of risk for HIV and STIs), and access to health care (e.g., cost and transportation barriers, lack of local respectful care). Findings highlighted salient barriers and assets influencing prevention and care and suggest that multilevel interventions are needed to improve access to and use of HIV, STI, and HCV prevention and care services.
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Affiliation(s)
- Ana D Sucaldito
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - John W Chaffin
- Western North Carolina AIDS Project, Asheville, North Carolina
| | - Rachel Faller
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Tucker McGuire
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Mohammed Jibriel
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Sulianie Mertus
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - David M Kline
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Laurie Russell
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jeanette Stafford
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lucero Refugio Aviles
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Peggy H Weil
- Western North Carolina AIDS Project, Asheville, North Carolina
| | - Aimee M Wilkin
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Tanner AE, Palakshappa D, Morse CG, Mann-Jackson L, Alonzo J, Garcia M, Wright E, Dharod A, Isom S, Sucaldito AD, Aviles LR, Rhodes SD. Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure. Trials 2022; 23:998. [PMID: 36510319 PMCID: PMC9743787 DOI: 10.1186/s13063-022-06924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM). METHODS In Aim 1, we will recruit a longitudinal cohort of 1800 adult (≥18 years) PWH from our clinic-based population to determine the difference in the prevalence and incidence of cardiometabolic comorbidities between food-secure and food-insecure PWH. Food insecurity screening, indicators of cardiometabolic comorbidities, and other characteristics documented in the electronic health record (EHR) will be collected annually for up to 3 years from this cohort. In Aim 2, we will conduct a randomized controlled trial among a sample of food-insecure PWH who have prediabetes or T2DM to compare changes in insulin sensitivity over 6 months between participants in weCare/Secure and participants receiving usual care. In Aim 3, we will conduct semi-structured individual in-depth interviews to explore the effect of the intervention among intervention participants with varying insulin sensitivity outcomes. TRIAL STATUS Aim 1 (longitudinal cohort) recruitment began in May 2022 and is ongoing. Aim 2 (intervention) recruitment is planned for spring 2023 and is expected to be completed in spring 2024. Aim 3 (process evaluation) data collection will occur after sufficient completion of the 6-month assessment in Aim 2. Final results are anticipated in fall 2025. CONCLUSIONS This research seeks to advance our understanding of how food insecurity impacts the development of cardiometabolic comorbidities among PWH and how food insecurity interventions may alleviate relevant comorbidities. Given the growing interest among health systems in addressing food insecurity, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04943861 . Registered on June 29, 2021.
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Affiliation(s)
- Amanda E. Tanner
- grid.266860.c0000 0001 0671 255XDepartment of Public Health Education, University of North Carolina Greensboro, Coleman 437E, Greensboro, NC 27402 USA
| | - Deepak Palakshappa
- grid.241167.70000 0001 2185 3318Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Caryn G. Morse
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lilli Mann-Jackson
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Jorge Alonzo
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Manuel Garcia
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Elena Wright
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ajay Dharod
- grid.241167.70000 0001 2185 3318Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Wake Forest Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott Isom
- grid.241167.70000 0001 2185 3318Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ana D. Sucaldito
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Lucero Refugio Aviles
- grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Scott D. Rhodes
- grid.241167.70000 0001 2185 3318Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA ,grid.241167.70000 0001 2185 3318Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, USA
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Aviles LR, Galindo CA, Bessler PA, Courtenay-Quirk C, Smart BD, Garcia M, Goldenberg T, Sucaldito AD, Reboussin BA. Adapting a Group-Level PrEP Promotion Intervention Trial for Transgender Latinas During the COVID-19 Pandemic. AIDS Educ Prev 2022; 34:481-495. [PMID: 36454131 PMCID: PMC10552717 DOI: 10.1521/aeap.2022.34.6.481] [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: 06/17/2023]
Abstract
The COVID-19 pandemic has profoundly affected the conduct of community-based and community-engaged research. Prior to the pandemic, our community-based participatory research partnership was testing ChiCAS, an in-person, group-level behavioral intervention designed to promote uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised gender-affirming hormone therapy among Spanish-speaking transgender Latinas. However, the pandemic required adaptations to ensure the safe conduct of the ChiCAS intervention trial. In this article, we describe adaptations to the trial within five domains. Transgender women are disproportionately affected by HIV, and it is essential to find ways to continue research designed to support their health within the context of the COVID-19 pandemic and future infectious disease outbreaks, epidemics, and pandemics. These adaptations offer guidance for ongoing and future community-based and community-engaged research during the COVID-19 pandemic and/or potential subsequent outbreaks (e.g., monkeypox), epidemics, and pandemics, particularly within under-served marginalized and minoritized communities.
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Affiliation(s)
| | | | | | - Jorge Alonzo
- Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | | | | | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Song EY, Smart BD, Garcia M, McCoy TP, Schafer KR, Wilkin AM. Outcomes From a Randomized Trial of a Bilingual mHealth Social Media Intervention to Increase Care Engagement Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women With HIV. Health Educ Behav 2022; 49:975-984. [PMID: 36196926 PMCID: PMC10421562 DOI: 10.1177/10901981221125400] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The North Carolina Community Research Partnership developed, implemented, and tested weCare, a 12-month bilingual mHealth social media intervention designed to reduce missed HIV care appointments and increase viral suppression among racially/ethnically diverse gay, bisexual, and other men who have sex with men (GBMSM) and transgender women living with HIV by harnessing established social media platforms (i.e., Facebook, texting, and dating apps). METHODS We randomized 198 GBMSM and transgender women (mean age = 26) living with HIV to the weCare intervention (n = 100) or usual-care (n = 98) group. Inclusion criteria included being newly diagnosed or not in care. Participants completed structured assessments at baseline and 6-month postintervention follow-up (18 months after baseline data collection). HIV care appointment and viral load data were abstracted from each participant's electronic health record at baseline and follow-up. Follow-up retention was 85.5%. RESULTS Among participants, 94% self-identified as cisgender men, 6% as transgender, 64% as African American/Black, and 13% as Latine. Participants in both groups significantly reduced missed HIV care appointments and increased viral suppression at follow-up compared with baseline. However, there were no significant differences between weCare and usual-care participants for either outcome at follow-up. CONCLUSIONS An intervention effect was not identified for our two primary outcomes. Several factors may have influenced the lack of significant differences between weCare and usual-care participants at follow-up, including intervention implementation (e.g., staffing changes and lack of fidelity to the intervention as originally designed by the partnership), data collection (e.g., data collection time points and retention strategies), and clinical (e.g., contamination) factors.
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Affiliation(s)
- Scott D Rhodes
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Jorge Alonzo
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Benjamin D Smart
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Manuel Garcia
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Aimee M Wilkin
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Hall MA, Bertoni AG, McCoy TP, Aguilar-Palma SK, Garcia M, Miranda D, Turner MJ. Increasing COVID-19 testing and vaccination among Spanish speakers in the USA: protocol for the development and evaluation of the Nuestra Comunidad Saludable intervention using a group-randomised trial design. BMJ Open 2022; 12:e066585. [PMID: 36385019 PMCID: PMC9670094 DOI: 10.1136/bmjopen-2022-066585] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Our community-based participatory research partnership aims to expand understanding of the social, ethical and behavioural implications of COVID-19 testing and vaccination to inform the development of an integrated intervention that harnesses community-based peer navigation and mHealth strategies to improve COVID-19 testing and vaccination; test the intervention; and develop and disseminate practice, research and policy recommendations to further increase COVID-19 testing and vaccination among Spanish-speaking Latine communities in the USA. METHODS AND ANALYSIS We will conduct 50 individual in-depth interviews with health providers, who have conducted COVID-19 testing and/or vaccination activities within Spanish-speaking communities, and with representatives from Latine-serving community-based organisations. We will also conduct six focus groups with 8-12 Spanish-speaking Latine community member participants each for a total number of about 60 focus group participants. Next, we will develop the Nuestra Comunidad Saludable intervention based on findings from interviews and focus groups and use a longitudinal group-randomised trial design with two arms (intervention and delayed intervention) to evaluate the impact of the intervention. We will recruit, enrol and collect baseline data from 20 community-based peer navigators (Navegantes) and their social network members (n=8 unique social network members per Navegante). Navegantes (coupled with their social networks) will be randomised to intervention or delayed intervention groups (10 Navegantes and 80 social network members per group). ETHICS AND DISSEMINATION Ethical approval for data collection was granted by the Wake Forest University School of Medicine Institutional Review Board. Following the description of study procedures, we will obtain consent from all study participants. Study findings will be disseminated through an empowerment theory-based community forum, peer-reviewed publications and presentations at scientific meetings, and reports and briefs for lay, community and practitioner audiences. TRIAL REGISTRATION NUMBER NCT05302908.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Amanda E Tanner
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Wake Forest University School of Law, Winston-Salem, North Carolina, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas P McCoy
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | | | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Mann-Jackson L, Simán FM, Hall MA, Alonzo J, Linton JM, Rhodes SD. State Preemption of Municipal Laws and Policies that Protect Immigrant Communities: Impact on Latine Health and Well-Being in North Carolina. Inquiry 2022; 59:469580221087884. [PMID: 35343266 PMCID: PMC8961392 DOI: 10.1177/00469580221087884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Some U.S. municipalities have proclaimed themselves "sanctuary cities" and/or adopted laws and policies limiting local involvement in enforcement of federal immigration policies. Several states, however, have adopted laws that preempt municipal laws and policies designed to protect immigrants. We explored the consequences of House Bill (H.B.) 318, one such preemption law in North Carolina (NC), on the health and well-being of Latine immigrants. METHODS We conducted focus groups with Latine immigrants (n=49) and in-depth interviews with representatives from health, social service, and immigrant-serving organizations and local government (including law enforcement) (n=21) in NC municipalities that, before HB 318, adopted laws and policies supporting immigrants. Data were analyzed using constant comparison. RESULTS Twelve themes emerged, including the positive impacts of municipal sanctuary laws and policies are limited by preemption and other state and federal actions; laws and policies like HB 318 are confusing, have a chilling effect on health services use, and make life harder overall for Latine communities; intensified federal immigration enforcement has increased fear among Latine communities; Trump administration policies worsened anti-immigrant climates; and use of community identification cards and greater information dissemination and inter-organization coordination can lessen the consequences of preemption and other restrictive laws and policies. CONCLUSION State preemption of protective municipal laws and policies negatively and profoundly affects immigrant health and well-being. However, creative strategies have been implemented to respond to preemption. These findings provide critical data for decision-makers and community leaders regarding the detrimental impacts of preemption laws and mitigation of these impacts.
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Affiliation(s)
- Lilli Mann-Jackson
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | | | - Mark A. Hall
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- Wake Forest University School of
Law, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | - Julie M. Linton
- University of South Carolina (UofSC)
School of Medicine Greenville, Greenville, SC, USA
- Prisma Health Upstate, Greenville, SC, USA
| | - Scott D. Rhodes
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
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Schafer KR, Tanner AE, Mann-Jackson L, Alonzo J, Song EY, Rhodes SD. Stigma, Social Support, and Substance Use in Diverse Men Who Have Sex With Men and Transgender Women Living with HIV in the US Southeast. South Med J 2022; 115:26-32. [PMID: 34964058 PMCID: PMC8726574 DOI: 10.14423/smj.0000000000001345] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) rates in the southeast United States are high and substance use is common among people living with HIV (PLWH). This study used baseline data from the weCare intervention study to examine factors associated with the use of alcohol, tobacco, and marijuana among racially and ethnically diverse young gay, bisexual, and other men who have sex with men (GBMSM) and transgender women in the southeast who were newly diagnosed as having HIV, not linked to care, out of care, and/or not virally suppressed. METHODS Self-reported data were collected from 196 GBMSM and transgender women living with HIV via Audio Computer-Assisted Self-Interview at enrollment. Measures assessed demographics; stigma; social support; basic and clinical service needs; HIV disclosure; social media use; and recent use of alcohol, tobacco, and marijuana. Logistic regression identified correlates of past 30-day substance use. RESULTS In multivariable analysis, increased age and needing basic support services were associated with past 30-day tobacco, cigarette, electronic cigarette, and/or hookah use. Increased HIV-related stigma and needing basic support services were associated with past 30-day marijuana use. Being White and needing clinical support services were associated with infrequent or no past 30-day marijuana use. CONCLUSIONS HIV-related stigma and needing basic support services were associated with substance use among GBMSM and transgender women living with HIV in the southeastern United States. Routine screening for basic needs could identify GBMSM and transgender women living with HIV at risk for substance use and offer insight into intervention leverage points.
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Affiliation(s)
- Katherine R Schafer
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Amanda E Tanner
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Lilli Mann-Jackson
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Jorge Alonzo
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Eunyoung Y Song
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Scott D Rhodes
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
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Rhodes SD, Kuhns LM, Alexander J, Alonzo J, Bessler PA, Courtenay-Quirk C, Denson DJ, Evans K, Galindo CA, Garofalo R, Gelaude DJ, Hotton AL, Johnson AK, Mann-Jackson L, Muldoon A, Ortiz R, Paul JL, Perloff J, Pleasant K, Reboussin BA, Refugio Aviles L, Song EY, Tanner AE, Trent S. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS Educ Prev 2021. [PMID: 34370565 DOI: 10.1521/aeap.2021.33.4.345]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa M Kuhns
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Jorge Alonzo
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Damian J Denson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaiji Evans
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Garofalo
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy K Johnson
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abigail Muldoon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Reyna Ortiz
- Chicago House and Social Service Agency, Chicago, Illinois
| | | | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Kevin Pleasant
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Amanda E Tanner
- University of North Carolina Greensboro, Greensboro, North Carolina
| | - Scott Trent
- Triad Health Project, Greensboro, North Carolina
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11
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Rhodes SD, Kuhns LM, Alexander J, Alonzo J, Bessler PA, Courtenay-Quirk C, Denson DJ, Evans K, Galindo CA, Garofalo R, Gelaude DJ, Hotton AL, Johnson AK, Mann-Jackson L, Muldoon A, Ortiz R, Paul JL, Perloff J, Pleasant K, Reboussin BA, Refugio Aviles L, Song EY, Tanner AE, Trent S. Evaluating Locally Developed Interventions to Promote PrEP Among Racially/Ethnically Diverse Transgender Women in the United States: A Unique CDC Initiative. AIDS Educ Prev 2021; 33:345-360. [PMID: 34370565 PMCID: PMC8565450 DOI: 10.1521/aeap.2021.33.4.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/13/2023]
Abstract
In the United States, transgender women are disproportionately affected by HIV. However, few evidence-based prevention interventions exist for this key population. We describe two promising, locally developed interventions that are currently being implemented and evaluated through the Centers for Disease Control and Prevention Combination HIV Prevention for Transgender Women Project: (a) ChiCAS, designed to promote the uptake of pre-exposure prophylaxis (PrEP), condom use, and medically supervised hormone therapy among Spanish-speaking transgender Latinas, and (b) TransLife Care, designed to address the structural drivers of HIV risk through access to housing, employment, legal services, and medical services, including HIV preventive care (e.g., PrEP use) among racially/ethnically diverse urban transgender women. If the evaluation trials determine that these interventions are effective, they will be among the first such interventions for use with transgender women incorporating PrEP, thereby contributing to the evidence-based resources that may be used to reduce HIV risk among this population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lisa M Kuhns
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Jorge Alonzo
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Damian J Denson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kaiji Evans
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Garofalo
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | | | - Anna L Hotton
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amy K Johnson
- Northwestern University, Department of Pediatrics, Feinberg School of Medicine, and the Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abigail Muldoon
- Ann & Robert H. Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Illinois
| | - Reyna Ortiz
- Chicago House and Social Service Agency, Chicago, Illinois
| | | | - Judy Perloff
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Kevin Pleasant
- Chicago House and Social Service Agency, Chicago, Illinois
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Amanda E Tanner
- University of North Carolina Greensboro, Greensboro, North Carolina
| | - Scott Trent
- Triad Health Project, Greensboro, North Carolina
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Black KZ, Lightfoot AF, Schaal JC, Mouw MS, Yongue C, Samuel CA, Faustin YF, Ackert KL, Akins B, Baker SL, Foley K, Hilton AR, Mann-Jackson L, Robertson LB, Shin JY, Yonas M, Eng E. 'It's like you don't have a roadmap really': using an antiracism framework to analyze patients' encounters in the cancer system. Ethn Health 2021; 26:676-696. [PMID: 30543116 PMCID: PMC6565499 DOI: 10.1080/13557858.2018.1557114] [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] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
Background: Cancer patients can experience healthcare system-related challenges during the course of their treatment. Yet, little is known about how these challenges might affect the quality and completion of cancer treatment for all patients, and particularly for patients of color. Accountability for Cancer Care through Undoing Racism and Equity is a multi-component, community-based participatory research intervention to reduce Black-White cancer care disparities. This formative work aimed to understand patients' cancer center experiences, explore racial differences in experiences, and inform systems-level interventions.Methods: Twenty-seven breast and lung cancer patients at two cancer centers participated in focus groups, grouped by race and cancer type. Participants were asked about what they found empowering and disempowering regarding their cancer care experiences. The community-guided analysis used a racial equity approach to identify racial differences in care experiences.Results: For Black and White patients, fear, uncertainty, and incomplete knowledge were disempowering; trust in providers and a sense of control were empowering. Although participants denied differential treatment due to race, analysis revealed implicit Black-White differences in care.Conclusions: Most of the challenges participants faced were related to lack of transparency, such that improvements in communication, particularly two-way communication could greatly improve patients' interaction with the system. Pathways for accountability can also be built into a system that allows patients to find solutions for their problems with the system itself. Participants' insights suggest the need for patient-centered, systems-level interventions to improve care experiences and reduce disparities.
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Affiliation(s)
- Kristin Z. Black
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA,
| | - Alexandra F. Lightfoot
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Mary S. Mouw
- Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Christina Yongue
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA,
| | - Cleo A. Samuel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | - Yanica F. Faustin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,
| | | | - Barbara Akins
- Behavioral Health, Cone Health System, Greensboro, North Carolina, USA,
| | - Stephanie L. Baker
- Public Health Studies Program, Elon University, Elon, North Carolina, USA,
| | - Karen Foley
- University of Pittsburgh Cancer Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA,
| | - Alison R. Hilton
- Durham County Department of Public Health, Durham, North Carolina, USA,
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,
| | - Linda B. Robertson
- University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA,
| | - Janet Y. Shin
- Georgia Department of Public Health, Atlanta, Georgia, USA,
| | - Michael Yonas
- Social Innovation, Research and Special Initiatives, The Pittsburgh Foundation, Pittsburgh, Pennsylvania, USA,
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA, ,
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Rhodes SD, Mann-Jackson L, Alonzo J, Nall J, Simán FM, Song EY, Garcia M, Tanner AE, Eng E. Harnessing "Scale-Up and Spread" to Support Community Uptake of the HoMBReS por un Cambio Intervention for Spanish-Speaking Men: Implementation Science Lessons Learned by a CBPR Partnership. Am J Mens Health 2021; 14:1557988320938939. [PMID: 32659149 PMCID: PMC7359643 DOI: 10.1177/1557988320938939] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Latinx men in the southern United States are affected disproportionately by HIV and other sexually transmitted infections (STIs). However, few evidence-based prevention interventions exist to promote health equity within this population. Developed by a well-established community-based participatory research partnership, the HoMBReS por un Cambio intervention decreases sexual risk among Spanish-speaking, predominately heterosexual Latinx men who are members of recreational soccer teams in the United States. Scale-up and spread, an implementation science framework, was used to study the implementation of this evidence-based community-level intervention within three community organizations that represent typical community-based providers of HIV and STI prevention interventions (i.e., an AIDS service organization, a Latinx-serving organization, and a county public health department). Archival and interview data were analyzed, and 24 themes emerged that mapped onto the 12 scale-up and spread constructs. Themes included the importance of strong and attentive leadership, problem-solving challenges early, an established relationship between innovation developers and implementers, organizational capacity able to effectively work with men, trust building, timelines and incremental deadlines, clear and simple guidance regarding all aspects of implementation, appreciating the context (e.g., immigration-related rhetoric, policies, and actions), recognizing men’s competing priorities, and delineated supervision responsibilities. Scale-up and spread was a useful framework to understand multisite implementation of a sexual risk reduction intervention for Spanish-speaking, predominately heterosexual Latinx men. Further research is needed to identify how constructs, like those within scale-up and spread, affect the process across the implementation continuum, given that the uptake and implementation of an innovation is a process, not an event.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Program in Community Engagement, Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Program in Community Engagement, Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Program in Community Engagement, Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer Nall
- Carolina Family Health Centers, Inc, Wilson, NC, USA
| | | | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Program in Community Engagement, Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
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Ma A, Erausquin JT, Tanner AE, Song EY, Garcia M, Alonzo J, Mann-Jackson L, Rhodes SD. Health Vulnerability Model for Latinx Sexual and Gender Minorities: Typologies with Socioeconomic Stability, Health Care Access, and Social Characteristics Indicators. Health Behavior Research 2021. [DOI: 10.4148/2572-1836.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Irby MB, Moore KR, Mann-Jackson L, Hamlin D, Randall I, Summers P, Skelton JA, Daniel SS, Rhodes SD. Community-Engaged Research: Common Themes and Needs Identified by Investigators and Research Teams at an Emerging Academic Learning Health System. Int J Environ Res Public Health 2021; 18:3893. [PMID: 33917675 PMCID: PMC8068003 DOI: 10.3390/ijerph18083893] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/20/2022]
Abstract
Community-engaged research (CEnR) has emerged within public health and medicine as an approach to research designed to increase health equity, reduce health disparities, and improve community and population health. We sought to understand how CEnR has been conducted and to identify needs to support CEnR within an emerging academic learning health system (aLHS). We conducted individual semi-structured interviews with investigators experienced in CEnR at an emerging aLHS in the southeastern United States. Eighteen investigators (16 faculty and 2 research associates) were identified, provided consent, and completed interviews. Half of participants were women; 61% were full professors of varied academic backgrounds and departments. Interviews were audio-recorded, transcribed, coded, and analyzed using constant comparison, an approach to grounded theory. Twenty themes emerged that were categorized into six domains: Conceptualization and Purpose, Value and Investment, Community-Academic Partnerships, Sustainability, Facilitators, and Challenges. Results also identified eight emerging needs necessary to enhance CEnR within aLHSs. The results provide insights into how CEnR approaches can be harnessed within aLHSs to build and nurture community-academic partnerships, inform research and institutional priorities, and improve community and population health. Findings can be used to guide the incorporation of CEnR within aLHSs.
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Affiliation(s)
- Megan B. Irby
- Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Keena R. Moore
- Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (K.R.M.); (I.R.)
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy and Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - DeWanna Hamlin
- Formerly of the Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Isaiah Randall
- Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (K.R.M.); (I.R.)
| | - Phillip Summers
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Joseph A. Skelton
- Department of Pediatrics and Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Stephanie S. Daniel
- Department of Family and Community Medicine and Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy and Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
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Abstract
States have enacted a wave of statutes over the past several years preempting local government law and policies that potentially promote public health in various ways. Among these local preemption measures are statutes in at least 9 states that outlaw municipal policies providing some form of "sanctuary" to immigrants. Such policies, and their preemption, have importance both for direct access to health services and for broader social determinants of health.This article gauges the coverage and potential impact of these state preemption laws based on key informant interviews nationally and a close legal analysis of relevant laws and policy documents. It distinguishes between preemption laws focused on law enforcement cooperation and those that also encompass a wider array of "welcoming" policies and initiatives. It also distinguishes between more passive forms of preemption that prohibit barring cooperation with federal immigration enforcement, and those statutes that more affirmatively require active measures to assist federal enforcement.Drawing these distinctions can help municipalities determine which immigrant-supportive measures are still permitted, and how best to mitigate the adverse public health effects of these preemption laws.
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Affiliation(s)
- Mark A Hall
- Mark A. Hall, Lilli Mann-Jackson, and Scott D. Rhodes are with the Department of Social Science and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Lilli Mann-Jackson
- Mark A. Hall, Lilli Mann-Jackson, and Scott D. Rhodes are with the Department of Social Science and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Scott D Rhodes
- Mark A. Hall, Lilli Mann-Jackson, and Scott D. Rhodes are with the Department of Social Science and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
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Rhodes SD, Mann-Jackson L, Alonzo J, Garcia M, Tanner AE, Smart BD, Horridge DN, Van Dam CN, Wilkin AM. A Rapid Qualitative Assessment of the Impact of the COVID-19 Pandemic on a Racially/Ethnically Diverse Sample of Gay, Bisexual, and Other Men who Have Sex with Men Living with HIV in the US South. AIDS Behav 2021; 25:58-67. [PMID: 32830296 PMCID: PMC7443372 DOI: 10.1007/s10461-020-03014-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA.
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Benjamin D Smart
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | - Danielle N Horridge
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community-Engaged Research, Winston-Salem, NC, USA
| | | | - Aimee M Wilkin
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Rhodes SD, Daniel-Ulloa J, Wright SS, Mann-Jackson L, Johnson DB, Hayes NA, Valentine JA. Critical Elements of Community Engagement to Address Disparities and Related Social Determinants of Health: The Centers of Disease Control and Prevention Community Approaches to Reducing Sexually Transmitted Disease Initiative. Sex Transm Dis 2021; 48:49-55. [PMID: 32826480 PMCID: PMC7736098 DOI: 10.1097/olq.0000000000001267] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/11/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Community Approaches to Reducing Sexually Transmitted Disease (CARS), a unique initiative of the US Centers for Disease Control and Prevention, promotes the use of community engagement to increase sexually transmitted disease (STD) prevention, screening, and treatment and to address locally prioritized STD-related social determinants of health within communities experiencing STD disparities, including youth, persons of color, and sexual and gender minorities. We sought to identify elements of community engagement as applied within CARS. METHODS AND MATERIALS Between 2011 and 2018, we collected and analyzed archival and in-depth interview data to identify and explore community engagement across 8 CARS sites. Five to 13 interview participants (mean, 7) at each site were interviewed annually. Participants included project staff and leadership, community members, and representatives from local community organizations (e.g., health departments; lesbian, gay, bisexual, transgender, and queer-serving organizations; faith organizations; businesses; and HIV-service organizations) and universities. Data were analyzed using constant comparison, an approach to grounded theory development. RESULTS Twelve critical elements of community engagement emerged, including commitment to engagement, partner flexibility, talented and trusted leadership, participation of diverse sectors, establishment of vision and mission, open communication, reducing power differentials, working through conflict, identifying and leveraging resources, and building a shared history. CONCLUSIONS This study expands the community engagement literature within STD prevention, screening, and treatment by elucidating some of the critical elements of the approach and provides guidance for practitioners, researchers, and their partners as they develop, implement, and evaluate strategies to reduce STD disparities.
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Affiliation(s)
- Scott D. Rhodes
- From the Department of Social Sciences and Health Policy and the CTSI Program in Community Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jason Daniel-Ulloa
- University of Washington, Bothell, School of Nursing and Health Studies, Bothell, WA
| | - Shauntá S. Wright
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lilli Mann-Jackson
- From the Department of Social Sciences and Health Policy and the CTSI Program in Community Engaged Research, Wake Forest School of Medicine, Winston-Salem, NC
| | - David B. Johnson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Norman A. Hayes
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jo A. Valentine
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Alonzo J, Mann-Jackson L, Garcia M, Tanner AE, Rhodes SD. Meeting the needs of young Latino gay, bisexual, and other men who have sex with men (MSM) and transgender women living with HIV through the weCare intervention in the United States (US). EHQUIDAD 2021; 15:209-232. [PMID: 33681870 PMCID: PMC7935230 DOI: 10.15257/ehquidad.2021.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Young gay, bisexual, and other MSM (men who have sex with men) and transgender women in the United States (US) who are living with HIV, and particularly those who are Latino, have low rates of viral suppression. The weCare intervention uses social media to increase HIV care engagement. METHOD We used community-based participatory research to develop the intervention as well as theory-based social media messages tailored to each participant's unique context. We analyzed elements and characteristics of weCare, messages sent by the Cyber Health Educator (CHE), and lessons learned to meet the needs of Latino participants living with HIV. RESULTS We identified 6 core elements, 5 key characteristics, effective social media messages used in implementation, and 8 important lessons regarding relationships between the CHE and HIV clinics, the CHE and participants, and participants and the health system. CONCLUSIONS Social media offers a promising platform to retain young Latino gay bisexual and other MSM and transgender women living with HIV in care and achieve viral suppression.
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Affiliation(s)
- Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
| | - Amanda E. Tanner
- University of North Carolina Greensboro, Department of Public Health Education, 1400 Spring Garden St., Greensboro, NC USA 27412
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
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Smart BD, Mann-Jackson L, Alonzo J, Tanner AE, Garcia M, Refugio Aviles L, Rhodes SD. Transgender women of color in the U.S. South: A qualitative study of social determinants of health and healthcare perspectives. Int J Transgend Health 2020; 23:164-177. [PMID: 35403118 PMCID: PMC8986221 DOI: 10.1080/26895269.2020.1848691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Research has shown that transgender and nonbinary people experience health disparities. However, few studies have explored, in-depth, the health-related experiences, perceptions, needs, and priorities of transgender women of color living in the U.S. South, a region that poses unique challenges to achieving health for transgender people. Aims: This study explored the social determinants of health, healthcare experiences, and health-related priorities of transgender women of color living in the U.S. South. Methods: Using a community-based participatory research approach, we conducted iterative in-depth interviews with 15 African American/Black and Latinx transgender women in North Carolina in May-July 2019 for a total of 30 interviews. We analyzed interview data using constant comparison, an approach to grounded theory. Results: Participants' mean age was 34 (range 19-56) years. Twenty themes emerged that were categorized into three domains: (1) social determinants of health (family rejection; bullying, discrimination, and violence; isolation; policy barriers; mistrust in systems; employment obstacles; sex work; high cost of care; transportation barriers; church antagonism; and substance misuse), (2) healthcare experiences (emotional burden of healthcare interactions; name and gender misidentification; staff discomfort and insensitivity; sexual risk assumptions; and use of nonmedical or predatory providers), and (3) health-related priorities (understanding healthcare; respect at all levels of healthcare; inclusive gender-affirming care; and comprehensive resources). Discussion: Transgender women of color living in the U.S. South face profound health barriers compounded throughout the life course and have unmet healthcare needs. Participants faced multilayered minority stressors: racial discrimination from society at large and within the LGTBQ community; gender identity discrimination within their regional context and racial/ethnic communities; and exclusion from existing health equity movements for transgender women of color, which often are found in and focus on larger urban communities. Health interventions mindful of this intersection are needed, including antidiscrimination policies and increasing gender-affirming healthcare access.
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Affiliation(s)
- Benjamin D. Smart
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Amanda E. Tanner
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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21
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Rhodes SD, Mann-Jackson L, Alonzo J, Garcia M, Tanner AE, Smart BD, Horridge DN, Van Dam CN, Wilkin AM. A rapid qualitative assessment of the impact of the COVID-19 pandemic on a racially/ethnically diverse sample of gay, bisexual, and other men who have sex with men living with HIV in the US South. Res Sq 2020. [PMID: 32818212 PMCID: PMC7430588 DOI: 10.21203/rs.3.rs-57507/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.
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22
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Tanner AE, Mann-Jackson L, Song EY, Alonzo J, Schafer KR, Ware S, Horridge DN, Garcia JM, Bell J, Hall EA, Baker LS, Rhodes SD. Supporting Health Among Young Men Who Have Sex With Men and Transgender Women With HIV: Lessons Learned From Implementing the weCare Intervention. Health Promot Pract 2020; 21:755-763. [PMID: 32757841 DOI: 10.1177/1524839920936241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Young gay, bisexual, and other men who have sex with men and transgender women with HIV, particularly those who are racial or ethnic minorities, often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, an mHealth (mobile health) intervention where cyberhealth educators utilize established social media platforms (e.g., Facebook, texting, and GPS-based mobile applications ["apps"]) designed for social and sexual networking) to improve HIV-related care engagement and health outcomes. As part of the process evaluation of weCare, we conducted 32 interviews with intervention participants (n = 18) and HIV clinic providers and staff (n = 14). This article highlights three key intervention characteristics that promoted care engagement, including that weCare is (1) targeted (e.g., using existing social media platforms, similarity between intervention participants and cyberhealth educator, and implementation within a supportive clinical environment), (2) tailored (e.g., bidirectional messaging and trusting relationship between participants and cyberhealth educators to direct interactions), and (3) personalized (e.g., addressing unique care needs through messaging content and flexibility in engagement with intervention). In addition, interviewees' recommendations for improving weCare focused on logistics, content, and the ways in which the intervention could be adapted to reach a larger audience. Quality improvement efforts to ensure that mHealth interventions are relevant for young gay, bisexual, and other men who have sex with men and transgender women are critical to ensure care engagement and support health outcomes.
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Affiliation(s)
- Amanda E Tanner
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | | | - Jorge Alonzo
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Samuella Ware
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | | | | | - Jonathan Bell
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Logan S Baker
- University of Virginia's College at Wise, Wise, VA, USA
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Rhodes SD, Alonzo J, Mann-Jackson L, Song EY, Tanner AE, Garcia M, Smart BD, Baker LS, Eng E, Reboussin BA. A peer navigation intervention to prevent HIV among mixed immigrant status Latinx GBMSM and transgender women in the United States: outcomes, perspectives and implications for PrEP uptake. Health Educ Res 2020; 35:165-178. [PMID: 32441760 PMCID: PMC7243724 DOI: 10.1093/her/cyaa010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/11/2020] [Indexed: 05/23/2023]
Abstract
The Latinx population in the United States is disproportionately affected by HIV. Our community-based participatory research partnership developed, implemented and evaluated a Spanish-language peer navigation intervention designed to increase HIV testing and condom use among social networks of immigrant Spanish-speaking Latinx gay, bisexual and other men who have sex with men (GBMSM) and transgender women (TW). We randomized 21 social networks of Latinx GBMSM and TW, ages 18-55 years, to the intervention, known as HOLA, or a waitlist control group. Social network participants (n = 166) completed structured assessments at baseline and 12-month follow-up (24 months after baseline). Follow-up retention was 95%. Individual in-depth interviews with a sample of participants documented their intervention-related experiences, needs, and priorities to inform future research. At follow-up, HOLA participants reported increased HIV testing (adjusted odds ratio = 8.3; 95% CI = 3.0-23.0; P < 0.0001). All study participants reported increased condom use; there was no significant difference between HOLA and waitlist control participants. In-depth interviews identified critical intervention elements and impacts and community needs and priorities. The HOLA intervention is effective for increasing HIV testing among Latinx GBMSM and TW, an initial step within the HIV prevention and care continua, and may be adaptable to promote pre-exposure prophylaxis uptake.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC 27402, USA
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Benjamin D Smart
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Wake Forest Clinical and Translational Science Institute, Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Logan S Baker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Eugenia Eng
- Department of Health Behavior, University of North Carolina at Chapel Hill, Rosenau Hall, Chapel Hill, NC 27599, USA
| | - Beth A Reboussin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Mann-Jackson L, Choi D, Sutfin EL, Song EY, Foley KL, Wilkin AM, Morse CG, Rojas NF, Oh TS, Rhodes SD. A Qualitative Systematic Review of Cigarette Smoking Cessation Interventions for Persons Living with HIV. J Cancer Educ 2019; 34:1045-1058. [PMID: 31037506 PMCID: PMC6819245 DOI: 10.1007/s13187-019-01525-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/09/2023]
Abstract
Persons living with HIV (PLWH) have disproportionately high rates of both cigarette smoking and tobacco-induced negative health outcomes. The goal of this qualitative systematic review was to identify gaps in the existing literature and future directions for smoking cessation support for PLWH. Three online databases were searched from their inception through December 31, 2017, using designated search terms. Peer-reviewed English-language articles that documented an intervention designed to increase smoking cessation among PLWH were reviewed. Data were abstracted using a standardized form to document study and intervention characteristics and results. Thirty-two articles, describing 28 unique intervention studies, met inclusion criteria. Interventions consisted primarily of combinations of counseling, pharmacotherapy, and the use of information and communications technology; few interventions were implemented at the clinic level. Thirteen interventions resulted in significant improvements in cessation-related outcomes. Information and communications technology and clinic-level interventions had the greatest potential for increasing smoking cessation among PLWH. Efficacious interventions designed for PLWH in the US South, and for groups of PLWH facing additional health disparities (e.g., communities of color and sexual and gender minorities), are needed. There is also a need for more rigorous research designs to test the efficacy of interventions designed to increase cessation-related outcomes among PLWH.
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Affiliation(s)
- Lilli Mann-Jackson
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - David Choi
- Stanford University, 401 Quarry Road, Palo Alto, CA, 94304, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Eunyoung Y Song
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kristie L Foley
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Aimee M Wilkin
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Nicole F Rojas
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Timothy S Oh
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Scott D Rhodes
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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25
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Horridge DN, Oh TS, Alonzo J, Mann-Jackson L, Tanner AE, Song EY, Smart BD, Van Dam CN, Baker LS, Rhodes SD. Barriers to HIV Testing Within a Sample of Spanish-speaking Latinx Gay, Bisexual, and Other Men Who Have Sex with Men: Implications for HIV Prevention and Care. Health Behavior Research 2019. [DOI: 10.4148/2572-1836.1069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Painter TM, Song EY, Mullins MM, Mann-Jackson L, Alonzo J, Reboussin BA, Rhodes SD. Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South. AIDS Behav 2019; 23:251-265. [PMID: 31102108 PMCID: PMC6800592 DOI: 10.1007/s10461-019-02540-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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] [Indexed: 01/08/2023]
Abstract
Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.
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Affiliation(s)
- Thomas M Painter
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA.
| | - Eunyoung Y Song
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary M Mullins
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-37, Atlanta, GA, 30329, USA
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Horridge DN, Oh TS, Alonzo J, Mann-Jackson L, Tanner AE, Song EY, Smart BD, Van Dam CN, Baker LS, Rhodes SD. Barriers to HIV Testing Within a Sample of Spanish-speaking Latinx Gay, Bisexual, and Other Men Who Have Sex with Men: Implications for HIV Prevention and Care. Health Behav Res 2019; 2:https://doi.org/10.4148/2572-1836.1069. [PMID: 31799502 PMCID: PMC6889883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) have higher rates of HIV infection compared to the general population in the United States, and the infection rate is growing among Latinx GBMSM, compared to a decline in most other demographic subgroups. Uptake of pre-exposure prophylaxis (PrEP), a biomedical strategy designed to reduce HIV transmission, is very low among Latinx GBMSM. HIV testing is a critical first step in the HIV prevention and care continua. We analyzed data from a community-based sample of Latinx GBMSM in the southeastern United States to identify the most common HIV testing barriers and the factors associated with barriers. The five most commonly reported HIV testing barriers included not knowing where to get tested, not having health insurance, fear of being HIV positive, practicing safer sex and perceiving not needing to be tested, and not being recommended to get tested. Using multivariable logistic regression modeling, speaking only Spanish, being unemployed, and adhering to traditional notions of masculinity were associated with increased barriers to HIV testing. We recommend that interventions to increase HIV testing among Latinx GBMSM be in Spanish and use culturally congruent messaging, be accessible to those who are unemployed, and incorporate positive risk-reducing aspects of masculinity.
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Affiliation(s)
| | | | | | - Lilli Mann-Jackson
- Wake Forest School of Medicine and Wake Forest Clinical and Translational Science Institute, Program in Community Engagement
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Tanner AE, Song EY, Mann-Jackson L, Alonzo J, Schafer K, Ware S, Garcia JM, Arellano Hall E, Bell JC, Van Dam CN, Rhodes SD. Preliminary Impact of the weCare Social Media Intervention to Support Health for Young Men Who Have Sex with Men and Transgender Women with HIV. AIDS Patient Care STDS 2018; 32:450-458. [PMID: 30398955 PMCID: PMC6909718 DOI: 10.1089/apc.2018.0060] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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] [Indexed: 01/27/2023] Open
Abstract
Young racial/ethnic minority men who have sex with men (MSM) and transgender women with HIV often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, a social media intervention utilizing Facebook, texting, and GPS-based mobile social and sexual networking applications to improve HIV-related care engagement and health outcomes. We compared viral load suppression and clinic appointment attendance among 91 participants during the 12-month period before and after weCare implementation. McNemar's chi-square test analyses were conducted comparing the pre- and postintervention difference using paired data. Since February 2016, intervention staff and 91 intervention participants (79.1% African American and 13.2% Latino, mean age = 25) exchanged 13,830 messages during 3,758 conversations (average: 41.3 conversations per participant) across a variety of topics, including appointment reminders, medication adherence, problem solving, and reducing barriers. There were significant reductions in missed HIV care appointments (68.0% vs. 53.3%, p = 0.04) and increases in viral load suppression (61.3% vs. 88.8%, p < 0.0001) 12 months postimplementation. Our results highlight the initial success of weCare in improving care engagement and viral suppression. Social media is an important tool, especially for young MSM and transgender women, to support individual- (e.g., viral suppression) and community- (e.g., reduced transmission efficiency) level health. It may also be a useful tool for improving engagement with biomedical HIV prevention tools (e.g., PrEP use).
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Affiliation(s)
- Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - Eunyoung Y. Song
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Katherine Schafer
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Samuella Ware
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, North Carolina
| | - J. Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Elias Arellano Hall
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jonathan C. Bell
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Cornelius N. Van Dam
- Regional Center for Infectious Disease, Cone Health, Greensboro, North Carolina
- University of North Carolina AHEC-Greensboro, Greensboro, North Carolina
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Mann-Jackson L, Song EY, Tanner AE, Alonzo J, Linton JM, Rhodes SD. The Health Impact of Experiences of Discrimination, Violence, and Immigration Enforcement Among Latino Men in a New Settlement State. Am J Mens Health 2018; 12:1937-1947. [PMID: 29962271 PMCID: PMC6199437 DOI: 10.1177/1557988318785091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among Latinos in the United States, particularly in new settlement states, racial/ethnic discrimination, violence, and immigration enforcement contribute to health disparities. These types of experiences were explored among Latino men in North Carolina through quantitative assessment data ( n = 247). Qualitative in-depth interviews were also conducted with a subsample of Latino men who completed the assessment ( n = 20) to contextualize quantitative findings. Participants reported high rates of unfair treatment, discrimination or violence, and questioning about their immigration status. Having been questioned about one's immigration status was significantly associated with increased drug use (adjusted odds ratio [AOR] = 2.16; 95% confidence interval [CI] [1.07, 4.38]) and increased depressive symptoms (AOR = 2.87; 95% CI [1.07, 7.67]). Qualitative themes included: reports of frequent discrimination based on immigration status, race/ethnicity, and language; workplaces and police interactions as settings where reported discrimination is most common and challenging; frequent violent victimization; psychological consequences of experiences of discrimination and violence and concerns related to immigration enforcement for Latino men and their families; inter- and intra-community tensions; health-care services as safe spaces; use of coping strategies; and system-level approaches for reducing discrimination and violent victimization of Latinos. Findings point to the need to address underlying causes of discrimination and violence toward Latinos, particularly those related to immigration enforcement, to support health and well-being.
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Affiliation(s)
- Lilli Mann-Jackson
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eunyoung Y Song
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda E Tanner
- 2 Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Jorge Alonzo
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julie M Linton
- 3 Department of Pediatrics and Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Horridge DN, Van Dam CN, Trent S, Bell J, Simán FM, Vissman AT, Nall J, Andrade M. Community-Engaged Research as an Approach to Expedite Advances in HIV Prevention, Care, and Treatment: A Call to Action. AIDS Educ Prev 2018; 30:243-253. [PMID: 29969308 PMCID: PMC6055521 DOI: 10.1521/aeap.2018.30.3.243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/13/2023]
Abstract
Throughout the world, we continue to face profound challenges to reducing the impact of the HIV epidemic. Community-engaged research has emerged as an approach to increase our understanding of HIV and reduce health disparities, increase health equity, and promote community and population health. Our partnership has conducted more than 25 community-engaged research studies in the U.S. and Guatemala, and members have identified nine themes to facilitate community-engaged research and expedite advances in HIV prevention, care, and treatment. These themes include the inclusion of multisectoral partners, trust building and maintenance, the alignment of partner priorities, a can-do attitude, capacity and desire to move beyond service and conduct research, flexibility, power sharing, empowerment, an assets orientation, the shared and timely use of findings, and a stepwise approach. To reduce HIV disparities, community-engaged research is as critical now as ever, and we desperately need to reinvigorate our commitment to and support of it.
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Affiliation(s)
- Scott D Rhodes
- Wake Forest School of Medicine, Winston-Salem, North Carolina
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement
| | | | - Lilli Mann-Jackson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement
| | - Jorge Alonzo
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Cornelius N Van Dam
- Regional Center for Infectious Diseases, Cone Health, Greensboro, North Carolina
| | | | - Jonathan Bell
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Aaron T Vissman
- Center for Health and Human Services Research, Talbert House, Cincinnati, Ohio
| | - Jennifer Nall
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Rhodes SD, Tanner AE, Mann-Jackson L, Alonzo J, Simán FM, Song EY, Bell J, Irby MB, Vissman AT, Aronson RE. Promoting Community and Population Health in Public Health and Medicine: A Stepwise Guide to Initiating and Conducting Community-engaged Research. J Health Dispar Res Pract 2018; 11:16-31. [PMID: 31428533 PMCID: PMC6699784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Various methods, approaches, and strategies designed to understand and reduce health disparities, increase health equity, and promote community and population health have emerged within public health and medicine. One such approach is community-engaged research. While the literature describing the theory, principles, and rationale underlying community engagement is broad, few models or frameworks exist to guide its implementation. We abstracted, analyzed, and interpreted data from existing project documentation including proposal documents, project-specific logic models, research team and partnership meeting notes, and other materials from 24 funded community-engaged research projects conducted over the past 17 years. We developed a 15-step process designed to guide the community-engaged research process. The process includes steps such as: networking and partnership establishment and expansion; building and maintaining trust; identifying health priorities; conducting background research, prioritizing "what to take on"; building consensus, identifying research goals, and developing research questions; developing a conceptual model; formulating a study design; developing an analysis plan; implementing the study; collecting and analyzing data; reviewing and interpreting results; and disseminating and translating findings broadly through multiple channels. Here, we outline and describe each of these steps.
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Rhodes SD, Mann-Jackson L, Alonzo J, Simán FM, Vissman AT, Nall J, Abraham C, Aronson RE, Tanner AE. Engaged for Change: A Community-Engaged Process for Developing Interventions to Reduce Health Disparities. AIDS Educ Prev 2017; 29:491-502. [PMID: 29283276 PMCID: PMC5798238 DOI: 10.1521/aeap.2017.29.6.491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The science underlying the development of individual, community, system, and policy interventions designed to reduce health disparities has lagged behind other innovations. Few models, theoretical frameworks, or processes exist to guide intervention development. Our community-engaged research partnership has been developing, implementing, and evaluating efficacious interventions to reduce HIV disparities for over 15 years. Based on our intervention research experiences, we propose a novel 13-step process designed to demystify and guide intervention development. Our intervention development process includes steps such as establishing an intervention team to manage the details of intervention development; assessing community needs, priorities, and assets; generating intervention priorities; evaluating and incorporating theory; developing a conceptual or logic model; crafting activities; honing materials; administering a pilot, noting its process, and gathering feedback from all those involved; and editing the intervention based on what was learned. Here, we outline and describe each of these 13 steps.
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Affiliation(s)
- Scott D. Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Aaron T. Vissman
- Center for Health and Human Services Research, Talbert House, Cincinnati, OH
| | - Jennifer Nall
- Forsyth County Department of Public Health, Winston-Salem, NC
| | | | | | - Amanda E. Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC
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