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Nacht CL, Reynolds HE, Jessup O, Amato M, Storholm ED. The Association between Social Support and Pre-Exposure Prophylaxis use among Sexual Minority Men in the United States: A Scoping Literature Review. AIDS Behav 2024:10.1007/s10461-024-04446-4. [PMID: 39039399 DOI: 10.1007/s10461-024-04446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Sexual minority men (SMM) are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is an effective way of reducing HIV incidence, PrEP use has remained relatively low. Social support may be one effective factor in increasing PrEP use among SMM, but the association between social support and PrEP use/adherence is not well understood. The objective of this paper was to summarize the current literature on the association of social support and PrEP use among SMM in the United States. A systematic search was conducted using six different databases MEDLINE / PubMed, PsycINFO, Cochrane CENTRAL, Google Scholar, Embase, and Web of Science using terms established from keywords and medical subject headings (MeSH) terms before being adapted to each database. Data were extracted for key study factors (e.g., study population, geographic location, study design) and main findings. This search produced eleven articles: ten manuscripts and one conference abstract. Of these, two were randomized control trials, two were interventions, three were qualitative, and four were cross-sectional. The studies were widespread across the country, but most were in major metropolitan areas. From the articles included in this review, findings were inconsistent in the association between social support; some studies showed null findings, others that only certain sources of social support were significant, and others that there was a significant association between social support and PrEP use. This review highlights the complexity of the relationship between social support and PrEP use among SMM, indicating the need for further research to identify specific types and sources of support that effectively enhance PrEP uptake and adherence. Targeted interventions based on these insights could significantly reduce HIV incidence in the population.
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Affiliation(s)
- Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, San Diego, CA, USA.
| | - Hannah E Reynolds
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Owen Jessup
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Marianna Amato
- College of Education, San Diego State University, San Diego, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
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Besera G, Snead MC, Goodwin M, Smoots A, Bish CL, Ruiz A, Sayyad A, Avripas S, Ubri P, Ahn R, Pineau V, Warren N, Mukangu D, Johnson-Agbakwu CE, Goldberg H, Okoroh E. The women's health needs study among women from countries with high prevalence of female genital mutilation living in the United States: Design, methods, and participant characteristics. PLoS One 2024; 19:e0302820. [PMID: 38820266 PMCID: PMC11142442 DOI: 10.1371/journal.pone.0302820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/12/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The Women's Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this paper is to describe the WHNS design, methods, strengths and limitations, as well as select demographic and health-related characteristics of participants. METHODS We conducted a cross-sectional survey from November 2020 -June 2021 in four US metropolitan areas, using a hybrid venue-based sampling (VBS) and respondent-driven sampling (RDS) approach to identify women for recruitment. RESULTS Of 1,132 participants, 395 were recruited via VBS and 737 RDS. Most were born, or their mothers were born, in either a West African country (Burkina Faso, Guinea, Mali, Mauritania, Sierra Leone, The Gambia) (39.0%) or Ethiopia (30.7%). More than a third were aged 30-39 years (37.5%) with a majority who immigrated at ages ≥13 years (86.6%) and had lived in the United States for ≥5 years (68.9%). Medicaid was the top health insurer (52.5%), followed by private health insurance (30.5%); 17% of participants had no insurance. Nearly half of women reported 1-2 healthcare visits within the past 12 months (47.7%). One in seven did not get needed health care due to cost (14.8%). Over half have ever used contraception (52.1%) to delay or avoid pregnancy and 76.9% had their last pelvic and/or Papanicolaou (pap) exam within the past 3 years. More than half experienced FGM (55.0%). Nearly all women believed that FGM should be stopped (92.0%). CONCLUSION The VBS/RDS approach enabled recruitment of a diverse study population. WHNS advances research related to the health characteristics, needs, and experiences of women living in the US from countries where FGM is prevalent.
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Affiliation(s)
- Ghenet Besera
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Margaret Christine Snead
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary Goodwin
- Independent Consultant, Atlanta, Georgia, United States of America
| | - Ashley Smoots
- Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Connie L. Bish
- Independent Consultant, Atlanta, Georgia, United States of America
| | - Alicia Ruiz
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ayeesha Sayyad
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sabrina Avripas
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Petry Ubri
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Roy Ahn
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Vicki Pineau
- NORC at the University of Chicago, Chicago, Illinois, United States of America
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Washington, DC, United States of America
| | - Doris Mukangu
- Amani Women Center, Atlanta, Georgia, United States of America
| | - Crista E. Johnson-Agbakwu
- Collaborative in Health Equity, Office of Health Equity, The University of Massachusetts, Worcester, Massachusetts, United States of America
- Obstetrics & Gynecology, UMass Memorial Health, Worcester, Massachusetts, United States of America
- Division of Preventive and Behavioral Medicine, Population and Quantitative Health Sciences, University of Massachusetts T.H. Chan Medical School, Worcester, Massachusetts, United States of America
| | - Howard Goldberg
- Independent Consultant, Atlanta, Georgia, United States of America
| | - Ekwutosi Okoroh
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Khalifa A, Kim B, Regan S, Moline T, Chaix B, Chen YT, Schneider J, Duncan DT. Examination of multidimensional geographic mobility and sexual behaviour among Black cisgender sexually minoritized men in Chicago. GEOSPATIAL HEALTH 2024; 19:10.4081/gh.2024.1273. [PMID: 38752862 PMCID: PMC11194757 DOI: 10.4081/gh.2024.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/13/2024] [Indexed: 06/06/2024]
Abstract
Black sexually minoritized men (BSMM) are the most likely to acquire HIV in Chicago- a racially segregated city where their daily travel may confer different HIV-related risks. From survey and GPS data among participants of the Neighbourhoods and Networks Cohort Study, we examined spatial (proportion of total activity space away from home), temporal (proportion of total GPS points away from home), and motivation-specific (discordance between residential and frequented sex or socializing neighbourhoods) dimensions of mobility. To identify potential drivers of BSMM's risk, we then examined associations between mobility and sexual behaviours known to cause HIV transmission: condomless anal sex, condomless anal sex with a casual partner, transactional sex, group sex, and sex-drug use. Multivariable logistic regression models assessed associations. Of 269 cisgender BSMM, most were 20-29 years old, identified as gay, and lowincome. On average, 96.9% (Standard Deviation: 3.7%) of participants' activity space and 53.9% (Standard Deviation: 38.1%) of participants' GPS points occurred outside their 800m home network buffer. After covariate adjustment, those who reported sex away from home were twice as likely to report condomless sex (Odds Ratio: 2.02, [95% Confidence Interval (CI): 1.08, 3.78]). Those who reported socializing away from home were four times more likely to have condomless sex with a casual partner (Odds Ratio: 4.16 [CI: 0.99, 29.0]). BSMM are on the move in Chicago, but only motivation-specific mobility may increase HIV transmission risk. Multidimensional investigations of mobility can inform place-based strategies for HIV service delivery.
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Affiliation(s)
- Aleya Khalifa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY.
| | - Byoungjun Kim
- Department of Surgery, New York University Grossman School of Medicine, New York, NY.
| | - Seann Regan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Tyrone Moline
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Basile Chaix
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Némésis Research Team, Paris.
| | - Yen-Tyng Chen
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
| | - John Schneider
- Department of Medicine, Public Health Sciences, University of Chicago, Chicago, IL.
| | - Dustin T Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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Cummins B, Johnson K, Schneider JA, Del Vecchio N, Moshiri N, Wertheim JO, Goyal R, Skaathun B. Leveraging social networks for identification of people with HIV who are virally unsuppressed. AIDS 2024; 38:245-254. [PMID: 37890471 PMCID: PMC10843229 DOI: 10.1097/qad.0000000000003767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES This study investigates primary peer-referral engagement (PRE) strategies to assess which strategy results in engaging higher numbers of people with HIV (PWH) who are virally unsuppressed. DESIGN We develop a modeling study that simulates an HIV epidemic (transmission, disease progression, and viral evolution) over 6 years using an agent-based model followed by simulating PRE strategies. We investigate two PRE strategies where referrals are based on social network strategies (SNS) or sexual partner contact tracing (SPCT). METHODS We parameterize, calibrate, and validate our study using data from Chicago on Black sexual minority men to assess these strategies for a population with high incidence and prevalence of HIV. For each strategy, we calculate the number of PWH recruited who are undiagnosed or out-of-care (OoC) and the number of direct or indirect transmissions. RESULTS SNS and SPCT identified 256.5 [95% confidence interval (CI) 234-279] and 15 (95% CI 7-27) PWH, respectively. Of these, SNS identified 159 (95% CI 142-177) PWH OoC and 32 (95% CI 21-43) PWH undiagnosed compared with 9 (95% CI 3-18) and 2 (95% CI 0-5) for SPCT. SNS identified 15.5 (95% CI 6-25) and 7.5 (95% CI 2-11) indirect and direct transmission pairs, whereas SPCT identified 6 (95% CI 0-8) and 5 (95% CI 0-8), respectively. CONCLUSION With no testing constraints, SNS is the more effective strategy to identify undiagnosed and OoC PWH. Neither strategy is successful at identifying sufficient indirect or direct transmission pairs to investigate transmission networks.
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Affiliation(s)
- Breschine Cummins
- Department of Mathematical Sciences, Montana State University, Bozeman, MT
| | - Kara Johnson
- Department of Mathematical Sciences, Montana State University, Bozeman, MT
| | - John A. Schneider
- Department of Medicine, University of Chicago
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | | | | | - Joel O. Wertheim
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Knox JR, Dolotina B, Moline T, Matthews I, Durrell M, Hanson H, Almirol E, Hotton A, Pagkas-Bather J, Chen YT, English D, Manuzak J, Rower JE, Miles C, Millar B, Jean-Louis G, Rendina HJ, Martins SS, Grov C, Hasin DS, Carrico AW, Shoptaw S, Schneider JA, Duncan DT. HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status-Neutral Cohort Study Using an Observational-Implementation Hybrid Approach. JMIR Res Protoc 2023; 12:e48548. [PMID: 38039075 PMCID: PMC10724817 DOI: 10.2196/48548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. OBJECTIVE This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. METHODS Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). RESULTS The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. CONCLUSIONS The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48548.
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Affiliation(s)
- Justin R Knox
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Dolotina
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tyrone Moline
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Isabella Matthews
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Yen-Tyng Chen
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Devin English
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Jennifer Manuzak
- Division of Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Joseph E Rower
- Center for Human Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Caleb Miles
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Millar
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - H Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Silvia S Martins
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Grov
- Einstein-CUNY-Rockefeller Center for AIDS Research, School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Deborah S Hasin
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Adam W Carrico
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, United States
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Evers YJ, Goense CJD, Hoebe CJPA, Dukers-Muijrers NHTM. Newly diagnosed HIV and use of HIV-PrEP among non-western born MSM attending STI clinics in the Netherlands: a large retrospective cohort study. Front Public Health 2023; 11:1196958. [PMID: 37404283 PMCID: PMC10315834 DOI: 10.3389/fpubh.2023.1196958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction The World Health Organization recommends HIV-PrEP for all people at risk for HIV infection, which includes men who have sex with men (MSM). Substantial part of new HIV diagnoses in the Netherlands are in non-western born MSM. This study evaluated new HIV diagnoses and reported PrEP use among non-western born MSM and compared it to western-born MSM. To inform public health efforts in the context of equitable PrEP access, we further assessed sociodemographic factors related to higher HIV risk and lower PrEP use among non-western born MSM. Methods Surveillance data of consultations among MSM in all Dutch STI-clinics (2016-2021) were analyzed. STI-clinics provide PrEP via the national pilot-program since August 2019. In non-western born MSM (born in Eastern-Europe/Latin-America/Asia/Africa/Dutch-Antilles/Suriname), sociodemographic factors were evaluated for association with HIV (by multivariable generalized estimating equations) and reported PrEP use in the past 3 months (by multivariable logistic regression; restricted to an at-risk for HIV person-level data-subset from August 2019). Results New HIV infections were diagnosed among 1.1% (493/44,394) of non-western born MSM-consultations (vs. 0.4% among western-born MSM, 742/210,450). Low education (aOR: 2.2, 95%CI: 1.7-2.7, vs. high education) and age under 25 years (aOR: 1.4, 95%CI: 1.1-1.8, vs. age above 35 years) were associated with new HIV diagnoses. PrEP use in the past 3 months was 40.7% in non-western born MSM (1,711/4,207; 34.9% among western-born MSM, 6,089/17,458). PrEP use was lower among non-western born MSM aged under 25 years (aOR: 0.3, 95%CI: 0.2-0.4), living in less urban areas (aOR: 0.7, 95%CI: 0.6-0.8), and having low education level (aOR: 0.6, 95%CI: 0.5-0.7). Conclusion Our study confirmed that non-western born MSM are an important key population in HIV prevention. Access to HIV prevention, including HIV-PrEP, should be further optimized to all non-western born MSM at risk for HIV, and specifically to those who are younger, live in less urban areas, and have a low education level.
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Affiliation(s)
- Ymke J. Evers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Cornelia J. D. Goense
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+ (MUMC+), Maastricht, Limburg, Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Limburg, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Walsh JL, Zarwell M, John SA, Quinn KG. Sources of Information about Pre-Exposure Prophylaxis (PrEP) and Associations with PrEP Stigma, Intentions, Provider Discussions, and Use in the United States. JOURNAL OF SEX RESEARCH 2023; 60:728-740. [PMID: 36036718 PMCID: PMC9971350 DOI: 10.1080/00224499.2022.2110208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The amount and type of information individuals receive about HIV pre-exposure prophylaxis (PrEP) may influence PrEP uptake. We surveyed 331 HIV-negative sexual and gender minorities who have sex with men at a Midwestern Pride festival in 2018 (Mage = 32, 68% White, 87% cisgender men) to assess sources and perceived tone of PrEP information and associated outcomes. Most participants (88%) had heard about PrEP. The most common sources were the internet (70%), social media (59%), and friends (54%). Messages from health campaigns were perceived as most positive and those from religious institutions as least positive. Sources differed based on demographics. Controlling for indications for PrEP use, those who heard about PrEP from health campaigns and those who heard more positive messages reported lower levels of PrEP stigma, βs = -0.27--0.23, ps < .05. Non-users who heard about PrEP from the internet had stronger intentions to use PrEP, β = 0.28, p < .05. Those who heard about PrEP from sexual partners and health campaigns were more likely to discuss PrEP with providers, PRs = 1.60-1.80, ps < .01. Finally, those who heard about PrEP from friends and partners were more likely to use PrEP, PRs = 2.01-2.24, ps < .05. Leveraging sexual partners, social network members, and health campaigns are promising avenues to advance PrEP implementation.
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Affiliation(s)
- Jennifer L. Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, WI
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, WI
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, The Medical College of Wisconsin, Milwaukee, WI
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Nazli A, Garner A, Gokengin D. Awareness of HIV pre-exposure prophylaxis among men who have sex with men using apps for sexual encounters in Turkiye. Int J STD AIDS 2022; 33:1124-1133. [DOI: 10.1177/09564624221126867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background New HIV diagnoses are rising in Turkiye. Men who have sex with men (MSM) are estimated to be the main driver of the epidemic. Pre-exposure prophylaxis (PrEP) was proven to be effective in reducing new HIV diagnoses and PrEP recently became available in Turkiye. Objective To assess awareness of and willingness to use PrEP and the level of off-licence use among MSM. Methods An anonymous self-completed questionnaire was sent out over the Hornet Gay Social Network from December 2019 to February 2020, available in Turkish and Arabic. It included 20 questions on HIV and STI testing, PrEP awareness, PrEP use, willingness to use, chemsex and sexual happiness level. Results Overall 4761 respondents who responded to more than 1/3 of the questions were eligible for analyses; 5.5% was Arabic speaking. The mean age was 30.5 years, 31.4% had never tested for HIV, 40.5% knew what PrEP was, the most common source of knowledge was the internet (44.5%), 2.5% (120) had used PrEP in the last 12 months and 1.7% (83) was current users. PrEP users had accessed drugs over the internet (47.6%), pharmacy (23%), and friends (13.8%). Almost 40% were willing to use PrEP in the following 6 months. Younger and Arabic speaking respondents had lower rates of HIV testing ( p = .001) and lower awareness for PrEP than comparators ( p = .004). Conclusion Awareness and willingness to use PrEP is high among MSM in Turkiye. The recent availability of PrEP in the country is a big step forward in terms of prevention.
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Affiliation(s)
- Arzu Nazli
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Alex Garner
- Mpact Global Action for Gay Men’s Health and Rights, California, US
| | - Deniz Gokengin
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
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Stephenson R, Chavanduka TMD, Sullivan S, Mitchell JW. Partner Support and Communication for Pre-exposure Prophylaxis (PrEP) Use Among Male Couples. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2549-2562. [PMID: 34799830 DOI: 10.1007/s10508-021-02118-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Between one to two-thirds of HIV infections among gay, bisexual, and other men who have sex with men are from primary partners, and there has been increased research attention focused on strategies to increase PrEP adoption among male couples. While there is evidence that partner support is a strong correlate of pre-exposure prophylaxis (PrEP) adoption, there has been a lack of attention on PrEP communication dynamics among male couples. In this paper, we build upon this literature through analysis of dyadic data from a large cross-sectional survey of 543 concordant sero-negative and serodiscordant male couples to examine individual and relationship factors associated with reports of partner communication around PrEP, comfort in discussing PrEP, and perceived partner-level support for PrEP use. PrEP use was relatively low (16.2%), and although 87.5% of men reported their partners would support their PrEP use, only 26.3% had talked to their partner recently about PrEP. PrEP communication and perceived support for PrEP were significantly negatively associated with PrEP stigma and stigma based on sexuality (i.e., internalized homophobia and enacted external stigma based on sexuality), while men with sexual agreements were more comfortable talking about PrEP with their partner. There is a need to adapt current interventions, or develop new dyadic interventions, that provide opportunities for male couples to talk and learn about PrEP together, as a potential pathway to engage them toward PrEP use.
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Affiliation(s)
- Rob Stephenson
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA.
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
| | - Tanaka M D Chavanduka
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
| | - Stephen Sullivan
- The Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI, 48109, USA
| | - Jason W Mitchell
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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10
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Lee F, Sheeler D, Hotton A, Vecchio ND, Flores R, Fujimoto K, Harawa N, Schneider JA, Khanna AS. Stimulant use interventions may strengthen 'Getting to Zero' HIV elimination initiatives in Illinois: Insights from a modeling study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103628. [PMID: 35218990 PMCID: PMC9058209 DOI: 10.1016/j.drugpo.2022.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/02/2022] [Accepted: 02/12/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) Getting to Zero (GTZ) is an Illinois-based HIV elimination initiative. GTZ identifies younger Black men who have sex with men (YBMSM) as a population who have experienced disproportionate HIV incidence. Rising stimulant use among YBMSM has been determined to impede engagement in the HIV prevention and treatment continua for reducing onward HIV transmission. Given the limited development of dedicated or culturally appropriate interventions for this population, this modeling study explores the impact of stimulant use on HIV incidence among YBMSM and assesses the impact of interventions to treat stimulant use on downstream HIV transmission to achieve GTZ goals. METHODS A previously developed agent-based network model (ABNM), calibrated using data for YBMSM in Illinois, was extended to incorporate the impact of stimulant use (methamphetamines, crack/cocaine, and ecstasy) on sexual networks and engagement in HIV treatment and prevention continua. The model simulated the impact of a residential behavioral intervention (BI) for reducing stimulant use and an outpatient biomedical intervention (mirtazapine) for treating methamphetamine use. The downstream impact of these interventions on population-level HIV incidence was the primary intervention outcome. RESULTS Baseline simulated annual HIV incidence in the ABNM was 6.93 [95% Uncertainty Interval (UI): 6.83,7.04] per 100 person years (py) and 453 [95% UI: 445.9,461.2] new infections annually. A residential rehabilitation intervention targeted to 25% of stimulant using persons yielded a 27.1% reduction in the annual number of new infections. Initiating about 50% of methamphetamine using persons on mirtazapine reduced the overall HIV incidence among YBMSM by about 11.2%. A 30% increase in antiretroviral treatment (ART) and preexposure prophylaxis (PrEP) uptake in the non-stimulant using YBMSM population combined with a 25% uptake of BI for stimulant using persons produces an HIV incidence consistent with HIV elimination targets (about 200 infections/year) identified in the GTZ initiative. CONCLUSIONS Behavioral and biomedical interventions to treat stimulant use, in addition to expanding overall ART and PrEP uptake, are likely to enhance progress towards achieving GTZ goals.
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Affiliation(s)
- Francis Lee
- Chicago Center for HIV Elimination, The University of Chicago, United States; Department of Medicine, The University of Chicago, United States
| | - Daniel Sheeler
- Chicago Center for HIV Elimination, The University of Chicago, United States; Department of Medicine, The University of Chicago, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, The University of Chicago, United States; Department of Medicine, The University of Chicago, United States
| | - Natascha Del Vecchio
- Chicago Center for HIV Elimination, The University of Chicago, United States; Department of Medicine, The University of Chicago, United States
| | - Rey Flores
- Chicago Center for HIV Elimination, The University of Chicago, United States; Department of Medicine, The University of Chicago, United States
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth), United States
| | - Nina Harawa
- Department of Epidemiology, University of California at Los Angeles, United States; Department of Psychiatry and Human Behavior, Charles R. Drew University, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, The University of Chicago, United States; Department of Medicine, The University of Chicago, United States
| | - Aditya S Khanna
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, United States; Department of Behavioral and Social Sciences, Brown University School of Public Health, United States.
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11
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Pre-Exposure Prophylaxis Stigma and Beliefs in the Efficacy of Pre-Exposure Prophylaxis: An Analysis of a Cross-Sectional Survey of Male Couples in the United States. J Assoc Nurses AIDS Care 2021; 33:406-420. [PMID: 34812796 DOI: 10.1097/jnc.0000000000000315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Increasing the use of pre-exposure prophylaxis (PrEP) among male couples is critical to the success of the United States' Ending the HIV Epidemic campaign. By leveraging dyadic data from a larger cross-sectional study of male couples, the present analysis examined individual, partner, and relationship characteristics associated with PrEP stigma and perceived efficacy of PrEP. Actor-Partner Independence Models were fit separately for both outcomes. Individual and partner risk behaviors, including substance use, binge drinking, and higher number of condomless casual sex partners, were associated with lower levels of both PrEP stigma and belief in the efficacy of PrEP. Networks that supported PrEP use were associated with decreased PrEP stigma and increased belief in PrEP efficacy. Stigma-informed PrEP interventions for couples should be considered foundational to the success of the United States' Ending the HIV Epidemic campaign.
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12
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Schuyler A, Alidina Z, Dolcini MM, Harper G, Fortenberry JD, Singh R, Jamil O, Pollack L, Catania J. Pre-Exposure Prophylaxis (PrEP) Dissemination: Adapting Diffusion Theory to Examine PrEP Adoption. AIDS Behav 2021; 25:3145-3158. [PMID: 34152531 PMCID: PMC11298242 DOI: 10.1007/s10461-021-03345-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/24/2022]
Abstract
PrEP adoption among African-American men-who-have-sex-with-men (AAMSM) remains low. We applied Diffusion-of-Innovations (DOI) theory to understand PrEP adoption processes among young HIV-negative/status unknown AAMSM (AAYMSM; N = 181; 17-24 years). Quantitative and qualitative analyses were used to examine predictors of PrEP diffusion stages. Most AAYMSM were in the persuasion stage (PrEP-aware, hadn't adopted; 72.4%). Our results suggest that model antecedents are DOI stage-specific. PrEP awareness (knowledge stage) was associated with lower levels of social stigma (p < .03) and greater health literacy (p < .05), while sexual risk (p < .03) and education (p < .03) predicted PrEP adoption (12.2%). PrEP efficacy and side effects were primary innovation characteristics influencing adoption receptivity in the persuasion stage. Interventions to improve PrEP diffusion should be tailored to stage-specific antecedents depending on how a community is stratified across the DOI stages.
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Affiliation(s)
- Ashley Schuyler
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA.
| | - Zainab Alidina
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
| | - M Margaret Dolcini
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
| | - Gary Harper
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Ryan Singh
- Oregon Social Learning Center, Eugene, OR, USA
| | - Omar Jamil
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lance Pollack
- University of California, San Francisco, San Francisco, CA, USA
| | - Joseph Catania
- School of Social and Behavioral Health Sciences, Hallie E Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 410 Waldo Hall, Corvallis, OR, 97331, USA
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13
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Russ S, Zhang C, Liu Y. Pre-Exposure Prophylaxis Care Continuum, Barriers, and Facilitators among Black Men Who Have Sex with Men in the United States: A Systematic Review and Meta-Analysis. AIDS Behav 2021; 25:2278-2288. [PMID: 33438151 DOI: 10.1007/s10461-020-03156-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 01/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP) represents a viable HIV prevention tool for black men who have sex with men (BMSM). However, aggregated evidence regarding the presentations and determinants of the PrEP continuum (e.g., awareness, willingness, intention, uptake and adherence) remains absent to empirically inform future intervention efforts. We meta-analytically summarized the prevalence and qualitatively synthesized key barriers/facilitators of the stages of the PrEP continuum among a pooled sample of 42,870 BMSM aggregated from 56 published studies. Our random-effect models indicated a pooled prevalence of PrEP awareness (50.8%, 95% CI: 43.6-58.0%, willingness/intention (58.2%, 95% CI: 52.0-68.1%) and uptake (15.5%, 95% CI: 12.8-18.2%). Qualitative summary revealed that perception of HIV risk, intersectional/PrEP-related stigma and medical mistrust were among the most quoted factors that influence PrEP use. BMSM remain underrepresented in key stages of the PrEP continuum. Futures interventions are continuously needed to target multilevel barriers/facilitators to enhance the PrEP continuum among BMSM.
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14
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The Co-Evolution of Network Structure and PrEP Adoption among a Large Cohort of PrEP Peer Leaders: Implications for Intervention Evaluation and Community Capacity-Building. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116051. [PMID: 34199829 PMCID: PMC8200056 DOI: 10.3390/ijerph18116051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
Abstract
Background: Peer leader interventions are effective strategies for promoting prevention behaviors in communities at risk for HIV, yet little is known about their effects on the social and behavioral dynamics of peer leaders themselves. Methods: Using data from PrEP Chicago, an RCT PrEP for prevention intervention for young Black MSM (YBMSM), we apply stochastic actor-based models to longitudinally model the impact of study participation on the online friendship and PrEP adoption dynamics among a network of peer leaders (n = 174) and a network of control group counterparts (n = 166). Results: Peer leaders assigned to the same leadership training workshop were more likely to form new Facebook friendships with one another, whereas control participants assigned to the same attention control workshop were no more or less likely to form new friendships. Further, peer leaders with greater PrEP intentions and those living with HIV were more active in forming new friendships with other peer leaders, effects not found in the control network. PrEP adoption was not influenced by network dynamics in either group. Conclusions: The implications of these findings are discussed through the lens of community-capacity building and the role that peer leader interventions and the networks they engage can impact public health.
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15
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Bowman B, Psichogyiou M, Papadopoulou M, Sypsa V, Khanna A, Paraskevis D, Chanos S, Friedman SR, Hatzakis A, Schneider J. Sexual Mixing and HIV Transmission Potential Among Greek Men Who have Sex with Men: Results from SOPHOCLES. AIDS Behav 2021; 25:1935-1945. [PMID: 33555414 PMCID: PMC8081711 DOI: 10.1007/s10461-020-03123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
HIV incidence among men who have sex with men (MSM) in Greece remains unchanged despite effective response to a recent outbreak among people who inject drugs (PWID). Network factors are increasingly understood to drive transmission in epidemics. The primary objective of the study was to characterize MSM in Greece, their sexual behaviors, and sexual network mixing patterns. We investigated the relationship between serostatus, sexual behaviors, and self-reported sex networks in a sample of MSM in Athens, Greece, generated using respondent driven sampling. We estimated mixing coefficients (r) based on survey-generated egonets. Additionally, multiple logistic regression was used to estimate adjusted odds ratios (AOR) and to assess relationships between serostatus, sexual behaviors, and sociodemographic indicators. A sample of 1,520 MSM participants included study respondents (n = 308) and their network members (n = 1,212). Mixing based on serostatus (r = 0.12, σr = 0.09–0.15) and condomless sex (r = 0.11, σr = 0.07–0.14) was random. However, mixing based on sex-drug use was highly assortative (r = 0.37, σr = 0.32–0.42). This study represents the first analysis of Greek MSM sexual networks. Our findings highlight protective behavior in two distinct network typologies. The first typology mixed assortatively based on serostatus and sex-drug use and was less likely to engage in condomless sex. The second typology mixed randomly based on condomless sex but was less likely to engage in sex-drug use. These findings support the potential benefit of HIV prevention program scale-up for this population including but not limited to PrEP.
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Affiliation(s)
- Benjamin Bowman
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
| | - Mina Psichogyiou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martha Papadopoulou
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vana Sypsa
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aditya Khanna
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Samuel R. Friedman
- Institute for Infectious Disease Research, National Development & Research Institutes, New York, NY USA
- Department of Population Health, New York University Langone Medical School, New York, NY USA
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - John Schneider
- Pritzker School of Medicine, University of Chicago, Chicago, IL USA
- Department of Medicine, Infectious Diseases, University of Chicago, Chicago, IL USA
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16
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Khanna AS, Edali M, Ozik J, Collier N, Hotton A, Skwara A, Ardestani BM, Brewer R, Fujimoto K, Harawa N, Schneider JA. Projecting the number of new HIV infections to formulate the "Getting to Zero" strategy in Illinois, USA. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3922-3938. [PMID: 34198418 PMCID: PMC8281377 DOI: 10.3934/mbe.2021196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Getting to Zero (GTZ) initiatives focus on expanding use of antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) to eliminate new HIV infections. Computational models help inform policies for implementation of ART and PrEP continuums. Such models, however, vary in their design, and may yield inconsistent predictions. Using multiple approaches can help assess the consistency in results obtained from varied modeling frameworks, and can inform optimal implementation strategies. METHODS A study using three different modeling approaches is conducted. Two approaches use statistical time series analysis techniques that incorporate temporal HIV incidence data. A third approach uses stochastic stimulation, conducted using an agent-based network model (ABNM). All three approaches are used to project HIV incidence among a key population, young Black MSM (YBMSM), over the course of the GTZ implementation period (2016-2030). RESULTS All three approaches suggest that simultaneously increasing PrEP and ART uptake is likely to be more effective than increasing only one, but increasing ART and PrEP by 20% points may not eliminate new HIV infections among YBMSM. The results further suggest that a 20% increase in ART is likely to be more effective than a 20% increase in PrEP. All three methods consistently project that increasing ART and PrEP by 30% simultaneously can help reach GTZ goals. CONCLUSIONS Increasing PrEP and ART uptake by about 30% might be necessary to accomplish GTZ goals. Such scale-up may require addressing psychosocial and structural barriers to engagement in HIV and PrEP care continuums. ABNMs and other flexible modeling approaches can be extended to examine specific interventions that address these barriers and may provide important data to guide the successful intervention implementation.
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Affiliation(s)
- Aditya Subhash Khanna
- Center for Alcohol and Addiction Studies, Brown University, Providence RI USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence RI USA
| | - Mert Edali
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- Department of Industrial Engineering, Yildiz Technical University, Besiktas, Istanbul 34349, Turkey
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Abigail Skwara
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Babak Mahdavi Ardestani
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Nina Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University, Los Angeles, CA, USA
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - John A. Schneider
- Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
- Department of Medicine, The University of Chicago, Chicago, IL, USA
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17
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Algarin AB, Zhou Z, Canidate S, Gebru NM, Krieger JL, Neil JM, Cook RL, Ibañez GE. PrEP awareness among people living with HIV in Florida: Florida Cohort study. AIDS Care 2021; 33:428-433. [PMID: 31960703 PMCID: PMC7371495 DOI: 10.1080/09540121.2020.1717421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/09/2020] [Indexed: 02/02/2023]
Abstract
In 2017, Florida ranked 2nd nationally in prevalence and incidence rates of HIV infections in the United States. Due to the high burden of HIV and low viral suppression in Florida, it is of increased importance to study methods of HIV prevention such as preexposure prophylaxis(PrEP) in this state. Our study aimed to examine correlates of PrEP awareness among PLWH in Florida and describe patterns of PrEP awareness/information sources. Using data collected from the Florida Cohort study between 2014 and 2018, 530 PLWH answered items that were hypothesized to be correlated with PrEP awareness. Of our sample, 53.8% were aware of PrEP. Urban location of recruitment, sexual partner's use of PrEP, use of viral suppression as an HIV prevention strategy, and engagement in transactional sex were all significantly associated with higher odds of PrEP awareness. Care providers and HIV/AIDS support groups were the most frequently listed sources of PrEP awareness, sources of future PrEP information, and most trusted sources for PrEP information. Findings from this study could inform future interventions that aim to increase PrEP awareness among PLWH to increase PrEP awareness and uptake among their HIV-negative social and sexual networks.
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Affiliation(s)
- Angel B. Algarin
- Florida International University, Department of Epidemiology, 11200 SW 8th St., AHC5- 505, Miami, FL, 33199
| | - Zhi Zhou
- University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Shantrel Canidate
- University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Nioud Mulugeta Gebru
- University of Florida, Department of Health Education & Behavior, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Janice L. Krieger
- University of Florida, Department of Advertising, 1885 Stadium Rd, Gainesville, FL 32611
| | - Jordan M Neil
- Mongan Institute Health Policy Center, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114
| | - Robert L. Cook
- University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Gladys E. Ibañez
- Florida International University, Department of Epidemiology, 11200 SW 8th St., AHC5- 505, Miami, FL, 33199
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18
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Teixeira da Silva D, Bouris A, Ramachandran A, Blocker O, Davis B, Harris J, Pyra M, Rusie LK, Brewer R, Pagkas-Bather J, Hotton A, Ridgway JP, McNulty M, Bhatia R, Schneider JA. Embedding a Linkage to Preexposure Prophylaxis Care Intervention in Social Network Strategy and Partner Notification Services: Results From a Pilot Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 86:191-199. [PMID: 33109935 PMCID: PMC8103968 DOI: 10.1097/qai.0000000000002548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased preexposure prophylaxis (PrEP) uptake among black men who have sex with men and black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/ sexually transmitted infections testing may be an important strategy to accelerate PrEP uptake. SETTING Partner Services PrEP study is a pilot, randomized, control trial to improve linkage to PrEP care among BMSM/TW presenting for network services in Chicago, IL, from 2015 to 2017. METHODS BMSM/TW (N = 146) aged 18-40 years were recruited from network services (partners services and social network strategy services). Intervention participants developed an individualized linkage plan based on the information-motivation-behavioral skills model and received minibooster sessions. Control participants received treatment as usual. Sociodemographic, behavioral, and clinical factors were examined at baseline and 3- and 12-month postintervention. Intent-to-treat analyses examined linkage to PrEP care within 3-month postintervention (primary outcome). Secondary outcomes were PrEP initiation, time to linkage to PrEP care, and time to PrEP initiation. RESULTS Compared with control participants, a significantly greater proportion of the intervention participants were linked to PrEP care within 3 months (24% vs. 11%; P = 0.04) and initiated PrEP (24% vs. 11%; P = 0.05). Among those linked to PrEP care within the study period, intervention participants were linked significantly sooner than control participants [median (interquartile range) days, 26.5 (6.0-141.8) vs. 191.5 (21.5-297.0); P = 0.05]. CONCLUSION Study results support the preliminary efficacy of Partner Services PrEP to improve linkage to PrEP care and PrEP initiation among BMSM/TW.
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Affiliation(s)
- Daniel Teixeira da Silva
- Department of Combined Internal Medicine and Pediatrics, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | | | | | - Billy Davis
- Chicago Center for HIV Elimination, Chicago, IL
| | | | - Maria Pyra
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
| | | | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | - Jade Pagkas-Bather
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL
| | - Jessica P Ridgway
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | - Moira McNulty
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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19
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Pagkas-Bather J, Ozik J, Millett G, Schneider JA. The last Black man with HIV in San Francisco: the potential role of gentrification on HIV getting to zero achievements. Lancet HIV 2021; 7:e853-e856. [PMID: 33275918 DOI: 10.1016/s2352-3018(20)30250-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 01/02/2023]
Abstract
San Francisco was the first city in the USA to develop a Getting to Zero HIV elimination strategy. The cause of decreased HIV incidence has been attributed to the use of biomedical prevention methods, such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP). These strategies have benefitted White men who have sex with men (MSM), whose population has increased over the past decade. However, Black MSM in San Francisco continue to have higher HIV incidence and outmigration rates. We posit that the declining overall HIV incidence, including among White MSM, is not only explained by the use of TaSP and PrEP, but is also due to the declining Black population and rising HIV incidence among Black MSM, who have historically been more likely to acquire HIV due to structural, racial, and criminal justice-related factors than have White MSM.
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Affiliation(s)
- Jade Pagkas-Bather
- Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA; Argonne National Laboratory, Lemont, IL, USA
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA; Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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21
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Schneider JA, Young L, Ramachandran A, Michaels S, Cohen H, Robinson I, Alon L, Hill B, Nakasone S, Balenciaga M, Motley D, Bouris A, Khanna A, Ferreira M, Valente T, Schumm P. A Pragmatic Randomized Controlled Trial to Increase PrEP Uptake for HIV Prevention: 55-Week Results From PrEPChicago. J Acquir Immune Defic Syndr 2021; 86:31-37. [PMID: 33306562 PMCID: PMC7722461 DOI: 10.1097/qai.0000000000002518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We tested preliminary efficacy of a peer change agent type I network intervention to increase pre-exposure prophylaxis (PrEP) linkage to care among network members connected to young Black men who have sex with men. DESIGN Parent study is a pragmatic randomized controlled trial with 110 weeks of total follow-up. Interim midpoint analyses are performed here using participant data before crossover assignment at 55 weeks. METHODS We randomly assigned 423 participants in Chicago to receive the network intervention, an opinion leader workshop with telephonic booster sessions, versus a time-matched control from 2016 to 2018. The consolidated surrogate outcome was PrEP referral and linkage to clinical care among network members connected to study participants and was collected from independent administrative data. RESULTS Each study participant in the trial (n = 423) had on average 1822 network contacts who could be eligible for PrEP referral and linkage. During the 55-week observation period, PrEP referral was most likely to occur within 3 days of an intervention session compared to control [odds ratio (OR) 0.07 (0.02-0.013); P = 0.007] resulting in 1-2 referrals of network members per session. Network members with referral or linkage were more likely to be connected to study participants in the intervention arm than the control condition [aOR 1.50 (1.09-2.06); P = 0.012]. CONCLUSIONS A peer change agent type I network intervention is preliminarily effective at diffusing PrEP through a network of individuals highly susceptible to HIV over 55 weeks. This low-intensity intervention demonstrated network-level impact among populations that have experienced limited PrEP care engagement in the United States.
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Affiliation(s)
| | | | | | | | - Hildie Cohen
- NORC at the University of Chicago, Chicago, IL; and
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Walsh T, Schneider JA, Ardestani BM, Young LE. Individual and Social Network Structure Characteristics Associated with Peer Change Agent Engagement and Impact in a PrEP Intervention. AIDS Behav 2020; 24:3385-3394. [PMID: 32394233 DOI: 10.1007/s10461-020-02911-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Interventions that utilize the influence of peer change agents (PCAs) have been shown to be effective strategies for engaging key populations in HIV prevention. To date, little is known about the characteristics of PCAs associated with their effectiveness. Drawing on data from a peer leader PrEP intervention for young Black men who have sex with men (YBMSM) (N = 423), we evaluated the effects of experiential (i.e., living with HIV, PrEP awareness, PrEP use), psychographic (i.e., self-perceived leadership, innovativeness), and network (i.e., degree centrality, eigenvector centrality, and brokerage) characteristics on three effectiveness outcomes: (1) recruiting peers into the study; (2) completing "booster" sessions; and (3) linking peers to PrEP care. For each outcome, multivariable regressions were performed. On average, PCAs recruited 0.89 peers, completed 1.99 boosters, and had 1.33 network peers linked to PrEP care. Experiential factors: Prior PrEP awareness was positively associated with booster completion. Network factors: Being a network broker (i.e., connecting otherwise disconnected communities) was positively associated with peer recruitment but negatively associated with linking peers to PrEP, and degree centrality (i.e., the number of network connections someone has) and eigenvector centrality (i.e., being connected to well-connected network associates) were positively associated with linking peers to PrEP. Psychographic characteristics were not associated with any outcome. These findings can be used to inform PCA selection and to identify subpopulations who require additional support to excel as PCAs.
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23
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PrEP4Love: The Role of Messaging and Prevention Advocacy in PrEP Attitudes, Perceptions, and Uptake Among YMSM and Transgender Women. J Acquir Immune Defic Syndr 2020; 83:450-456. [PMID: 31939870 DOI: 10.1097/qai.0000000000002297] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite high efficacy, use of pre-exposure prophylaxis (PrEP) remains low among young men who have sex with men (MSM) and transgender women (TW), primarily because of barriers such as stigma and resource awareness. We evaluated a social marketing campaign known as PrEP4Love that works to eliminate PrEP stigma; and awareness gaps through targeted advertising. SETTING Chicago, Illinois. METHODS Participants were enrolled within a cohort study of young MSM and TW (RADAR). Data were collected between June 2017 and April 2018 from HIV-negative individuals attending a follow-up visit. Surveys assessed demographics, PrEP attitudes and perceptions, and PrEP4Love campaign awareness. Associations between PrEP4Love awareness and PrEP perceptions, uptake, and behaviors were assessed using multiple logistic regression controlling for age, race/ethnicity, gender, sexual identity, and ever having used PrEP. RESULTS Of 700 participants, the majority (75.9%) indicated seeing PrEP4Love ads in Chicago. Those who had seen ads were more likely to be out to their providers (odds ratio = 1.95; 95% confidence interval: 1.17 to 3.23) than those who had not, and those who had conversations were significantly more likely to have initiated the conversation themselves. Individuals who had seen ads were more likely to have taken PrEP in the last 6 months (odds ratio = 1.87; 95% confidence interval: 1.15 to 3.16) and more likely to believe their friends and the general public approved of and used PrEP. CONCLUSION Social marketing campaigns are promising interventions that have the potential to alleviate barriers to HIV prevention, particularly among MSM and TW. Future research should evaluate the impact of these initiatives at multiple time points.
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Skaathun B, Pho MT, Pollack HA, Friedman SR, McNulty MC, Friedman EE, Schmitt J, Pitrak D, Schneider JA. Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States. J Int AIDS Soc 2020; 23:e25554. [PMID: 33119195 PMCID: PMC7594703 DOI: 10.1002/jia2.25554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Incident HIV infections persist in the United States (U.S.) among marginalized populations. Targeted and cost-efficient testing strategies can help in reaching HIV elimination. This analysis compares the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. METHODS We performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men. All occurred at the same academic medical centre during the following times: routine testing, 2011 to 2016; MPS, 2013 to 2016; SN: 2013 to 2014. Costs were in 2016 dollars and included personnel, HIV testing, training, materials, overhead. Outcomes included cost per test, HIV-positive test and new diagnosis. Sensitivity analyses were performed to assess the impact of population demographics. RESULTS The RS programme completed 57,308 HIV tests resulting in 360 (0.6%) HIV-positive tests and 165 new HIV diagnoses (0.28%). The MPS completed 146 HIV tests, resulting in 79 (54%) HIV-positive tests and eight new HIV diagnoses (5%). The SN strategy completed 508 HIV tests, resulting in 210 (41%) HIV-positive tests and 37 new HIV diagnoses (7.2%). Labour accounted for the majority of costs in all strategies. The estimated cost per new HIV diagnosis was $16,773 for the RS programme, $61,418 for the MPS programme and $15,683 for the SN testing programme. These costs were reduced for the RS and MPS strategies in sensitivity analyses limiting testing efficacy to the highest prevalence patient populations ($2,841 and $33,233 respectively). CONCLUSIONS The SN strategy yielded the highest proportion of new diagnoses, followed closely by the MPS programme. Both the SN strategy and RS programme were comparable in the cost per new diagnosis. A simultaneous approach that consists of RS in combination with SN testing may be most effective for identifying new HIV infections in settings with heterogeneous epidemics with both high rates of HIV prevalence and HIV testing.
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Affiliation(s)
- Britt Skaathun
- Department of Infectious Diseases and Global Public HealthUniversity of CaliforniaSan DiegoCAUSA
- Department of Public Health SciencesUniversity of ChicagoChicagoILUSA
- Chicago Center for HIV EliminationChicagoILUSA
| | - Mai T Pho
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | - Harold A Pollack
- School of Social Service AdministrationUniversity of ChicagoChicagoILUSA
| | - Samuel R Friedman
- Department of Population HealthNew York University Medical SchoolNew YorkNYUSA
| | - Moira C McNulty
- Chicago Center for HIV EliminationChicagoILUSA
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | | | | | - David Pitrak
- Department of MedicineUniversity of ChicagoChicagoILUSA
| | - John A Schneider
- Department of Public Health SciencesUniversity of ChicagoChicagoILUSA
- Chicago Center for HIV EliminationChicagoILUSA
- Department of MedicineUniversity of ChicagoChicagoILUSA
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25
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Role of Social and Sexual Network Factors in PrEP Utilization Among YMSM and Transgender Women in Chicago. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:1089-1097. [PMID: 30712223 DOI: 10.1007/s11121-019-00995-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite demonstrated efficacy, uptake of HIV pre-exposure prophylaxis (PrEP) remains low, particularly among high-risk demographics such as transgender women, Black men who have sex with men (BMSM), and young MSM (YMSM). Research thus far has largely focused on individual factors that may impede PrEP uptake in these demographics, leaving social network factors relatively unexplored. The present study used data collected from participants within RADAR, a longitudinal cohort study in Chicago focused on understanding the individual, dyadic, network, social, and biologic factors associated with HIV infection within YMSM. Of the 906 study participants who did not report an HIV diagnosis at baseline, 7.0% reported using PrEP in the prior 6 months. Recent PrEP use was associated with both individual-level (age and gender) and network-level factors (mean relationship strength, sexual network degree, etc.). These findings highlight the need to expand beyond focusing on individual-level drivers of PrEP uptake, as well as changing our understanding of who is most important within a network (centrality vs. strength of weak ties). Future work is needed to determine whether variables associated with PrEP uptake are similarly connected to PrEP adherence.
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Quinn KG, Christenson E, Spector A, Amirkhanian Y, Kelly JA. The Influence of Peers on PrEP Perceptions and Use Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men: A Qualitative Examination. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2129-2143. [PMID: 32016815 PMCID: PMC7321862 DOI: 10.1007/s10508-019-01593-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 05/12/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising part of HIV prevention, yet racial disparities in PrEP uptake persist. Evidence indicates that Black gay, bisexual, and other men who have sex with men (GBM) face numerous social and structural barriers to PrEP, including stigma, medical mistrust, and exclusion from the healthcare system. However, little research has examined how social networks can influence PrEP use and help Black GBM overcome these identified barriers. To understand the influence of peers and social networks on Black GBM's perceptions of and decisions about PrEP use, we conducted in-depth interviews with 46 Black GBM in Milwaukee, WI and Cleveland, OH. Data were analyzed using multistage inductive coding and thematic content analysis, using MAXQDA software. Results indicate that participants' primary source of information on PrEP was other Black GBM in their communities. Peers and social networks served three primary functions with regard to PrEP: (1) filling informational gaps left by healthcare providers, (2) increasing trust of PrEP, and (3) reducing PrEP stigma. Participants described the "movers and shakers" in Black LGBT communities who have been influential in educating others and advocating for PrEP. Well-respected vocal advocates for PrEP have emerged in the Black LGBT community as PrEP champions who have successfully influenced young Black GBM's views on PrEP. Our results reveal the role social networks and peer groups can play in increasing PrEP use among Black GBM. Social network interventions may help overcome the stigma and mistrust that are contributing to PrEP disparities.
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Affiliation(s)
- Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA.
| | - Erika Christenson
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Antoinette Spector
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yuri Amirkhanian
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Jeffrey A Kelly
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
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Nguyen AC, Young LE, Beymer MR, Suen SC. Developing targeted HIV risk predictors for young black men who have sex with men: a two-city comparative study. Int J STD AIDS 2020; 31:335-344. [PMID: 32089091 DOI: 10.1177/0956462419886472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV burden in the United States is geographically and demographically heterogeneous. While efforts over the last few decades have reduced HIV incidence, young black men who have sex with men (YBMSM) account for a significant portion of new HIV diagnoses compared to any other race and age group. The Centers for Disease Control and Prevention has allocated funding to help reduce HIV in the YBMSM community; however, their recommended screening/treatment criteria do not emphasize demographic specificity. To better guide more applicable screening guidelines specifically for YBMSM, we examine demographic, behavioral, sexual network, and biological predictors of HIV status among YBMSM in two demographically distinct cities with high HIV burden in the United States: Chicago, IL and Los Angeles, CA. We perform multivariable logistic regressions to identify predictors of HIV in these populations. We found that having a history of syphilis was the only statistically significant predictor across both cities despite inclusion of other characteristics previously shown to be associated with HIV among YBMSM. Syphilis history could be a powerful HIV risk indicator for YBMSM and, therefore, should be integrated into clinical screening practices for critical biomedical prevention options like HIV pre-exposure prophylaxis.
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Affiliation(s)
- Anthony C Nguyen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Lindsay E Young
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Matthew R Beymer
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
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Adherence to PrEP Among Young Men Who Have Sex With Men Participating in a Sexual Health Services Demonstration Project in Alameda County, California. J Acquir Immune Defic Syndr 2020; 81:406-413. [PMID: 30973542 DOI: 10.1097/qai.0000000000002051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Young men of color who have sex with men face a continual increase in rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an important prevention method for these young men. SETTING The Connecting Resources for Urban Sexual Health (CRUSH) demonstration project provided sexual health services, including PrEP, to young men who have sex with men aged 18-29 years. We report on adherence and factors influencing it. METHODS Participants were offered HIV and sexually transmitted infection testing, prevention counseling, PrEP, and when appropriate, sexually transmitted infection treatment and postexposure prophylaxis. Participants taking PrEP had erythrocyte tenofovir diphosphate and emtricitabine levels measured through dried blood spot testing at 4, 12, and 24 weeks to estimate medication adherence. Participants also completed surveys to assess demographic and psychosocial measures. RESULTS From February 2014 to November 2015, CRUSH enrolled 257 participants. Ninety-three percent started PrEP, 81% of whom initiated it at their first visit. Twelve percent required postexposure prophylaxis before starting PrEP. Adherence at protective levels was initially high with 87% demonstrating levels consistent with at least 4 doses per week at week 4, compared with 77% at the 48-week follow-up. African American race, exposure to violence, and having survival needs were associated with significantly lower levels of adherence [odds ratio (OR): 0.33; confidence interval (CI): 0.11 to 0.97, P < 0.04; OR: 0.79; CI: 0.59 to 1.04, P < 0.10; OR: 0.51; CI: 0.24 to 1.05, P < 0.07]. CONCLUSIONS Most young men who initiate PrEP adhere at levels that confer protection against HIV infection. Interventions should account for differences in life experiences, particularly addressing the structural challenges facing young African American men.
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Macapagal K, Kraus A, Korpak AK, Jozsa K, Moskowitz DA. PrEP Awareness, Uptake, Barriers, and Correlates Among Adolescents Assigned Male at Birth Who Have Sex with Males in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:113-124. [PMID: 31602584 PMCID: PMC7263631 DOI: 10.1007/s10508-019-1429-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 05/26/2023]
Abstract
In May 2018, the US Food and Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for adolescents under age 18. Although this is an important step toward HIV prevention for adolescents assigned male at birth who have sex with males (AMSM), limited research exists to gauge their awareness of PrEP as a prevention option. Additionally, the attitudes and perceived barriers regarding PrEP among this population have not been well studied. We conducted an online survey from February to April 2018, in which 219 AMSM age 15-17 read a description of PrEP, and then answered questions about PrEP awareness, perceived barriers, and demographic and behavioral correlates. A slight majority (54.8%) had heard of PrEP before, and 56.1% did not know how they would access PrEP. Of those who had heard of PrEP, 2.5% had ever used it. Most had first learned about PrEP online, through media or geosocial networking (GSN) applications to meet male partners. Those who had heard of PrEP were more likely to be older, to have used GSN applications, and to have greater HIV knowledge. Not knowing how to access PrEP was predicted by having had more partners, lower HIV knowledge, and never having talked to a provider about PrEP. Believing that one could not afford PrEP was predicted by greater perceived risk of HIV. Findings suggest moderate awareness of PrEP among AMSM, that youth at greater risk of HIV may perceive greater barriers, and that online spaces can play a significant role in increasing PrEP knowledge and reducing implementation barriers.
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Affiliation(s)
- Kathryn Macapagal
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA.
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA.
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ashley Kraus
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Aaron K Korpak
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Kyle Jozsa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David A Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, Suite 1400, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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Zarwell M, Ransome Y, Barak N, Gruber D, Robinson WT. PrEP indicators, social capital and social group memberships among gay, bisexual and other men who have sex with men. CULTURE, HEALTH & SEXUALITY 2019; 21:1349-1366. [PMID: 30724712 PMCID: PMC6684860 DOI: 10.1080/13691058.2018.1563912] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/23/2018] [Indexed: 05/25/2023]
Abstract
Efforts to reduce HIV among gay, bisexual and other men who have sex with men include increasing awareness and uptake of pre-exposure prophylaxis (PrEP). Social capital may facilitate engagement in HIV prevention. Membership of social groups including chosen families (i.e. friends as family relationships) - one potential indicator of social capital - may be protective against HIV risk and infection. In this cross-sectional quantitative study, we examined social capital items and social group membership in association with PrEP outcomes. In 2014, the New Orleans arm of the National HIV Behavioral Surveillance recruited 353 HIV-negative men, of whom 46% identified as Black, Latino or Other Race and 54% as Non-Hispanic White, using venue-based sampling to complete a structured survey. Multivariable logistic regression models tested the relations between social group membership and social capital with PrEP indicators. Men who reported community group participation were more likely to be aware of PrEP compared to those who did not. Men in chosen families associated with a family name were least likely to be aware of and willing to take PrEP compared to those not in any other social groups. Social group membership is a potential social capital indicator for assessing HIV prevention among men.
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Affiliation(s)
- Meagan Zarwell
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Narquis Barak
- NO/AIDS Task Force d.b.a CrescentCare Health, New Orleans, LA, USA
| | - DeAnn Gruber
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- STD/HIV Program, Louisiana Office of Public Health, New Orleans, LA, USA
| | - William T. Robinson
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- STD/HIV Program, Louisiana Office of Public Health, New Orleans, LA, USA
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Khanna AS, Schneider JA, Collier N, Ozik J, Issema R, di Paola A, Skwara A, Ramachandran A, Webb J, Brewer R, Cunningham W, Hilliard C, Ramani S, Fujimoto K, Harawa N. A modeling framework to inform preexposure prophylaxis initiation and retention scale-up in the context of 'Getting to Zero' initiatives. AIDS 2019; 33:1911-1922. [PMID: 31490212 PMCID: PMC6760326 DOI: 10.1097/qad.0000000000002290] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE(S) 'Getting to Zero' (GTZ) initiatives aim to eliminate new HIV infections over a projected time frame. Increased preexposure prophylaxis (PrEP) uptake among populations with the highest HIV incidence, such as young Black MSM, is necessary to accomplish this aim. Agent-based network models (ABNMs) can help guide policymakers on strategies to increase PrEP uptake. DESIGN Effective PrEP implementation requires a model that incorporates the dynamics of interventions and dynamic feedbacks across multiple levels including virus, host, behavior, networks, and population. ABNMs are a powerful tool to incorporate these processes. METHODS An ABNM, designed for and parameterized using data for young Black MSM in Illinois, was used to compare the impact of PrEP initiation and retention interventions on HIV incidence after 10 years, consistent with GTZ timelines. Initiation interventions selected individuals in serodiscordant partnerships, or in critical sexual network positions, and compared with a controlled setting where PrEP initiators were randomly selected. Retention interventions increased the mean duration of PrEP use. A combination intervention modeled concurrent increases in PrEP initiation and retention. RESULTS Selecting HIV-negative individuals for PrEP initiation in serodiscordant partnerships resulted in the largest HIV incidence declines, relative to other interventions. For a given PrEP uptake level, distributing effort between increasing PrEP initiation and retention in combination was approximately as effective as increasing only one exclusively. CONCLUSION Simulation results indicate that expanded PrEP interventions alone may not accomplish GTZ goals within a decade, and integrated scale-up of PrEP, antiretroviral therapy, and other interventions might be necessary.
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Affiliation(s)
| | | | - Nicholson Collier
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois
| | - Rodal Issema
- Chicago Center for HIV Elimination
- Department of Medicine
| | - Angela di Paola
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Abigail Skwara
- Chicago Center for HIV Elimination
- Department of Medicine
| | | | - Jeannette Webb
- Chicago Center for HIV Elimination
- Department of Medicine
| | - Russell Brewer
- Chicago Center for HIV Elimination
- Department of Medicine
| | - William Cunningham
- Department of Health Policy and Management, University of California, Los Angeles
| | - Charles Hilliard
- Department of Psychiatry and Human Behavior, Charles R. Drew University
| | | | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Nina Harawa
- Department of Psychiatry and Human Behavior, Charles R. Drew University
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, California, USA
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Young LE, Fujimoto K, Alon L, Zhang L, Schneider JA. The multiplex social environments of young Black men who have sex with men: How online and offline social structures impact HIV prevention and sex behavior engagement. JOURNAL OF SOCIAL STRUCTURE : JOSS 2019; 20:70-95. [PMID: 32855626 PMCID: PMC7449318 DOI: 10.21307/joss-2019-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
In the United States, young Black men who have sex with men (YBMSM) remain disproportionately affected by HIV. The social networks in which YBMSM are embedded are generally understood to be critical factors in understanding their vulnerability. In this study, we acknowledge the relational richness of YBMSMs' social environments (what we define as multiplexity) and their increasing prioritization of online social networking sites (SNS). Specifically, we investigate whether protective and/or risky features of YBMSMs' Facebook friendships and group affiliations are related to their HIV prevention and sex behavior engagement, while also accounting for features of their offline confidant (or support) and sex networks. Using data from a population-based cohort study of YBMSM living in Chicago (N=268), we perform a series of multiple logistic regression analyses to examine associations between features of YBMSMs' Facebook, confidant, and sexual networks with three prevention outcomes and three sex behavior outcomes, while also controlling for factors at the individual and structural levels. Results show that network features play a more significant role in predicting engagement in sex behaviors than prevention behaviors. Specifically, having more confidants, having confidants who are family members, meeting sex partners online, having more YBMSM Facebook friends, belonging to Facebook groups with an LGBTQ focus, and having greater subject diversity in one's Facebook group affiliations were significantly associated with one or more sex behavior outcomes. We conclude with a discussion of the implications of our findings for HIV prevention intervention efforts.
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Affiliation(s)
- Lindsay E Young
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Leigh Alon
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Liang Zhang
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Schueler K, Ferreira M, Nikolopoulos G, Skaathun B, Paraskevis D, Hatzakis A, Friedman SR, Schneider JA. Pre-exposure Prophylaxis (PrEP) Awareness and Use Within High HIV Transmission Networks. AIDS Behav 2019; 23:1893-1903. [PMID: 30706217 PMCID: PMC6800107 DOI: 10.1007/s10461-019-02411-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Improved implementation of pre-exposure prophylaxis (PrEP) should be a valuable tool within communities experiencing high HIV incidence, such as black men who have sex with men (MSM). Using baseline data from the Chicago arm of the Transmission Reduction Intervention Project (TRIP), we examined awareness and use of PrEP within HIV potential transmission networks. Transmission Reduction Intervention Project recruited participants ages 18-69 (N = 218) during 2014-2016 from networks originating from recently and chronically HIV-infected MSM and transgender persons. In total, 53.2% of participants had heard of PrEP, while 8 (6.5%) HIV-negative participants reported ever using PrEP. In multivariable regression, PrEP awareness was associated with identifying as gay, attending some college or higher, having an HIV test in the previous 6 months, and experiencing HIV-related social support. PrEP awareness was not associated with experiencing or observing HIV-related stigma. PrEP use was associated with participants knowing two or more other PrEP-users. These findings demonstrate moderate awareness, but low uptake of PrEP within HIV potential transmission networks in Chicago. Future research should explore how to increase PrEP use in these networks and investigate the social dynamics behind our finding that PrEP users are more likely to know other PrEP users.
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Affiliation(s)
- Kellie Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Suite 104, Chicago, IL, 60637, USA
| | - Matthew Ferreira
- Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA
| | | | - Britt Skaathun
- Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel R Friedman
- National Development and Research Institutes, New York City, NY, USA
| | - John A Schneider
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Suite 104, Chicago, IL, 60637, USA.
- Chicago Center for HIV Elimination, University of Chicago, 5841 S Maryland Ave, MC5065, Chicago, IL, 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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Li J, Berg CJ, Kramer MR, Haardörfer R, Zlotorzynska M, Sanchez TH. An Integrated Examination of County- and Individual-Level Factors in Relation to HIV Pre-exposure Prophylaxis Awareness, Willingness to Use, and Uptake Among Men Who Have Sex with Men in the US. AIDS Behav 2019; 23:1721-1736. [PMID: 30430340 DOI: 10.1007/s10461-018-2334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study explored the extent to which county- and individual-level factors were associated with awareness, willingness to use, and use of pre-exposure prophylaxis (PrEP) among US men who have sex with men (MSM). We conducted multilevel analyses using a sample of 8338 MSM residing in 1257 US counties drawn from the 2014-2015 American Men's Internet Survey to examine these associations, with focuses on variation in PrEP outcomes across counties and proportion variation explained by county-level factors (HIV prevalence, racial composition, median household income, income inequality, health insurance coverage). Results showed that PrEP awareness varied moderately across counties (intraclass correlation coefficients [ICC] = 7.7%), willingness to use did not vary; however, the actual use varied substantially (ICC = 20.7%). Half of the variation in awareness and use was explained by county-level factors. Higher median household income was associated with greater likelihood of awareness and use. Higher income inequality was associated with greater likelihood of PrEP awareness. Findings can inform the development of multilevel interventions to address PrEP uptake among MSM and identify communities where structural intervention is most needed.
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Affiliation(s)
- Jingjing Li
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, USA
- Department of Epidemiology, School of Health Sciences, Wuhan University, Luojiashan, Wuhan, Hubei, People's Republic of China
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, USA
| | - Michael R Kramer
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, USA
| | - Maria Zlotorzynska
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Travis H Sanchez
- Department of Epidemiology, Emory University School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
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Dubin S, Goedel WC, Park SH, Hambrick HR, Schneider JA, Duncan DT. Perceived Candidacy for Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men in Paris, France. AIDS Behav 2019; 23:1771-1779. [PMID: 30250992 DOI: 10.1007/s10461-018-2279-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34-2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07-1.50, aRR 1.32; 95% CI 1.13-1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21-4.16, aRRR 2.58; 95% CI 1.09-6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03-0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions.
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Fujimoto K, Wang P, Flash CA, Kuhns LM, Zhao Y, Amith M, Schneider JA. Network Modeling of PrEP Uptake on Referral Networks and Health Venue Utilization Among Young Men Who Have Sex with Men. AIDS Behav 2019; 23:1698-1707. [PMID: 30430341 DOI: 10.1007/s10461-018-2327-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study is to identify individual-level factors and health venue utilization patterns associated with uptake of pre-exposure prophylaxis (PrEP) and to evaluate whether PrEP uptake behavior is further diffused among young men who have sex with men (YMSM) through health venue referral networks. A sample of 543 HIV-seronegative YMSM aged 16-29 were recruited in 2014-2016 in Chicago, IL, and Houston, TX. Stochastic social network models were estimated to model PrEP uptake. PrEP uptake was associated with more utilization of health venues in Houston and higher levels of sexual risk behavior in Chicago. In Houston, both Hispanic and Black YMSM compared to White YMSM were less likely to take PrEP. No evidence was found to support the spread of PrEP uptake via referral networks, which highlights the need for more effective PrEP referral network systems to scale up PrEP implementation among at-risk YMSM.
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Affiliation(s)
- Kayo Fujimoto
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX, 77030-5401, USA.
| | - Peng Wang
- Faculty of Business and Law, Centre for Transformative Innovation, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Charlene A Flash
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, BCM 285, Houston, TX, 77030, USA
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Department of Pediatrics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, and Northwestern University, 225 E. Chicago Avenue, #161, Chicago, IL, 60611, USA
| | - Yucheng Zhao
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX, 77030-5401, USA
| | - Muhammad Amith
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St Suite 600, Houston, TX, 77030, USA
| | - John A Schneider
- Departments of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue MC 5065, Chicago, IL, 60637, USA
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Duncan DT, Hickson DA, Goedel WC, Callander D, Brooks B, Chen YT, Hanson H, Eavou R, Khanna AS, Chaix B, Regan SD, Wheeler DP, Mayer KH, Safren SA, Carr Melvin S, Draper C, Magee-Jackson V, Brewer R, Schneider JA. The Social Context of HIV Prevention and Care among Black Men Who Have Sex with Men in Three U.S. Cities: The Neighborhoods and Networks (N2) Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1922. [PMID: 31151275 PMCID: PMC6603520 DOI: 10.3390/ijerph16111922] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
Background: In many parts of the world, stark racial disparities in human immunodeficiency virus (HIV) prevalence, incidence, prevention, and care outcomes persist among gay, bisexual, and other men who have sex with men (MSM), with Black MSM significantly impacted in the United States (U.S.). Individual-level characteristics, including sexual behaviors and socioeconomic status, do not fully account for racial/ethnic disparities in HIV among MSM. We hypothesize that neighborhood contexts and network characteristics influence risk for HIV infection as well as HIV-related prevention and care behaviors. As such, the study design includes the use of real-time geospatial methods and in-depth assessments of multiple network typologies to investigate the impact of neighborhood and network-level factors on HIV prevention and treatment among Black MSM residing in longstanding priority HIV elimination areas in the U.S., namely Chicago, Illinois and in the Deep South (Jackson, Mississippi and New Orleans, Louisiana) (n = 450, n = 50, and n = 100, respectively). We describe the design, sampling methods, data collection, data management methods, and preliminary findings of the ongoing 'Neighborhoods and Networks (N2) Cohort Study'. Methods/Design: N2 employs a prospective longitudinal design. The sample includes Black MSM participants in Chicago recruited via respondent-driven sampling and assessed every six months over two years of follow-up. Participants enrolled in Jackson and New Orleans are being recruited through existing health and community services and assessed every six months over one year of follow-up. Mobility within and between neighborhoods is being assessed using global positioning system (GPS) technology. Social and sexual networks among Black MSM are being studied through egocentric network inventories as well as newer methods of creating meso-level networks that involve social media (Facebook) and mobile phone contacts. Key HIV prevention outcomes such as pre-exposure prophylaxis (PrEP) care engagement, and HIV/STI (sexually transmitted infections) biomarkers will be examined at baseline and follow-up. Results: As of 31 December 2018, a total of 361 men were enrolled across all study sites: 259 in Chicago and 102 in the Deep South (75 in New Orleans and 27 in Jackson). At baseline, participants ranged in age from 17 to 65 years old (mean = 34.3, standard deviation = 5.1) with 123 men (34.1%) self-reported as HIV positive. While HIV treatment levels were similar between sites, men in the Deep South reported higher rates of adherence than men in Chicago (63.3% versus 49.4%, p = 0.03). Sexual risk profiles were mainly the same between men from different study sites, with 22.9% of men in Chicago and 28.9% in the Deep South reporting consistent condom use during vaginal and anal sex (p = 0.26). Regarding their home neighborhoods, men in the Deep South were more likely than those in Chicago to characterize theirs as having a good reputation (43.1% versus 24.7%, p < 0.001) and as being safe (37.3% versus 21.2%, p = 0.002). Conclusions: The focus on Black MSM in the N2 Study will allow for a nuanced exploration of the attitudes, beliefs, behaviors, and practices of a diverse group of Black MSM. The study is also positioned to provide novel insight about neighborhood and network characteristics that influence HIV-related behaviors. A health equity framework ensures that Black MSM are not explicitly or implicitly deemed as deviant, disordered, or the non-reference group. Findings from N2 will provide guidance for the implementation of more impactful HIV prevention interventions that engage a diverse population of Black MSM as we work toward HIV elimination in the U.S.
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Affiliation(s)
- Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - DeMarc A Hickson
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
- Us Helping Us, People Into Living, Inc., Washington, DC 20010, USA.
| | - William C Goedel
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Denton Callander
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Brandon Brooks
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | - Yen-Tyng Chen
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Hillary Hanson
- Survey Lab, University of Chicago, Chicago, IL 60637, USA.
| | - Rebecca Eavou
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - Aditya S Khanna
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
| | - Basile Chaix
- Pierre-Louis Institute of Epidemiology Public Health (UMR-S 1136), Faculté de Médecine Saint-Antoine, Sorbonne Universités, 75012 Paris, France.
| | - Seann D Regan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, NY 10016, USA.
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Steven A Safren
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
| | - Sandra Carr Melvin
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | - Cordarian Draper
- Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc., Jackson, MS 39202, USA.
| | | | - Russell Brewer
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL 60637, USA.
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA.
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Chen YT, Kolak M, Duncan DT, Schumm P, Michaels S, Fujimoto K, Schneider JA. Neighbourhoods, networks and pre-exposure prophylaxis awareness: a multilevel analysis of a sample of young black men who have sex with men. Sex Transm Infect 2019; 95:228-235. [PMID: 30518619 DOI: 10.1136/sextrans-2018-053639] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/17/2018] [Accepted: 10/28/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Young black men who have sex with men (YBMSM) in the USA represent a subgroup that has the highest HIV incidence among the overall population. In the USA, pre-exposure prophylaxis (PrEP) is an effective prevention intervention to prevent HIV acquisition when taken regularly. Neighbourhood and network factors may relate to PrEP awareness, but have not been studied in YBMSM. This study aimed to examine the relationship of neighbourhood and network characteristics with PrEP awareness among YBMSM. METHODS We used data collected from a sample of 618 YBMSM in Chicago (2013-2014). Home addresses were collected for participants and enumerated network members. Administrative data (eg, 2014 American Community Survey, Chicago Department of Public Health) were used to describe residence characteristics. Network member characteristics were also collected (eg, sexual partners' sex-drug use, confidant network members who were also MSM). Multilevel analysis was performed to examine the relationships of neighbourhood and network characteristics to PrEP awareness. RESULTS Higher neighbourhood-level educational attainment (adjusted odds ratio (aOR) 1.02, p=0.03) and greater primary care density (aOR 1.38, p=0.01) were associated with greater PrEP awareness; greater neighbourhood alcohol outlet density (aOR 0.52, p=0.004) was associated with less PrEP awareness. Sexual network members residing in the same neighbourhood as the participants (aOR 2.58, p=0.03) and discussions around avoiding HIV acquisition with confidants (aOR 2.26, p=0.04) were associated with greater PrEP awareness. CONCLUSIONS The results suggest that neighbourhood and network characteristics can influence PrEP awareness in YBMSM. Additional studies are needed to understand the influences of neighbourhood (eg, MSM serving venues) and network (eg, peer to peer communication) characteristics on dissemination of PrEP information, uptake and adherence and the related mechanisms behind the associations.
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Affiliation(s)
- Yen-Tyng Chen
- Chicago Center for HIV Elimination, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, Illinois, USA
| | - Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, School of Medicine, New York University, New York City, New York, USA
| | - Phil Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Dubov A, Ogunbajo A, Altice FL, Fraenkel L. Optimizing access to PrEP based on MSM preferences: results of a discrete choice experiment. AIDS Care 2019; 31:545-553. [PMID: 30554519 PMCID: PMC6408226 DOI: 10.1080/09540121.2018.1557590] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/03/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP uptake remains low among men who have sex with men (MSM), the population bearing the highest HIV burden in the U.S. OBJECTIVES To elicit MSM stakeholder preferences in order to inform program development aimed at improving uptake of PrEP. METHODS 554 MSM were recruited through social networking applications to complete a stated preference [choice-based conjoint (CBC)] survey. Respondents completed 14 choice tasks presenting experimentally varied combinations of five attributes related to PrEP administration (dosing frequency, dispensing venue, prescription practices, adherence support, and costs). Latent class analysis was used to estimate the relative importance of each attribute and preferences across seven possible PrEP delivery programs. RESULTS Preferences clustered into five groups. PrEP affordability was the most influential attribute across groups, followed by dosing strategy. Only one group liked daily and on-demand PrEP equally (n = 74) while the other four groups disliked the on-demand intermittent option. Monthly injectable PrEP is preferred by two (n = 210) out of the five groups, including young MSM. Two groups (n = 267) were willing to take PrEP across all the hypothetical programs. One group (n = 183) almost exclusively considered costs in their decision-making. Participants in the most racially diverse among groups (n = 88) had a very low level of interest in PrEP initiation. CONCLUSION Our data suggest that PrEP uptake will be maximized by making daily PrEP affordable to MSM and streamlining PrEP consultation visits for young MSM. Young MSM should be prioritized for injectable PrEP when it becomes available. A successful PrEP program will spend resources on removing structural barriers to PrEP access and educating MSM of color, and will emphasize protection of privacy to maximize uptake among rural/suburban MSM.
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Affiliation(s)
- Alex Dubov
- Yale Center for Interdisciplinary Research on AIDS, 135 College Street, Suite 200, New Haven, CT, 06510-2483, Phone: (404)914-7231,
| | - Adedotun Ogunbajo
- Yale University School of Public Health, Department of Social and Behavioral Sciences, 60 College Street, New Haven, CT 06510,
| | - Frederick L. Altice
- Director of Clinical and Community Research, Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283, Phone: (203)737-2883,
| | - Liana Fraenkel
- Yale University School of Medicine, Section of Rheumatology, PO Box 208031, 300 Cedar Street, TAC Bldg., New Haven, CT 06520-8031, Phone: (203) 932-5711 ×5914,
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Skaathun B, Voisin DR, Cornwell B, Lauderdale DS, Schneider JA. A Longitudinal Examination of Factors Associated with Network Bridging Among YMSM: Implications for HIV Prevention. AIDS Behav 2019; 23:1326-1338. [PMID: 30136156 PMCID: PMC6386635 DOI: 10.1007/s10461-018-2258-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Social-environmental factors may be associated with social network stability, which has implications for HIV acquisition. However, the link between social-environmental factors, network composition and HIV risk has not been examined previously among a city-population based sample of young Black men who have sex with Men (YBMSM). Respondent driven sampling was used to recruit a cohort of 618 YMBSM. Respondents were evaluated at baseline, 9 and 18 months beginning June 2013. A logistic regression model was used to assess the relationship between bridging (i.e. having non-redundant contacts in one's network, indicating network instability) and social-environmental factors and HIV risk factors between respondents, and a conditional logit model was used to assess these relationships within respondents over time. Bridging was associated with adverse social-environmental factors and higher HIV risk, indicating that bridging may be on the explanatory pathway. Future studies should assess the extent to which network stability factors mitigate HIV risk.
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Affiliation(s)
- Britt Skaathun
- Department of Medicine, University of California-San Diego, San Diego, CA, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
- University of California, San Diego, 9500 Gillman Dr., La Jolla, CA, 92093-0507, USA.
| | - Dexter R Voisin
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
| | | | - Diane S Lauderdale
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
- STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA
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Jaiswal J, Griffin M, Singer SN, Greene RE, Acosta ILZ, Kaudeyr SK, Kapadia F, Halkitis PN. Structural Barriers to Pre-exposure Prophylaxis Use Among Young Sexual Minority Men: The P18 Cohort Study. Curr HIV Res 2019; 16:237-249. [PMID: 30062970 DOI: 10.2174/1570162x16666180730144455] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. METHOD Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. RESULTS While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. CONCLUSION Paying for PrEP and talking to one's provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.
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Affiliation(s)
- Jessica Jaiswal
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY 10012, United States.,Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT 06510, United States
| | - Marybec Griffin
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY 10012, United States
| | - Stuart N Singer
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, United States
| | - Richard E Greene
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, United States
| | - Ingrid Lizette Zambrano Acosta
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States
| | - Saara K Kaudeyr
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States
| | - Farzana Kapadia
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Department of Epidemiology, College of Global Public Health, New York University, 719 Broadway, 10th floor, New York NY 10003, United States.,Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY 10016, United States
| | - Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, United States.,Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West Piscataway, NJ 08854, United States.,Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway Township, NJ 08854, United States.,School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ 08102, United States
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Mannheimer S, Hirsch-Moverman Y, Franks J, Loquere A, Hughes JP, Li M, Amico KR, Grant RM. Factors Associated With Sex-Related Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men in New York City in HPTN 067. J Acquir Immune Defic Syndr 2019; 80:551-558. [PMID: 30865051 PMCID: PMC6417801 DOI: 10.1097/qai.0000000000001965] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND HPTN 067 assessed the feasibility of daily and non-daily dosing of open-label emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based pre-exposure prophylaxis (PrEP). METHODS Factors associated with sex-related PrEP adherence were assessed among men who have sex with men (MSM) randomized to one of 3 PrEP dosing arms in HPTN 067 in New York City. Sex-related PrEP adherence was defined per protocol as at least 1 PrEP tablet taken within 4 days pre-sex and at least 1 additional PrEP tablet taken within 24 hours post-sex, assessed via electronic drug monitoring and weekly interviews. Demographic data and behavioral measures were evaluated for association with sex-related PrEP adherence. Logistic regression for clustered data was used to estimate the unadjusted and adjusted odds ratios. RESULTS Of 176 randomized MSM participants, 59% were Black, 10% White, 25% Hispanic, and 6% other; median age was 31 years. In the multivariable analyses, higher sex-related PrEP adherence was significantly associated with daily dosing arm, older age, employment, and higher PrEP adherence behavioral skills. Lower sex-related PrEP adherence was significantly associated with identifying as Black or Hispanic (compared with White), opiate use, and reporting "I forgot" as an adherence barrier. CONCLUSIONS This analysis identified populations of MSM who might benefit from additional support to optimize PrEP adherence, including those who are younger, unemployed, or opiate users. MSM with lower PrEP behavioral skills may benefit from targeted interventions. Further study is needed to assess racial and ethnic disparities in PrEP adherence, which may reflect broader social and economic inequalities not captured in this study.
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Affiliation(s)
- Sharon Mannheimer
- Department of Epidemiology, ICAP, Mailman School of Public Health, Columbia University, New York City Health + Hospitals/Harlem, New York, NY
| | | | - Julie Franks
- ICAP, Mailman School of Public Health, Columbia University, New York, NY
| | - Avelino Loquere
- ICAP, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; and
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43
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Jenness SM, Maloney KM, Smith DK, Hoover KW, Goodreau SM, Rosenberg ES, Weiss KM, Liu AY, Rao DW, Sullivan PS. Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States. Am J Epidemiol 2019; 188:743-752. [PMID: 30312365 DOI: 10.1093/aje/kwy230] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
The potential for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States might be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (BMSM and WMSM) in the Atlanta, Georgia, area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could affect HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (hazard ratio = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (hazard ratio = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.
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Affiliation(s)
- Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dawn K Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Albany, New York
| | - Kevin M Weiss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Darcy W Rao
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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44
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Barriers to HIV pre-exposure prophylaxis among African, Caribbean and Black men in Toronto, Canada. PLoS One 2019; 14:e0213740. [PMID: 30925582 PMCID: PMC6440797 DOI: 10.1371/journal.pone.0213740] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/27/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction Single-tablet combination emtricitabine/tenofovir is highly effective as HIV pre-exposure prophylaxis (PrEP). Scale-up efforts have targeted men who have sex with men (MSM), but patterns of racial disparities in PrEP use have begun to emerge. African, Caribbean and Black (ACB) communities in Canada and USA are also disproportionately affected by HIV, and there is lack of guidance regarding PrEP implementation in this priority population. Methods ACB men from Toronto, Canada were recruited in community settings by peers. Participants completed a detailed socio-behavioural questionnaire. Biological samples were collected and tested for sexually transmitted infections. Willingness to accept PrEP was assessed in relation to actual and self-perceived risk of acquiring HIV, as well as demographic and behavioural variables. Results 424 ACB men were included in the analysis. ACB MSM were more likely to accept PrEP than ACB men only reporting sex with women (MSW; 50.0% vs. 23.6%). The most common reasons for PrEP non-acceptance were concerns regarding side-effects and low self-perceived risk. PrEP acceptance was lowest among younger men (12.5%) and those born in Canada (15.2%). Men with a high self-perceived HIV risk were more likely to accept PrEP (41.3% vs. 22.7% of men with a low self-perceived risk), but only 25.4% of men who were defined as being at high-risk, self-identified themselves as such. Conclusions Most ACB MSW were unlikely to accept PrEP, largely due to low self-perceived HIV risk, but PrEP acceptance among ACB MSM was similar to other contemporaneous Toronto MSM communities. PrEP acceptance was particularly low among younger ACB men and those born in Canada. Tailored strategies will be needed to effectively implement PrEP in Toronto ACB communities.
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45
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Alon L, Smith A, Liao C, Schneider J. Colorism Demonstrates Dampened Effects Among Young Black Men Who Have Sex with Men in Chicago. J Natl Med Assoc 2019; 111:413-417. [PMID: 30803718 DOI: 10.1016/j.jnma.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE Colorism is a well documented phenomenon affecting the health, income, education, and psychological wellbeing of African Americans with differing skin tones. There is little research, however, around how colorism may operate among intersectional racial sexual minorities, who additionally face both racism and homophobia, despite evidence that different forms of oppression interact with each other and may have modulating effects in this population. This study aims to clarify the effect colorism has on a variety of life and health outcomes in young black men who have sex with men (YBMSM). METHODS Data were obtained from interviews conducted as part of the uConnect study, a longitudinal cohort study of YBMSM on the South Side of Chicago. Skin color of participants was rated by independent raters. RESULTS While some previously found patterns in African American heterosexuals were observed in this population, most were not. CONCLUSION The effects of colorism did not appear to have a significant role among this population across a wide set of social and health domains.
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Affiliation(s)
- Leigh Alon
- Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Autumn Smith
- Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Chuanhong Liao
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA; Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
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46
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Chen YT, Issema RS, Khanna AS, Pho MT, Schneider JA. Prescription Opioid Use in a Population-Based Sample of Young Black Men Who Have Sex with Men: A Longitudinal Cohort Study. Subst Use Misuse 2019; 54:1991-2000. [PMID: 31198077 PMCID: PMC6764892 DOI: 10.1080/10826084.2019.1625400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Prescription opioid use (POU) among young adults is increasing. This represents a major public health concern due to the increased risks of opioid use misuse and opioid-related overdose. Limited research has examined the POU among young black men who have sex with men (YBMSM), a diverse group experiencing continued increases in HIV incidence over the past decade. Objective: This study aims to examine the prevalence and both the individual and network characteristics of POU among YBMSM. Methods: Data were from a longitudinal cohort study of 16-29 year old YBMSM (N = 514) between 2013 and 2016 in Chicago. Bivariate and multivariable associations were estimated using general estimating equations (GEE). Results: Approximately 4.2% of YBMSM reported POU in the past 12 months with a cumulative incidence rate of 4.1% over the 18-month follow-up period. YBMSM having criminal justice involvements, experiencing violence, or using any illicit drug other than marijuana in the past 12 months were more likely to report POU in the past 12 months. The presence of a mother figure, however, was associated with a decreased risk of POU in the past 12 months, while engaging in condomless anal sex with their named sexual partners was associated with an increased risk of POU in the past 12 months. Conclusions: This is one of the first studies to describe POU among a population-based sample of YBMSM. The high incidence rate of POU among YBMSM is alarming, and it underscores the need for further analysis on POU among this key population.
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Affiliation(s)
- Yen-Tyng Chen
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA
| | - Rodal S Issema
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA
| | - Aditya S Khanna
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA
| | - Mai T Pho
- Department of Medicine, University of Chicago , Chicago , IL , USA
| | - John A Schneider
- Chicago Center for HIV Elimination , Chicago , IL , USA.,Department of Medicine, University of Chicago , Chicago , IL , USA.,Department of Public Health Sciences, University of Chicago , Chicago , IL , USA
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Zhang HL, Murthy B, Johnston B, Mortiboy M, Wu J, Samsa GP, Seña AC, McKellar MS. Public Awareness of HIV Pre-Exposure Prophylaxis in Durham, North Carolina: Results of a Community Survey. N C Med J 2019; 80:7-11. [PMID: 30622197 PMCID: PMC9970027 DOI: 10.18043/ncm.80.1.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adoption of HIV pre-exposure prophylaxis (PrEP) remains limited among populations at greatest risk for HIV acquisition. This study aims to assess awareness of PrEP among individuals in Durham, North Carolina, which has one of the highest rates of HIV diagnoses in the state.METHOD In 2015-2016, we administered a survey including questions to assess PrEP awareness to individuals at multiple venues throughout Durham, North Carolina.RESULTS A total of 139 respondents were surveyed. The majority were male (66%) and black/African American (75%); 21% were Hispanic/Latino. There were an estimated 53 men who have sex with men (MSM), of which 18 (33%) were black MSM M 24 years of age. Overall, only 53/138 (38%) respondents were aware of PrEP. Awareness was reported among 33/52 (63%) MSM respondents, 29/46 (63%) black MSM, and 10/17 (59%) black MSM M 24 years of age. In multivariate analysis, non-heterosexual orientation, health-insured status, and prior HIV testing were significantly associated with PrEP awareness. Ninety-four (69%) of 137 respondents reported prior HIV testing.LIMITATIONS Limitations include non-random sampling and limited sample size. Further research needs to be done in other areas of North Carolina, and assessment of PrEP acceptability and uptake needs to be performed.CONCLUSION This study reveals low overall awareness of PrEP in Durham, North Carolina, indicating that expanded outreach is necessary to increase public awareness and encourage adoption of PrEP among all demographics at risk for HIV.
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Affiliation(s)
- Helen L. Zhang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Bhavini Murthy
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barbara Johnston
- Department of Medicine, Duke University Medical Center, Durham, North Carolina,Lincoln Community Health Center, Durham, North Carolina
| | - Marissa Mortiboy
- Durham County Department of Public Health, Durham, North Carolina
| | - Jiewei Wu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Gregory P. Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Arlene C. Seña
- Durham County Department of Public Health, Durham, North Carolina,Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mehri S. McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Ezell JM, Ferreira MJ, Duncan DT, Schneider JA. The Social and Sexual Networks of Black Transgender Women and Black Men Who Have Sex with Men: Results from a Representative Sample. Transgend Health 2018; 3:201-209. [PMID: 30581993 PMCID: PMC6301432 DOI: 10.1089/trgh.2018.0039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Little research has evaluated the social and sexual network-related health outcomes of young black transgender women (TGW) or compared these outcomes with those of black men who have sex with men (MSM). Social network analysis offers one potent means of understanding the dynamics driving the broad spectrum of adverse outcomes experienced by these subgroups. Methods: We examined the social and sexual health network traits of 618 black individuals assigned male at birth who have sex with men, 47 (7.6%) of whom identified as TGW. Using respondent-driven sampling, data collection occurred over three waves between 2013 and 2016, in Chicago, Illinois. Univariate, logistic regression, and confidant and sexual network analyses were conducted to characterize dynamic network features. Results: TGW's mean age was 22.1 (standard deviation ±2.6). TGW's sexual networks were significantly less stable (stability ratio of 0.175 vs. 0.278 among MSM, p=0.03) and had greater network turnover (turnover ratio of 0.825 vs. 0.735, p=0.04). TGW also had significantly more sex partners (7.6 vs. 4.0, p=0.0002) and exchange sex (odds ratio=2.97; 95% confidence interval: 1.66–5.32, p<0.001), lower rates of employment (39.6% vs. 71.1%, p<0.001), and more reported an income <$20,000 (93.5% vs. 80.8%, p=0.029). Within confidant networks, TGW had a borderline significantly higher network turnover ratio (0.703 vs. 0.625, p=0.06). Furthermore, both TGW and MSM had high, but similar, HIV rates (42.3% vs. 30.6%, respectively; p=0.17). There were no significant structural network differences vis-à-vis mean degree (p=0.46), betweenness centrality (p=0.40), closeness centrality (p=0.18), or average shortest path length (borderline statistically significant at p=0.06). Conclusion: Using data from a representative sample of younger black individuals, we observed black TGW have less sexual network stability in contrast to black MSM but comparable structural network features. We further observed that both groups, and black TGW especially, possess considerable system-level, socioeconomic, and sexual health burdens.
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Affiliation(s)
- Jerel M Ezell
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois.,Department of Sociology, University of Chicago, Chicago, Illinois
| | - Matthew J Ferreira
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
| | - Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, NYU School of Medicine, New York, New York
| | - John A Schneider
- Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois.,Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois.,Department of Public Health Sciences, University of Chicago, Chicago, IL
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Are HIV Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity to Recently or Long-Term HIV-Infected Individuals? J Acquir Immune Defic Syndr 2018; 77:128-134. [PMID: 29135652 DOI: 10.1097/qai.0000000000001586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Debate remains as to the relative HIV transmission contributions from individuals who are recently HIV-infected and individuals who have long-term infections. In this study, we examine the relationship between new HIV seroconversions occurring among young black men who have sex with men and network proximity to recently or long-term HIV-infected individuals. A cohort of young black men who have sex with men (N = 618) was generated through respondent-driven sampling across 3 waves. A recent HIV infection was defined as either: (1) a confirmed seroconversion ≤9 months before interview date or (2) a laboratory confirmed acute infection; long-term HIV-infected individuals were defined as a diagnosis date ≥9 months before interview date. Respondent-driven sampling-weighted logistic regression was used to examine network proximity of HIV transmission events to HIV-infected individuals in the network. Within the cohort, 343 (55.5%) participants were identified as HIV seronegative at baseline. Of these, 33 (9.6%) seroconverted during the study period. The odds of seroconversion increased significantly with each additional recent HIV-infected individual in one's network [adjusted odds ratio = 12.96; 95% confidence interval: 5.69 to 29.50], but were not significantly altered by the number of long-term infected individuals in one's network. In addition, for each member of one's network who used pre-exposure prophylaxis, the odds of seroconversion decreased significantly (adjusted odds ratio = 0.44; 95% confidence interval: 0.20 to 0.96). Early diagnosis and treatment is a critical first step in the HIV care continuum and together with pre-exposure prophylaxis awareness and use are critical targets for disrupting the transmission of HIV through most at-risk networks.
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Morgan E, Skaathun B, Schneider JA. Sexual, Social, and Genetic Network Overlap: A Socio-Molecular Approach Toward Public Health Intervention of HIV. Am J Public Health 2018; 108:1528-1534. [PMID: 30252515 PMCID: PMC6187777 DOI: 10.2105/ajph.2018.304438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine how network-level factors influence individual risk of HIV acquisition, which is key in preventing disease transmission. METHODS We recruited a cohort of young Black men who have sex with men (n = 618) in Chicago, Illinois, from 2013 to 2016. We identified potential molecular ties via pairwise genetic distance analysis of HIV pol sequences with links inferred between individuals whose sequences were 1.5% or less genetically distant. We defined clusters as 1 or more connections to another individual. We conducted entity resolution between confidant, sexual, referral, and Facebook network data between network types. RESULTS Of 266 (43.0%) participants identified as HIV-positive, we obtained 86 (32.3%) genetic sequences. Of these, 35 (40.7%) were linked to 1 or more other sequence; however, none of these were identified in first-, second-, or third-degree confidant and sexual networks. Minimal overlap existed between genetic and Facebook ties. CONCLUSIONS These results suggest that HIV transmissions may have occurred before elicitation of network data; future studies should expand the data collection timeframe to more accurately determine risk networks. Virtual network data, such as Facebook, may be particularly useful in developing one's risk environment.
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Affiliation(s)
- Ethan Morgan
- All of the authors are with both the Department of Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. John A. Schneider is also affiliated with the Department of Medicine, University of Chicago
| | - Britt Skaathun
- All of the authors are with both the Department of Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. John A. Schneider is also affiliated with the Department of Medicine, University of Chicago
| | - John A Schneider
- All of the authors are with both the Department of Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, Chicago, IL. John A. Schneider is also affiliated with the Department of Medicine, University of Chicago
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