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Storholm ED, Huang W, Ogunbajo A, Horvath KJ, Reback CJ, Blumenthal J, Moore DJ, Flynn RP, Bolan RK, Corado KC, Morris SR. Gender-Based Violence and Post-traumatic Stress Disorder Symptoms Predict HIV PrEP Uptake and Persistence Failure Among Transgender and Non-binary Persons Participating in a PrEP Demonstration Project in Southern California. AIDS Behav 2023; 27:745-759. [PMID: 36053404 PMCID: PMC9908815 DOI: 10.1007/s10461-022-03807-1] [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] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Gender-based violence (GBV) against transgender and nonbinary (TGNB) persons is a pervasive public health issue. GBV has been linked to mental health problems such as depression and posttraumatic stress disorder (PTSD), as well has risk for HIV seroconversion and HIV treatment nonadherence. However, the impact of GBV on HIV pre-exposure prophylaxis (PrEP) use among TGNB persons has yet to be investigated. In the current study we assessed longitudinal PrEP persistence data from dried blood spots (DBS) collected from 172 racially and ethnically diverse TGNB participants during a 48-week PrEP demonstration project in Southern California from June 2017 to September 2020. Participants were categorized into three levels of PrEP uptake and persistence based on their PrEP levels at the start and end of the study: low-low, high-low, and high-high. Individual-, social-, and structural-level variables were then entered into multinomial logistic regression models to predict levels of PrEP uptake and persistence based on hypotheses informed by syndemic and minority stress theories. The models demonstrated that experience of GBV predicted significantly lower odds of PrEP uptake and persistence and greater PTSD symptoms predicted significantly greater odds of early PrEP discontinuation. Higher levels of coping skills, already being on PrEP at baseline, and being in a steady relationship were associated with greater odds of PrEP uptake and persistence. Implications for future GBV research, advocacy, interventions, and much needed structural changes focused on improving the health and safety of TGNB individuals are discussed.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | | | - Adedotun Ogunbajo
- RAND Corporation, Santa Monica, CA, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Cathy J Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Friends Research Institute, Los Angeles, CA, USA
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - David J Moore
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
| | | | | | | | - Sheldon R Morris
- AntiViral Research Center, University of California, San Diego School of Medicine, San Diego, CA, USA
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2
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Watson CWM, Pasipanodya E, Savin MJ, Ellorin EE, Corado KC, Flynn RP, Opalo C, Lampley E, Henry BL, Blumenthal J, Bolan R, Morris S, Moore DJ. Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California. AIDS Educ Prev 2020; 32:472-485. [PMID: 33779208 PMCID: PMC10953836 DOI: 10.1521/aeap.2020.32.6.472] [Citation(s) in RCA: 8] [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] [Indexed: 06/12/2023]
Abstract
While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.
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Affiliation(s)
- C Wei-Ming Watson
- University of California, San Diego
- San Diego State University/University of California San Diego
| | - Elizabeth Pasipanodya
- University of California, San Diego
- Santa Clara Valley Medical Center, Fruitdale, California
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3
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Maitino EM, Shafir SC, Beymer MR, Shover CL, Cunningham NJ, Flynn RP, Bolan RK. Age at first HIV test for MSM at a community health clinic in Los Angeles. AIDS Care 2019; 32:186-192. [PMID: 31663365 DOI: 10.1080/09540121.2019.1683806] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Young MSM, especially ethnic and racial minority young MSM, bear a disproportionate burden of new HIV infections. This group also has the highest rates of undiagnosed infection and lowest rates of viral suppression. Previous research indicates that young MSM are testing for HIV too late, which may explain why rates of new HIV infection are rising in young Hispanic MSM and not falling in young Black and White MSM despite advances in preventive medications. Analysis of our sample showed an overall average age at first HIV test of approximately 26. The average age at first HIV test was 25.5 years for Black/African American individuals, 24.7 years for Hispanic individuals, and 28 years for White individuals. More testing resources and innovative outreach methods are needed to increase rates of testing among young MSM.
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Affiliation(s)
- Emily M Maitino
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Matt R Beymer
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Los Angles LBGT Center, Los Angeles, CA, USA
| | - Chelsea L Shover
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nicole J Cunningham
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Risa P Flynn
- Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert K Bolan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Johnathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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4
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Shover CL, DeVost MA, Beymer MR, Gorbach PM, Flynn RP, Bolan RK. Using Sexual Orientation and Gender Identity to Monitor Disparities in HIV, Sexually Transmitted Infections, and Viral Hepatitis. Am J Public Health 2019; 108:S277-S283. [PMID: 30383431 DOI: 10.2105/ajph.2018.304751] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To quantify sexual orientation and gender identity (SOGI) disparities in incidence of HIV, other sexually transmitted infections (STIs), and viral hepatitis. METHODS We performed a records-based study of 19 933 patients visiting a federally qualified health center in Los Angeles, California, between November 2016 and October 2017 that examined HIV, STIs, and viral hepatitis incidence proportions. We created multivariable logistic regression models to examine the association between incidence proportions and SOGI among people living with HIV and HIV-negative patients. RESULTS Among those who were HIV-negative at baseline (n = 16 757), 29% tested positive for any STI during the study period, compared with 38% of people living with HIV. Stratified by birth sex, STI positivity was 32% among men and 11% among women. By SOGI, STI positivity was 35% among gay and bisexual cisgender men, 15% among heterosexual cisgender men, 11% among cisgender women, 25% among transgender women, 13% among gay and bisexual transgender men, 3% among heterosexual transgender men, and 26% among nonbinary people. CONCLUSIONS Stratifying by SOGI highlighted disparities that are obscured when stratifying by birth sex. Public Health Implications. To monitor and reduce disparities, health jurisdictions should include SOGI data with infectious disease reporting.
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Affiliation(s)
- Chelsea L Shover
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Michelle A DeVost
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Matthew R Beymer
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Pamina M Gorbach
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Risa P Flynn
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Robert K Bolan
- Chelsea L. Shover is with Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, and the Los Angeles LGBT Center, Department of Health and Mental Health Services, Los Angeles. Michelle A. DeVost, Risa P. Flynn, and Robert K. Bolan are with the Los Angeles LGBT Center. Matthew R. Beymer is with the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, and the Los Angeles LGBT Center. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Health, University of California Los Angeles, and the Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles
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5
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Beymer MR, DeVost MA, Weiss RE, Dierst-Davies R, Shover CL, Landovitz RJ, Beniasians C, Talan AJ, Flynn RP, Krysiak R, McLaughlin K, Bolan RK. Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California. Sex Transm Infect 2018; 94:457-462. [PMID: 29487172 DOI: 10.1136/sextrans-2017-053377] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/29/2017] [Accepted: 02/08/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective method for reducing HIV incidence among at-risk populations. However, concerns exist over the potential for an increase in STIs following PrEP initiation. The objective of this study is to compare the STI incidence before and after PrEP initiation within subjects among a cohort of men who have sex with men in Los Angeles, California. METHODS The present study used data from patients who initiated PrEP services at the Los Angeles LGBT Center between October 2015 and October 2016 (n=275). A generalised linear mixed model was used with a case-crossover design to determine if there was a significant difference in STIs within subjects 365 days before (before-PrEP period) and 365 days after PrEP initiation (after-PrEP period). RESULTS In a generalised linear mixed model, there were no significant differences in urethral gonorrhoea (P=0.95), rectal gonorrhoea (P=0.33), pharyngeal gonorrhoea (P=0.65) or urethral chlamydia (P=0.71) between periods. There were modest increases in rectal chlamydia (rate ratio (RR) 1.83; 95% CI 1.13 to 2.98; P=0.01) and syphilis diagnoses (RR 2.97; 95% CI 1.23 to 7.18; P=0.02). CONCLUSIONS There were significant increases in rectal chlamydia and syphilis diagnoses when comparing the periods directly before and after PrEP initiation. However, only 28% of individuals had an increase in STIs between periods. Although risk compensation appears to be present for a segment of PrEP users, the majority of individuals either maintain or decrease their sexual risk following PrEP initiation.
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Affiliation(s)
- Matthew R Beymer
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Michelle A DeVost
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, California, USA
| | | | - Chelsea L Shover
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Raphael J Landovitz
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Center for Clinical AIDS Research and Education (CARE), Los Angeles, California, USA
| | - Corinne Beniasians
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Ali J Talan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Risa P Flynn
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Robyn Krysiak
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Kayla McLaughlin
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
| | - Robert K Bolan
- Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, California, USA
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6
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Beymer MR, Kofron RM, Tseng CH, Bolan RK, Flynn RP, Sayles JM, Perez MJ, Jordan WC, Landovitz RJ. Results from the post-exposure prophylaxis pilot program (P-QUAD) demonstration project in Los Angeles County. Int J STD AIDS 2017; 29:557-562. [PMID: 29183270 DOI: 10.1177/0956462417743158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/15/2022]
Abstract
Post-exposure prophylaxis (PEP) is a promising but under-utilized strategy for HIV prevention in high-risk populations. Between March 2010 and June 2011, two community-based clinics in Los Angeles County provided PEP in a pilot program to 267 unique individuals. Courses were primarily dispensed to men who have sex with men (84%) and consisted overwhelmingly of a three-drug antiretroviral therapy regimen containing two nucleoside reverse transcriptase inhibitors and either an integrase inhibitor (raltegravir) or a boosted protease inhibitor (lopinavir/ritonavir). Approximately 64% of all PEP courses were followed for at least 12 weeks, and seven individuals seroconverted. Of the seven seroconversions, six had subsequent re-exposure. The low rate of PEP failure calls for expanded funding for PEP in other jurisdictions.
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Affiliation(s)
- Matthew R Beymer
- 1 Los Angeles LGBT Center, Los Angeles, CA, USA.,2 Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ryan M Kofron
- 3 Center for Clinical AIDS Research & Education, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- 4 Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA, USA
| | | | | | - Jennifer M Sayles
- 3 Center for Clinical AIDS Research & Education, Los Angeles, CA, USA
| | - Mario J Perez
- 5 Division of HIV and STD Programs, Department of Public Health, County of Los Angeles, Los Angeles, CA, USA
| | | | - Raphael J Landovitz
- 2 Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, CA, USA.,3 Center for Clinical AIDS Research & Education, Los Angeles, CA, USA
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7
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Beymer MR, Weiss RE, Bolan RK, Kofron RM, Flynn RP, Pieribone DL, Kulkarni SP, Landovitz RJ. Differentiating Nonoccupational Postexposure Prophylaxis Seroconverters and Non-Seroconverters in a Community-Based Clinic in Los Angeles, California. Open Forum Infect Dis 2017; 4:ofx061. [PMID: 28596981 DOI: 10.1093/ofid/ofx061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/29/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Nonoccupational postexposure prophylaxis (nPEP) is a 28-day regimen of antiretroviral medications taken within 72 hours of human immunodeficiency virus (HIV) exposure to prevent HIV acquisition. Although nPEP has been recommended since 1998, few studies have analyzed the characteristics that distinguish nPEP failures (seroconverters) and successes (non-seroconverters). METHODS This retrospective study analyzed all nPEP courses prompted by sexual exposure that were prescribed at the Los Angeles LGBT Center between March 2010 and July 2014. Fisher exact tests and logistic regressions were used to determine characteristics that distinguished nPEP seroconverters from non-seroconverters. RESULTS Of the nPEP courses administered, 1744 had a follow-up visit for HIV testing within 24 weeks of exposure and 17 individuals seroconverted. Seven reported a known re-exposure, 8 self-reported only condom-protected sex subsequent to the initial exposure, and 2 reported abstinence since the exposure. In multivariable analyses, seroconverters were more likely than non-seroconverters to report methamphetamine use, incomplete medication adherence, and nPEP initiation later in the 72-hour window. CONCLUSIONS Nonoccupational postexposure prophylaxis is an important emergency tool for HIV prevention. Our findings corroborate that timing of the initial nPEP dose is an important predictor of seroconversion. Although the current study did not offer the initial nPEP dose at the beginning of the visit, use of this fast-track dosing schedule will ensure that the first dose is taken as early as possible postexposure and may lower the likelihood for seroconversion. Furthermore, we recommend systematic screening for substance use because these individuals may be well suited for pre-exposure prophylaxis given their sustained risk.
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Affiliation(s)
- Matthew R Beymer
- Los Angeles LGBT Center, California.,Division of Infectious Diseases, Department of Medicine and
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | | | - Ryan M Kofron
- Center for Clinical AIDS Research and Education, Los Angeles, California
| | | | | | | | - Raphael J Landovitz
- Center for Clinical AIDS Research and Education, Los Angeles, California.,County of Los Angeles Department of Public Health, Division of HIV and STD Programs, California; and
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8
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Beymer MR, Bolan RK, Flynn RP, Kerrone DR, Pieribone DL, Kulkarni SP, Stitt JC, Mejia E, Landovitz RJ. Uptake and repeat use of postexposure prophylaxis in a community-based clinic in Los Angeles, California. AIDS Res Hum Retroviruses 2014; 30:848-55. [PMID: 24970113 DOI: 10.1089/aid.2014.0017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Postexposure prophylaxis (PEP) has become an important tool for HIV prevention in the men who have sex with men (MSM) communities within Los Angeles County. However, it is unclear as to whether the most sexually at-risk MSM populations are accessing PEP services. Furthermore, it is unclear what behavioral risk factors differentiate individuals who utilize PEP once (single PEP) versus those who utilize it multiple times (re-PEP). Data were collected between May 2011 and December 2012 on all clients enrolled in the Los Angeles LGBT Center's (the Center) PEP-LA program as well as on all sexually transmitted infection (STI) screening clients visiting the Center. Multivariate logistic regression models were used to analyze results. PEP clients had greater odds of having a history of gonorrhea in the past year when compared to high-risk, non-PEP clients (OR: 1.71; CI: 1.25-2.35). Furthermore, they had greater odds of using methamphetamines (OR: 1.71; CI: 1.30-2.24) and inhaled nitrates (OR: 1.62; CI: 1.30-2.01) in the past 12 months when compared to high-risk, non-PEP clients. Re-PEP clients had greater odds of methamphetamine use than single PEP clients (OR: 2.80; CI: 1.65-4.75). There were no significant differences by race/ethnicity between high-risk, non-PEP clients and PEP clients in either the entire cohort or MSM only sample. However, African Americans made up 8.5% of persons accessing PEP services but 16.7% of persons who tested HIV positive. Similar proportions of PEP use by race/ethnicity are problematic considering the disproportionate burden of HIV infections in the African American community. Although uptake among the highest risk populations has been brisk (n=649), inequities based upon race/ethnicity suggest the need for increased outreach.
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Affiliation(s)
- Matthew R. Beymer
- Los Angeles LGBT Center, Los Angeles, California
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | | | | | | | - David L. Pieribone
- County of Los Angeles Department of Public Health, Division of HIV and STD Programs (LAC DHSP), Los Angeles, California
| | - Sonali P. Kulkarni
- County of Los Angeles Department of Public Health, Division of HIV and STD Programs (LAC DHSP), Los Angeles, California
| | | | | | - Raphael J. Landovitz
- Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
- Center for Clinical AIDS Research & Education (CARE), Los Angeles, California
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9
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Young SD, Daniels J, Chiu CJ, Bolan RK, Flynn RP, Kwok J, Klausner JD. Acceptability of using electronic vending machines to deliver oral rapid HIV self-testing kits: a qualitative study. PLoS One 2014; 9:e103790. [PMID: 25076208 PMCID: PMC4116256 DOI: 10.1371/journal.pone.0103790] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/07/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Rates of unrecognized HIV infection are significantly higher among Latino and Black men who have sex with men (MSM). Policy makers have proposed that HIV self-testing kits and new methods for delivering self-testing could improve testing uptake among minority MSM. This study sought to conduct qualitative assessments with MSM of color to determine the acceptability of using electronic vending machines to dispense HIV self-testing kits. Materials and Methods African American and Latino MSM were recruited using a participant pool from an existing HIV prevention trial on Facebook. If participants expressed interest in using a vending machine to receive an HIV self-testing kit, they were emailed a 4-digit personal identification number (PIN) code to retrieve the test from the machine. We followed up with those who had tested to assess their willingness to participate in an interview about their experience. Results Twelve kits were dispensed and 8 interviews were conducted. In general, participants expressed that the vending machine was an acceptable HIV test delivery method due to its novelty and convenience. Discussion Acceptability of this delivery model for HIV testing kits was closely associated with three main factors: credibility, confidentiality, and convenience. Future research is needed to address issues, such as user-induced errors and costs, before scaling up the dispensing method.
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Affiliation(s)
- Sean D Young
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Joseph Daniels
- Program in Global Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - ChingChe J Chiu
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Robert K Bolan
- Los Angeles Gay and Lesbian Center, Los Angeles, California, United States of America
| | - Risa P Flynn
- Los Angeles Gay and Lesbian Center, Los Angeles, California, United States of America
| | - Justin Kwok
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jeffrey D Klausner
- Program in Global Health, University of California Los Angeles, Los Angeles, California, United States of America
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