1
|
Kiggundu R, Soh QR, Tieosapjaroen W, Fairley CK, Tucker JD, Tang W, Zhang L, Ong JJ. Restarting pre-exposure prophylaxis (PrEP) for HIV: a systematic review and meta-analysis. EClinicalMedicine 2024; 72:102647. [PMID: 38800799 PMCID: PMC11127197 DOI: 10.1016/j.eclinm.2024.102647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Background High coverage of pre-exposure prophylaxis (PrEP) will reduce HIV transmission and help end the HIV/AIDS pandemic. However, PrEP users face challenges, including long-term adherence. The study aimed to document the proportions of individuals who restart HIV PrEP after they stop and the reasons for restarting PrEP. Methods This study is a systematic review and meta-analysis. We systematically searched CINAHL, Embase, Emcare, Global Health, Medline, Scopus, and PsychINFO for peer-reviewed with no date restrictions. A grey literature search was conducted through Google search, a search of abstract books of AIDS conferences and the websites of WHO and UNAIDS. The data search was conducted in April 2023 and updated in February 2024. Two authors extracted data on the proportion of people who stopped and then restarted PrEP, reasons for restarting, and strategies to support people restarting PrEP. Two authors appraised the data using the Joanna Briggs Institute Appraisal Tools. We used a random-effects meta-analysis to pool estimates of restarting. We conducted meta-regression to determine potential sources of heterogeneity. This study is registered with PROSPERO, CRD42023416777. However, we deviated from our original plan as we did not identify enough studies for strategies to support restarting PrEP (primary objective). Subsequently, we revised our plan to strengthen our secondary objective to quantify the proportion of people who stopped and restarted PrEP, and explore possible reasons for its heterogeneity. Findings Of 988 studies, 30 unique studieswere included: 27 reported the proportion restarting PrEP, and of these, 7 also reported reasons for restarting PrEP, and 3 studies reported only on the reasons for restarting PrEP. No study evaluated interventions for restarting PrEP. For the meta-analysis, we included 27 studies. Most studies were from high-income countries (17/27, 63%) or the USA (15/27, 56%). Overall, 23.8% (95% CI: 15.9-32.7, I2 = 99.8%, N = 85,683) of people who stopped PrEP restarted PrEP. There was a lower proportion of restarting in studies from middle-income countries compared to high-income countries (adjusted odds ratio (aOR) 0.6, 95% CI: 0.50-0.73, p < 0.001). There was higher restarting in studies from Africa compared to the USA (aOR 1.55, 95% CI: 1.30-1.86), heterosexual populations compared to men who have sex with men or transgender women (aOR 1.50, 95% CI: 1.25-1.81, p < 0.001) and in studies defining restarting as those who had stopped PrEP for >1 month compared to those who stopped <1 month (aOR 1.20, 95% CI: 1.06-1.36, p < 0.001). Reasons for restarting PrEP included perceived higher risk for HIV acquisition and removal of barriers to access PrEP. In terms of quality assessment, overall, both randomised controlled trials had a low risk of bias, while the observational studies used in the meta-analysis had some potential risk of bias related to not explicitly addressing potential confounders (15/25, 60%) or not describing strategies to address incomplete follow-up (24/25, 96%). Interpretation About a quarter of people who stopped PrEP would restart, with substantial variation across countries and populations. It is important to understand the motivations and contextual factors influencing restarting PrEP and the support systems to enable restarting PrEP for those at ongoing risk. Funding Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Reuben Kiggundu
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Qi Rui Soh
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weiming Tang
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [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] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
Collapse
Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
3
|
Samuel KD, Ellis MS, Buttram ME. The impact of socio-environmental factors on doxycycline post-exposure prophylaxis awareness in the US: a cross-sectional study. Sex Health 2024; 21:SH23176. [PMID: 38739741 DOI: 10.1071/sh23176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
Background We investigated awareness and use of doxycycline post-exposure prophylaxis (doxyPEP) in the US. DoxyPEP has preventative benefits for bacterial STIs among people assigned male at birth. We considered how individual, interpersonal and social determinants of health, such as state-level LGBTQ equality, impact doxyPEP awareness. Methods We conducted an online snapshot cross-sectional survey in June 2023. Survey questions included demographics, sexual and substance use behaviours, and socio-environmental factors, and provided a short explanation of doxyPEP, with questions regarding prior awareness and use. Results Among a racially diverse sample of 196 participants (median age 33 years), 94% identified as cisgender men, 26% were aware of doxyPEP, whereas only 14 (7%) had ever used it. Factors significantly associated with awareness included being college educated (OR 2.50, 95% CI 1.09-5.74), a past year bacterial STI (OR 4.20, 95% CI 1.97-8.89), having discussed HIV pre-exposure prophylaxis with a health care provider (OR 3.88, 95% CI 1.99-7.57) and having taken HIV pre-exposure prophylaxis (OR 2.29, 95% CI 1.11-4.70). Socio-environmental factors associated with doxyPEP awareness included living in a large urban city (OR 2.14, 95% CI 1.12-4.10) and living in a state with higher levels of LGBTQ policy equality (OR 2.18, 95% CI 1.07-4.44). Conclusions Considering the disproportionate impact of bacterial STIs on men who have sex with men, especially those living in lower LGBTQ equality regions, such as the Southern US, our study emphasises how socio-environmental factors may limit awareness and uptake of novel biomedical approaches that have the potential to prevent morbidity and enhance sexual health.
Collapse
Affiliation(s)
- Krishen D Samuel
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA; and
| | - Matthew S Ellis
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mance E Buttram
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA; and
| |
Collapse
|
4
|
Brookins T, Reagan D, Tate M, Suprasert B, Taylor KD, Ruiz R, Miller K, Wilson EC, McFarland W. Disparities in HIV Testing and PrEP Awareness for Black Women who Inject Drugs in San Francisco, California. AIDS Behav 2024:10.1007/s10461-024-04338-7. [PMID: 38642211 DOI: 10.1007/s10461-024-04338-7] [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: 04/03/2024] [Indexed: 04/22/2024]
Abstract
HIV disproportionately affects Black/African Americans (AA), while PrEP is under-utilized by Black/AA, women, and people who inject drugs (PWID). In San Francisco, California's National HIV Behavioral Surveillance among PWID in 2022, Black/AA women were the least likely to be tested for HIV among all groups by sex and race/ethnicity and the least likely to be aware of PrEP among women. Yet, Black/AA women were no less likely to see a healthcare provider in the last year. Data suggest that providers' failure to discuss and address HIV risk with Black/AA female PWID is a major barrier to accessing effective care and prevention. El VIH afecta de manera desproporcionada a Black/afroamericanos (AA), mientras que la PrEP está infrautilizada por los Black/AA, las mujeres y las personas que se inyectan drogas (PWID). En la National HIV Behavioral Surveillance de PWID de San Francisco, California en 2022, las mujeres Black/AA eran las que menos probabilidades tenían de someterse a la prueba del VIH entre todos los grupos por sexo y raza/etnia y las que menos probabilidades tenían de conocer la PrEP entre las mujeres. Sin embargo, las mujeres Black/AA no tenían menos probabilidades de acudir a un profesional sanitario en el último año. Los datos sugieren que el hecho de que los proveedores no hablen ni aborden el riesgo de VIH con las PWID de raza Black/AA es un obstáculo importante para acceder a una atención y prevención eficaces.
Collapse
Affiliation(s)
- Taqwa Brookins
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Danyion Reagan
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA
| | - Moranda Tate
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA
| | - Bow Suprasert
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA
| | - Kelly D Taylor
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Raul Ruiz
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA
| | - Kassandra Miller
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA
| | - Willi McFarland
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 710, San Francisco, CA, 94102-6033, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
5
|
Weeden T, Garofalo R, Johnson AK, Schnall R, Cervantes M, Scherr T, Kuhns LM. Assessing Preferences for Long-Acting Injectable Pre-Exposure Prophylaxis Among Young Adult Sexual Minority Men and Transgender Women. Acad Pediatr 2024:S1876-2859(24)00148-7. [PMID: 38631476 DOI: 10.1016/j.acap.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. However, oral PrEP uptake is low, particularly among sexual and gender minority youth who are vulnerable to HIV infection. Alternative methods of PrEP delivery, such as long-acting injectable (LAI) PrEP may overcome barriers and be preferred. However, attitudes and preferences of younger sexual and gender minorities towards LAI PrEP have not been well studied. The purpose of this study is to describe preferences for initiating LAI PrEP among sexual and gender minority youth. METHODS We analyzed data collected as part of an HIV prevention randomized trial from January 2022 to February 2023, using multiple regression to identify factors associated with a preference for LAI PrEP. RESULTS The study sample (N = 265) was 50% youth of color, mean age 25 years (SD=3.4, range=18-31), and primarily identified as gay (71%) and male (91%). Forty two percent had heard of LAI PrEP and 31% preferred LAI PrEP over other prevention methods. In multiple regression analysis, LAI PrEP preference was associated with identifying as White, previous PrEP experience, and perceived LAI PrEP efficacy. CONCLUSIONS We conclude that gaps in awareness exist for LAI PrEP, however it may be preferred over other prevention methods especially in White youth, those with PrEP experience and higher perceptions of its efficacy. More education and outreach are needed to prevent extension of existing race and ethnicity disparities in use of oral daily PrEP to LAI PrEP.
Collapse
Affiliation(s)
- Terrance Weeden
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Robert Garofalo
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Amy K Johnson
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Rebecca Schnall
- School of Nursing (R Schnall), Columbia University, New York City, NY
| | - Marbella Cervantes
- Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Thomas Scherr
- Department of Chemistry (T Scherr), Vanderbilt University, Nashville, Tenn
| | - Lisa M Kuhns
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill.
| |
Collapse
|
6
|
Volk JE, Leyden WA, Lea AN, Lee C, Donnelly MC, Krakower DS, Lee K, Liu VX, Marcus JL, Silverberg MJ. Using Electronic Health Records to Improve HIV Preexposure Prophylaxis Care: A Randomized Trial. J Acquir Immune Defic Syndr 2024; 95:362-369. [PMID: 38412047 DOI: 10.1097/qai.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) use remains limited and inequitable, and strategies are needed to improve PrEP provision in primary care. METHODS We conducted a cluster randomized trial at Kaiser Permanente, San Francisco, to evaluate the effectiveness of a clinical decision support intervention guided by an electronic health record (EHR)-based HIV risk prediction model to improve PrEP provision. Primary care providers (PCPs) were randomized to usual care or intervention, with PCPs who provide care to people with HIV balanced between arms. PCPs in the intervention arm received an EHR-based staff message with prompts to discuss HIV prevention and PrEP before upcoming in-person or video visits with patients whose predicted 3-year HIV risk was above a prespecified threshold. The main study outcome was initiation of PrEP care within 90 days, defined as PrEP discussions, referrals, or prescription fills. RESULTS One hundred twenty-one PCPs had 5051 appointments with eligible patients (2580 usual care; 2471 intervention). There was a nonsignificant increase in initiation of PrEP care in the intervention arm (6.0% vs 4.5%, HR 1.32, 95% CI: 0.84 to 2.1). There was a significant interaction by HIV provider status, with an intervention HR of 2.59 (95% CI: 1.30 to 5.16) for HIV providers and 0.89 (95% CI: 0.59 to 1.35) for non-HIV providers (P-interaction <0.001). CONCLUSION An EHR-based intervention guided by an HIV risk prediction model substantially increased initiation of PrEP care among patients of PCPs who also care for people with HIV. Higher-intensity interventions may be needed to improve PrEP provision among PCPs less familiar with PrEP and HIV care.
Collapse
Affiliation(s)
- Jonathan E Volk
- Department of Infectious Diseases, Kaiser Permanente San Francisco, San Francisco, CA
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA; and
| | - Kristine Lee
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco, San Francisco, CA
| | - Vincent X Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | |
Collapse
|
7
|
OBrien SJ. Legacy of a magic gene- CCR5-∆32: From discovery to clinical benefit in a generation. Proc Natl Acad Sci U S A 2024; 121:e2321907121. [PMID: 38457490 PMCID: PMC10962972 DOI: 10.1073/pnas.2321907121] [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: 12/14/2023] [Accepted: 01/22/2024] [Indexed: 03/10/2024] Open
Abstract
The discovery of the 32-bp deletion allele of the chemokine receptor gene CCR5 showed that homozygous carriers display near-complete resistance to HIV infection, irrespective of exposure. Algorithms of molecular evolutionary theory suggested that the CCR5-∆32 mutation occurred but once in the last millennium and rose by strong selective pressure relatively recently to a ~10% allele frequency in Europeans. Several lines of evidence support the hypothesis that CCR5-∆32 was selected due to its protective influence to resist Yersinia pestis, the agent of the Black Death/bubonic plague of the 14th century. Powerful anti-AIDS entry inhibitors targeting CCR5 were developed as a treatment for HIV patients, particularly those whose systems had developed resistance to powerful anti-retroviral therapies. Homozygous CCR5-∆32/∆32 stem cell transplant donors were used to produce HIV-cleared AIDS patients in at least five "cures" of HIV infection. CCR5 has also been implicated in regulating infection with Staphylococcus aureus, in recovery from stroke, and in ablation of the fatal graft versus host disease (GVHD) in cancer transplant patients. While homozygous CCR5-∆32/32 carriers block HIV infection, alternatively they display an increased risk for encephalomyelitis and death when infected with the West Nile virus.
Collapse
Affiliation(s)
- Stephen J. OBrien
- Guy Harvey Oceanographic Center, Halmos College of Arts and Sciences, Nova Southeastern University, Ft Lauderdale, FL33004
- Indiana University School of Public Health, Bloomington, IN47405
| |
Collapse
|
8
|
Stewart J, Ruiz-Mercado G, Sperring H, Pierre CM, Assoumou SA, Taylor JL. Addressing Unmet PrEP Needs in Women: Impact of a Laboratory-Driven Protocol at an Urban, Essential Hospital. Open Forum Infect Dis 2024; 11:ofae056. [PMID: 38464490 PMCID: PMC10921387 DOI: 10.1093/ofid/ofae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) uptake in women remains low. We developed a laboratory result-driven protocol to link women with a positive bacterial sexually transmitted infection (STI) to HIV PrEP at an urban safety-net hospital. Methods Electronic health records of women with positive chlamydia, gonorrhea, and/or syphilis tests were reviewed, and those eligible for PrEP were referred for direct or primary care provider-driven outreach. We assessed the proportion of women with STIs who received PrEP offers, acceptance, and prescriptions before (July 1, 2018-December 31, 2018) and after (January 1, 2019-June 30, 2020) implementation to evaluate changes in the delivery of key elements of the PrEP care cascade (ie, PrEP offers, acceptance, and prescribing) for women with STIs after protocol implementation. Results The proportion of women who received PrEP offers increased from 7.6% to 17.6% (P < .001). After multivariable adjustment, only the postintervention period was associated with PrEP offers (odds ratio [OR], 2.49; 95% CI, 1.68-3.68). In subgroup analyses, PrEP offers increased significantly among non-Hispanic Black (OR, 2.75; 95% CI, 1.65-4.58) and Hispanic (OR, 5.34; 95% CI, 1.77-16.11) women but not among non-Hispanic White women (OR, 1.49; 95% CI, 0.54-4.05). Significant changes in PrEP acceptance and prescriptions were not observed in the sample overall. Conclusions A laboratory result-driven protocol was associated with a significant increase in PrEP offers to Black and Hispanic women with STI. These results provide concrete suggestions for health systems seeking to increase PrEP access and equity among women.
Collapse
Affiliation(s)
- Jessica Stewart
- Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Glorimar Ruiz-Mercado
- Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Heather Sperring
- Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Cassandra M Pierre
- Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Sabrina A Assoumou
- Section of Infectious Disease, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Gómez W, Gomez AM, Solis S, Dimonte C, Organista KC. Provider Perspectives on Multi-level Barriers and Facilitators to PrEP Access Among Latinx Sexual and Gender Minorities. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01948-8. [PMID: 38381327 DOI: 10.1007/s40615-024-01948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
Although pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention, inequities in access remain among Latinx sexual and gender minorities (LSGM). There is also a gap in the PrEP literature regarding providers' perspective on access inequities. This qualitative case study sought to explore barriers and facilitators to PrEP engagement in a community-based integrated health center primarily serving Latinx populations in Northern California. We conducted in-depth, semi-structured interviews with providers (9/15) involved in PrEP services and engaged in a constructivist grounded theory analysis consisting of memoing, coding, and identifying salient themes. Three participants worked as medical providers, three as outreach staff, and one each in planning, education, and research. The analysis surfaced four themes: geopolitical differences, culture as barrier, clinic as context, and patient strengths and needs. Participants referenced a lack of resources to promote PrEP, as well as the difficulties of working within an institution that still struggles with cultural and organizational mores that deprioritize sexual health. Another barrier is related to sexual health being positioned outside of patients' immediate needs owing to structural barriers, including poverty, documentation status, and education. Participants, however, observed that peer-based models, which emboldened their decision-making processes, were conducive to better access to PrEP, as well as allowing them to build stronger community ties. These data underscore the need for interventions to help reduce sexual stigma, promote peer support, and ameliorate structural barriers to sexual healthcare among LSGM.
Collapse
Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | | | - Sheilalyn Solis
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Cheryl Dimonte
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA
| | - Kurt C Organista
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| |
Collapse
|
10
|
Kerr J, Combs R, Sterrett-Hong E, Harris L, Northington T, Krigger K, Parker K. Evaluation of a community-informed multimedia intervention to increase PrEP awareness and intention among African American young adults. AIDS Care 2024:1-7. [PMID: 38301133 DOI: 10.1080/09540121.2023.2297739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
Despite the benefits of pre-exposure prophylaxis (PrEP) in preventing HIV and its potential for reducing racial/ethnic HIV inequities, PrEP remains underutilized among African Americans who may benefit from it. Factors of PrEP uptake include awareness and acceptability of this prevention strategy among this group, yet few community-informed interventions have been developed and evaluated to address these challenges. Thus, this study evaluates the effectiveness of a community-informed, six-month multimedia campaign (print, digital media, internet radio, social media) for African American young adults (age 18-29) in Louisville, Kentucky to increase PrEP awareness and PrEP use intentions. Pretest surveys, posttest surveys, and digital analytic metrics were used to determine campaign effectiveness. Logistic regressions indicate increased PrEP awareness over time (p ≤ 0.0001) and greater PrEP intention among participants reporting greater campaign affinity (p ≤ 0.05). Campaign digital analytic performance was similar to or exceeded that of industry competitors (e.g., healthcare organizations). Findings indicate that a community-informed multimedia campaign increased PrEP use intentions among those exhibiting greater campaign affinity (the extent to which participants report a favorable view of the campaign) and demonstrated similar or greater effectiveness in digital elements as industry competitors at a cost-effective price. Future studies should incorporate community-engaged approaches in developing health communication products for greater PrEP acceptability and efficiency.Trial registration: ClinicalTrials.gov identifier: NCT0355959.
Collapse
Affiliation(s)
- Jelani Kerr
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Ryan Combs
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Emma Sterrett-Hong
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Lesley Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | | | - Karen Krigger
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Kim Parker
- Parker-Owens Research Group, Frisco, TX, USA
| |
Collapse
|
11
|
Rivera AS, Pak K, Mefford MT, Hechter RC. Changes in Glomerular Filtration Rate After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide Fumarate for Human Immunodeficiency Virus Preexposure Prophylaxis. Open Forum Infect Dis 2024; 11:ofad695. [PMID: 38352151 PMCID: PMC10863550 DOI: 10.1093/ofid/ofad695] [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: 10/26/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024] Open
Abstract
Background Tenofovir alafenamide fumarate (TAF) was promoted as a safer alternative to tenofovir disoproxil fumarate (TDF) for human immunodeficiency virus oral preexposure prophylaxis (PrEP). It is unknown if switching from TDF to TAF translates to improved renal function. We used electronic health record (EHR) data to assess changes in creatinine-estimated glomerular filtration rate (eGFR) after switching from TDF to TAF. Methods We conducted a retrospective cohort study using EHR data from Kaiser Permanente Southern California. We identified individuals who switched from TDF to TAF between October 2019 and May 2022 and used time-varying propensity score matching to identify controls who were on TDF ("nonswitchers"). We then used Bayesian longitudinal modeling to compare differences in eGFR between switching and nonswitching scenarios. Results Among 5246 eligible individuals, we included 118 TDF to TAF switchers and 114 nonswitchers. Compared to nonswitchers, switchers had older age of starting TDF but similar body weights at index date. A higher proportion of switchers were White, on Medicare or Medicaid, and had dyslipidemia at index date. Switching to TAF was associated with a higher eGFR compared to staying on TDF in 3-15 months post-switch, but the differences were not statistically significant (eg, month 9 difference: 1.27 [95% credible interval, -1.35 to 3.89]). While most of the estimated changes showed eGFR increase associated with switching, most were <2 eGFR units. Sensitivity analyses to address missingness or nonadherence showed similar results. Conclusions Switching from TDF to TAF for PrEP was associated with a nonsignificant increase in eGFR. Findings need to be confirmed using larger cohorts.
Collapse
Affiliation(s)
- Adovich S Rivera
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katherine Pak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| |
Collapse
|
12
|
Zarwell M, Witt B, Marin-Cespedes S, Gorman B, Kumtap MU, Hoff R, Rysbayeva A, Jha P, Boehm EL, Harihar S, Issel LM, Robinson P. Uptake and Discontinuation of Pre-Exposure Prophylaxis Among Uninsured Transgender and Cisgender Women: A Public-Private Partnership Model in North Carolina. AIDS Patient Care STDS 2023; 37:525-534. [PMID: 37956243 DOI: 10.1089/apc.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) remains underutilized among cis and trans women. The PrEP Initiative Program (PIP) is a novel public-private partnership implemented at 12 local clinics in North Carolina. PIP provides HIV/sexually transmitted infection (STI) testing and clinical and laboratory monitoring for PrEP to uninsured/underinsured clients. We sought to understand service-related differences among both cis and trans women enrolled in PIP, including STIs diagnoses, clinic type, sources of referral, services needed, and reasons for PrEP discontinuation. The Kaplan-Meier curves display retention on PrEP over the duration of the program. Since 2018, 142 women (cis n = 113; trans n = 29) enrolled, and 136 started PrEP. The majority were ages 25-34 years (31.7%) or 18-24 years (29.6%), Black (57.8%) or Latinx (24.7%). Approximately 20.6% of recipients reported at least one STI while enrolled. Overall, trans women requested fewer services than cis women. After accounting for the amount of time each patient was taking PrEP, there were higher rates of trans women diagnosed with syphilis than cis women. Rates of persons with other STIs were not notably different between trans and cis women. Clinic access varied by gender: 69% of trans women were enrolled at only one site. Trans women were retained significantly longer: The Kaplan-Meier adjusted median time to discontinuation was 560 and 238 days for trans and cis women, respectively. PIP successfully reached historically marginalized and uninsured cis and trans women who may benefit from PrEP. Further investigations into factors contributing to recruitment and retention of women in HIV prevention programs are needed.
Collapse
Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| | - Brian Witt
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
- HIV/STI Division, Mecklenburg County Public Health Department, Charlotte, North Carolina, USA
| | - Sebastian Marin-Cespedes
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| | - Brianna Gorman
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
| | - Makshwar U Kumtap
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
| | - Rhoen Hoff
- Department of Psychology, UNC Charlotte, College of Liberal Arts and Sciences, Charlotte, North Carolina, USA
| | - Ainella Rysbayeva
- Department of Biology, UNC Charlotte, College of Liberal Arts and Sciences, Charlotte, North Carolina, USA
| | - Prashant Jha
- Department of Biology, UNC Charlotte, College of Liberal Arts and Sciences, Charlotte, North Carolina, USA
| | - Elsa L Boehm
- BASIS DC High School, Washington, District of Columbia, USA
| | - Sweta Harihar
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| | - L Michele Issel
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
| | - Patrick Robinson
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| |
Collapse
|
13
|
Herns S, Panwala R, Pfeil A, Sardinha M, Rossi V, Blumenthal J, Hill L. Predictors of PrEP retention in at risk patients seen at a HIV primary care clinic in San Diego. Int J STD AIDS 2023; 34:785-790. [PMID: 37271811 PMCID: PMC10561521 DOI: 10.1177/09564624231179276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adherence to medication and retention in care are key contributors to the efficacy of pre-exposure prophylaxis (PrEP) for prevention of HIV. Therefore, it is important to understand factors that may impact retention in various settings that prescribe PrEP. METHODS We evaluated factors associated with retention in care 3 and 12 months after PrEP initiation at a primary care HIV clinic in San Diego. Retention was defined as having an office/virtual visit within 1 month from the 3- or 12-months time point or interacting with the clinic leading to medication being refilled. RESULTS A total of 199 patients were included. Retention rates were 74.4% and 52.8% at 3 and 12 months respectively. In the multivariate analysis, reporting depression or anxiety was associated with being retained in care (p = 0.004) and identifying as cisgender female was associated with lack of retention (p = 0.04) at 3 months. Testing positive for a sexually transmitted infection was associated with 12-months retention (p = 0.004); however, this was likely influenced by difference in the frequency of testing in those retained versus not retained. CONCLUSION Ongoing efforts to determine the optimal method for provision of PrEP care that supports retention for different populations at risk for HIV, are needed.
Collapse
Affiliation(s)
- Shayna Herns
- University of California San Diego, San Diego, CA, USA
| | - Rebecca Panwala
- University of Massachusetts, Chan Medical School, Worcester, MA, USA
| | - Allan Pfeil
- University of California San Diego, San Diego, CA, USA
| | - Manuel Sardinha
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Vito Rossi
- University of California San Diego, San Diego, CA, USA
| | | | - Lucas Hill
- University of California San Diego, San Diego, CA, USA
| |
Collapse
|
14
|
Rivera AS, Pak KJ, Mefford MT, Hechter RC. Use of Tenofovir Alafenamide Fumarate for HIV Pre-Exposure Prophylaxis and Incidence of Hypertension and Initiation of Statins. JAMA Netw Open 2023; 6:e2332968. [PMID: 37695583 PMCID: PMC10495863 DOI: 10.1001/jamanetworkopen.2023.32968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Abstract
Importance Pre-exposure prophylaxis (PrEP) is an important tool for preventing HIV infection. However, PrEP's impact on cardiometabolic health is understudied. Objective To examine the risk of incident hypertension and statin initiation among adult (age ≥18 years) health plan members starting PrEP with tenofovir alafenamide fumarate (TAF) compared with propensity score-matched adults taking tenofovir disoproxil fumarate (TDF). Design, Setting, and Participants This retrospective cohort study used electronic health records (EHRs) from Kaiser Permanente Southern California. Adult members starting PrEP in Kaiser Permanente Southern California between October 2019 and May 2022 were included. Propensity score matching with multiple imputation (50 matched data sets) was conducted to generate 1 TAF:4 TDF matched data sets with balanced baseline covariates. Exposures PrEP initiation with either TAF or TDF during the study period. Main Outcomes and Measures Incident hypertension and statin initiation within 2 years of PrEP initiation were ascertained through blood pressure and outpatient pharmacy records, respectively. Risk differences and odds ratios (ORs) were estimated using logistic regression and g-computation. Results A total of 6824 eligible individuals were identified (mean [SD] age, 33.9 [10.3] years; 6618 [97%] male). This pool was used to generate 2 cohorts without baseline hypertension or statin use for matching (hypertension: n = 5523; statin: n = 6149) In both cohorts, those starting PrEP with TAF were older and were more likely to be non-Hispanic White compared with those starting with TDF. In matched analysis adjusting for baseline covariates, TAF use was associated with elevated risk of incident hypertension (TAF: n = 371; risk difference, 0.81 [95% CI, 0.12-1.50]; OR, 1.64 [95% CI, 1.05-2.56]). TAF use was also associated with elevated risk of statin initiation (TAF: n = 382; risk difference, 0.85 [95% CI, 0.37-1.33]; OR, 2.33 [95% CI, 1.41-3.85]). Subgroup analyses restricted to individuals 40 years and older at PrEP initiation showed similar results with larger risk difference in statin initiation (risk difference, 4.24 [95% CI, 1.82-6.26]; OR, 3.05 [95% CI, 1.64-5.67]). Conclusions and Relevance In this study of people taking PrEP, TAF use was found to be associated with higher incident hypertension and statin initiation compared with TDF use, especially in those 40 years or older. Continued monitoring of blood pressure and lipids for TAF users is warranted.
Collapse
Affiliation(s)
- Adovich S. Rivera
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Katherine J. Pak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Matthew T. Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Rulin C. Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| |
Collapse
|
15
|
Bekerman E, Yant SR, VanderVeen L, Hansen D, Lu B, Rowe W, Wang K, Callebaut C. Long-acting lenacapavir acts as an effective preexposure prophylaxis in a rectal SHIV challenge macaque model. J Clin Invest 2023; 133:e167818. [PMID: 37384413 PMCID: PMC10425210 DOI: 10.1172/jci167818] [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: 12/20/2022] [Accepted: 06/28/2023] [Indexed: 07/01/2023] Open
Abstract
Long-acting antiretroviral agents for preexposure prophylaxis (PrEP) represent a promising new alternative to daily oral regimens for HIV prevention. Lenacapavir (LEN) is a first-in-class long-acting capsid inhibitor approved for the treatment of HIV-1 infection. Here, we assessed the efficacy of LEN for PrEP using a single high-dose simian-human immunodeficiency virus (SHIV) rectal challenge macaque model. In vitro, LEN showed potent antiviral activity against SHIV, as it did for HIV-1. In macaques, a single subcutaneous administration of LEN demonstrated dose proportional increases in and durability of drug plasma levels. A high-dose SHIV inoculum for the PrEP efficacy evaluation was identified via virus titration in untreated macaques. LEN-treated macaques were challenged with high-dose SHIV 7 weeks after drug administration, and the majority remained protected from infection, as confirmed by plasma PCR, cell-associated proviral DNA, and serology testing. Complete protection and superiority to the untreated group was observed among animals whose LEN plasma exposure exceeded its model-adjusted clinical efficacy target at the time of challenge. All infected animals had subprotective LEN concentrations and showed no emergent resistance. These data demonstrate effective SHIV prophylaxis in a stringent macaque model at clinically relevant LEN exposures and support the clinical evaluation of LEN for HIV PrEP in humans.
Collapse
|
16
|
Harrington KRV, Chandra C, Alohan DI, Cruz D, Young HN, Siegler AJ, Crawford ND. Examination of HIV Preexposure Prophylaxis Need, Availability, and Potential Pharmacy Integration in the Southeastern US. JAMA Netw Open 2023; 6:e2326028. [PMID: 37498599 PMCID: PMC10375311 DOI: 10.1001/jamanetworkopen.2023.26028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023] Open
Abstract
Importance Daily preexposure prophylaxis (PrEP) use can prevent up to 99% of HIV infections; however, PrEP uptake is low due to poor access to PrEP-prescribing locations for populations at increased risk for HIV, especially in the southeastern US. Pharmacies are a feasible option to increase PrEP access, but little is known about how they could complement current PrEP-prescribing locations. Objective To examine geographic distributions of current PrEP-prescribing locations compared with pharmacies and the facility to need ratios (PFNRs) according to HIV risk in the Southeast and describe the potential reach of pharmacies to expand PrEP access. Design, Setting, and Participants Data for this cross-sectional study of PrEP-prescribing locations and pharmacies were compiled from January 1 to December 31, 2021. States or specific counties in the Southeast included in this study were jurisdictions identified as high-priority areas for the Ending the HIV Epidemic in the US (EHE) initiative. Exposure Expansion of HIV prevention services to pharmacies. Main Outcomes and Measures Choropleth maps of 5-year HIV risk per 100 000 persons were developed for EHE jurisdictions in the southeastern US. PrEP-prescribing locations (obtained from a national database of PrEP prescribers) and pharmacies (obtained from state pharmacy boards) were overlayed on HIV risk maps. The PFNRs by state were calculated as number of facilities (PrEP-prescribing locations or pharmacies) divided by 5-year HIV risk per 100 000 persons. Lower PFNRs indicated lower geographic availability of locations to meet the needs of the population at risk for HIV. The PFNRs for current PrEP-prescribing locations vs pharmacies were compared. Results Among the 2 southeastern states and 13 counties in 4 southeastern states included, PrEP-prescribing locations were unequally distributed across EHE areas, with substantially fewer in areas at high risk for HIV. Pharmacies were evenly dispersed across areas regardless of HIV risk. The mean PFNR across all states for current PrEP-prescribing locations was 0.008 (median, 0.000 [IQR, 0.000-0.003]); for pharmacies, it was 0.7 (median, 0.3 [IQR, 0.01-0.1]). The PFNRs were at least 20.3 times higher for pharmacies compared with PrEP-prescribing locations. States with the greatest potential increase in PFNRs with expansion to pharmacies included Kentucky, South Carolina, and Tennessee. Conclusions and Relevance The findings of this cross-sectional study suggest that expanding HIV prevention services to pharmacies in EHE areas in the Southeast could significantly increase capacity to reach individuals at increased risk of HIV transmission. Legislation aimed at allowing pharmacists to prescribe PrEP and provide HIV prevention services may be an important next step in ending the HIV epidemic.
Collapse
Affiliation(s)
- Kristin R. V. Harrington
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - Christina Chandra
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Daniel I. Alohan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Diego Cruz
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Henry N. Young
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
17
|
Rosen JG, Zhang L, Pelaez D, Park JN, Glick JL. A Capacity-Strengthening Intervention to Support HIV Pre-exposure Prophylaxis (PrEP) Awareness-Building and Promotion by Frontline Harm Reduction Workers in Baltimore, Maryland: A Mixed Methods Evaluation. AIDS Behav 2023; 27:2440-2453. [PMID: 36596866 PMCID: PMC9810241 DOI: 10.1007/s10461-022-03971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising but underutilized HIV prevention tool among people who inject drugs (PWID). We developed and piloted an intervention to bolster PrEP promotion competencies among frontline harm reduction workers (FHRW) serving PWID clients in Baltimore, Maryland. Between December 2021 and February 2022, we developed and facilitated four trainings, which included didactic and practice-based/role-playing components, with 37 FHRW from four organizations. FHRW completed three structured surveys (pretest, posttest, 6-week posttest) and in-depth interviews (n = 14) to measure changes in PrEP promotion competencies attributable to training participation. PrEP knowledge and self-efficacy increased significantly (p < 0.001) from pretest to posttest, sustained through 6-week posttest. The proportion of FHRW discussing PrEP with clients doubled during the evaluation period (30-67%, p = 0.006). Feeling empowered to discuss PrEP and provision of population-tailored PrEP information were facilitators of PrEP promotion, while limited client interaction frequency/duration, privacy/confidentiality concerns, and anticipated PrEP stigma by clients inhibited PrEP promotion. Our capacity-strengthening intervention successfully increased PrEP knowledge, self-efficacy, and promotion among FHRW, affirming the adaptability and feasibility of integrating our training toolkit into FHRW practice across implementation settings.
Collapse
Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, USA.
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center of Biomedical Research Excellent on Opioids and Overdose, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
18
|
Kriegel D, Daniels A, Seehusen DA. Is injectable PrEP superior to oral therapy for HIV protection? THE JOURNAL OF FAMILY PRACTICE 2023; 72:264-265. [PMID: 37549401 PMCID: PMC10410461 DOI: 10.12788/jfp.0630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
An RCT of HIV preexposure prophylaxis compared long-acting injectable cabotegravir with traditional daily oral tenofovir-emtricitabine-with clear results.
Collapse
|
19
|
Riley T, Bender M, Wang X, Mena L, Gipson J, Barnes A, Johnson KL, Backus KV, Gomillia CE, Ward LM, Khosropour CM. HIV Incidence Among Individuals Accessing Pre-Exposure Prophylaxis in Jackson, Mississippi. AIDS Patient Care STDS 2023; 37:332-336. [PMID: 37222734 PMCID: PMC10354303 DOI: 10.1089/apc.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Although pre-exposure prophylaxis (PrEP) is an efficacious biomedical intervention, the effectiveness of same-day PrEP programs has not been widely studied. We utilized data from three of the four largest PrEP providers in Mississippi from September 2018 to September 2021 linked to the Mississippi State Department of Health's Enhanced HIV/AIDS reporting system. HIV diagnosis was defined as testing newly positive for HIV at least 2 weeks after the initial PrEP visit. We calculated the cumulative incidence and incidence rate of HIV per 100 person-years (PY). Person-time was calculated as time from the initial PrEP visit to (1) HIV diagnosis or (2) December 31, 2021 (HIV surveillance data end date). We did not censor individuals if they discontinued PrEP to obtain an estimate of PrEP effectiveness rather than efficacy. Among the 427 clients initiating PrEP during the study period, 2.3% [95% confidence interval (CI): 0.9-3.8] subsequently tested positive for HIV. The HIV incidence rate was 1.18 per 100 PY (95% CI: 0.64-2.19) and median time to HIV diagnosis after the initial PrEP visit was 321 days (95% CI: 62-686). HIV incidence rates were highest among transgender and nonbinary individuals [10.35 per 100 PY (95% CI: 2.59-41.40)] compared with cisgender men and women, and among people racialized as Black [1.45 per 100 PY (95% CI: 0.76-2.80)] compared with White and other racialized groups. These findings indicate a need for more clinical and community interventions that support PrEP persistence and restarts among those at high risk of HIV acquisition.
Collapse
Affiliation(s)
- Taylor Riley
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Melverta Bender
- Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Xueyuan Wang
- Mississippi State Department of Health, Jackson, Mississippi, USA
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Open Arms Healthcare Center, Jackson, Mississippi, USA
| | - June Gipson
- Open Arms Healthcare Center, Jackson, Mississippi, USA
| | - Alicia Barnes
- Open Arms Healthcare Center, Jackson, Mississippi, USA
| | - Kendra L. Johnson
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kandis V. Backus
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Courtney E. Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Christine M. Khosropour
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
20
|
Khosropour CM, Riley T, Healy E, Backus KV, Gomillia CE, Mena L, Lockwood KR, Gordon FM, Means AR, Ward LM. Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study. BMC Public Health 2023; 23:1130. [PMID: 37312077 PMCID: PMC10262591 DOI: 10.1186/s12889-023-16072-1] [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: 10/07/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence. METHODS This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior. RESULTS There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals' desire to stay healthy and the support of PrEP clinic staff were facilitators. CONCLUSIONS The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.
Collapse
Affiliation(s)
- Christine M Khosropour
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | - Taylor Riley
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Elise Healy
- Department of Medicine, Health Sciences Building, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Kandis V Backus
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Khadijra R Lockwood
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Felicia M Gordon
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Arianna R Means
- Department of Global Health, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Lori M Ward
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| |
Collapse
|
21
|
Chamberlin G, Lopes MD, Iyer S, Psaros C, Bassett IV, Medeiros S, O'Connor C, Ard KL. "That was our afterparty": a qualitative study of mobile, venue-based PrEP for MSM. BMC Health Serv Res 2023; 23:504. [PMID: 37198608 DOI: 10.1186/s12913-023-09475-8] [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: 12/23/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND HIV preexposure prophylaxis (PrEP) uptake among men who have sex with men (MSM), a group disproportionately impacted by HIV, is not commensurate with need. Settings which reduce or remove barriers to accessing care are promising venues to support PrEP uptake. PrEP provision at mobile clinics represents a novel strategy to increase PrEP access; however, the acceptability and feasibility of this approach have not been well studied. METHODS Our objective was to understand patient and staff experiences of a mobile clinic van offering PrEP and sexual health services in Boston, Massachusetts, USA. We interviewed mobile unit users and conducted focus groups with mobile unit staff and users. Data were organized using Dedoose software, and content analysis was used to identify themes of access, community, and stigma. RESULTS Nineteen individuals (16 patients and 3 staff members) participated in interviews (N = 13) or focus groups (N = 6). All patients identified as MSM, 63% were Hispanic or Latino, and 21% of patient interviews were conducted in Spanish. Logistical and psychological convenience facilitated service use, while the community-oriented environment improved satisfaction with care. Overall, participants supported expansion of mobile unit services and recommended changes to improve access to longitudinal care. However, some barriers to PrEP persisted, including low HIV risk perception and stigma about sexual behavior. CONCLUSIONS Mobile units can promote sexual health and PrEP uptake, particularly for populations facing social and logistical barriers to care in traditional settings.
Collapse
Affiliation(s)
- Grace Chamberlin
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Surabhi Iyer
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kevin L Ard
- Harvard Medical School, Boston, MA, USA.
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
22
|
Davis-Ewart L, Lee JY, Viamonte M, Colon-Burgos J, Harkness A, Kanamori M, Duncan DT, Doblecki-Lewis S, Carrico AW, Grov C. "The familiar taste of poison": a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida. Harm Reduct J 2023; 20:58. [PMID: 37101251 PMCID: PMC10134657 DOI: 10.1186/s12954-023-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In the US, stimulant use is associated with a 3-6 times greater rate of HIV seroconversion in sexual minority men (SMM) than in those who do not use stimulants. Annually, 1 in 3 SMM who HIV seroconvert will be persistent methamphetamine (meth) users. The primary objective of this qualitative study was to explore experiences of stimulant use in SMM living in South Florida, a high priority region for the Ending the HIV Epidemic initiative. METHODS The sample included 25 SMM who use stimulants, recruited via targeted ads on social networking apps. Participants completed one-on-one semi-structured qualitative interviews, conducted from July 2019 through February 2020. A general inductive approach was used to identify themes relating to experiences, motivations, and overall relationship with stimulant use. RESULTS Mean age of participants was 38.8, ranging from 20 to 61 years old. Participants were 44% White, 36% Latino, 16% Black and 4% Asian. Most participants were born in the US, self-identified as gay, and preferred meth as their stimulant of choice. Themes included: (1) stimulants as cognitive enhancements for focus or task completion, including transitioning to meth after first using prescription psychostimulants; (2) unique South Florida environment where participants could be open regarding their sexual minority status while also being influential on their stimulant use; (3) stimulant use as both stigmatizing and a coping mechanism for stigma. Participants anticipated stigma by family and potential sexual partners due to their stimulant use. They also reported using stimulants to cope with feelings of stigma due to their minoritized identities. CONCLUSION This study is among the first to characterize motivations for stimulant use in SMM living in South Florida. Results highlight both the risk and protective factors of the South Florida environment, psychostimulant misuse as a risk for meth initiation, and the role of anticipated stigma on stimulant use in SMM. Understanding stimulant use motivations can help to shape intervention development. This includes developing interventions that address individual, interpersonal, and cultural factors that drive stimulant use and increase risk of HIV acquisition. Trial registration NCT04205487.
Collapse
Affiliation(s)
| | - Ji-Young Lee
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | | | - Josè Colon-Burgos
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | | | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Adam W Carrico
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, Office 812, New York, NY, 10027, USA.
| |
Collapse
|
23
|
Davis TL, Mittal M, Oragwu AC, Wang MQ, Boekeloo BO. Examining HIV Diagnosis and Linkage to PrEP Prescription Among Members at An Integrated Health System in the Southeast United States. AIDS Behav 2023; 27:796-805. [PMID: 36097086 DOI: 10.1007/s10461-022-03812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) is a priority method for preventing HIV infection. This study's aims were threefold: (1) identify characteristics of members of a large health maintenance organization, Kaiser Permanente Georgia (KPGA), associated with HIV infection, (2) identify which member characteristics associated with HIV were also associated with PrEP prescription, and (3) identify which HIV-associated characteristics were associated with under- or over-prescribing of PrEP. Analysis of variables from the electronic medical record revealed that age, race, gender, mental health diagnosis, STI diagnosis, and sexual orientation were independently associated with HIV diagnosis. The same characteristics were independently associated with PrEP prescription except for race. Persons identifying as Black or unknown race, women, and/or heterosexual; and who had an STI diagnosis and/or illicit drug use had lower odds of being prescribed PrEP than of having an HIV diagnosis. The implications of these findings for improving physician identification of candidates for PrEP prescription are discussed.
Collapse
Affiliation(s)
- Teaniese L Davis
- Center for Health Research, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Mona Mittal
- Department of Family Science, University of Maryland School of Public Health, College Park, MD, USA
| | - Adanna C Oragwu
- Clinical Pharmacy , Kaiser Permanente Georgia, Atlanta, GA, USA.,Global Medical Affairs, Gilead Sciences, Foster City, CA, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr, 20742. 301-405-2463, College Park, MD, USA
| | - Bradley O Boekeloo
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr, 20742. 301-405-2463, College Park, MD, USA.
| |
Collapse
|
24
|
Pre-exposure Prophylaxis Persistence at a Diverse Sexual Health Clinic: Comparison of the pre-COVID-19 era to the COVID-19 era. AIDS Behav 2023:10.1007/s10461-023-03996-3. [PMID: 36738345 PMCID: PMC9898849 DOI: 10.1007/s10461-023-03996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic interrupted health care delivery and exacerbated disparities. Many sexual health clinics transitioned to telemedicine, including for pre-exposure prophylaxis (PrEP). We conducted a retrospective cohort study of patients at an urban sexual health clinic to assess the likelihood and predictors of PrEP persistence in the year following PrEP initiation. We compared patients starting PrEP in the four months preceding the first COVID surge to those starting PrEP one year prior. We found lower PrEP persistence in the COVID cohort compared to the pre-COVID cohort (50.8% vs. 68.9%, respectively). In both cohorts, most care was provided through in-person visits and telemedicine was rare. In the pre-COVID cohort, older patients and those identifying as non-Hispanic White were more likely to persist on PrEP. In the COVID cohort, these disparities in PrEP persistence were not observed. Flexible models of care may facilitate equitable care engagement and re-engagement.
Collapse
|
25
|
Chen CY, Donga P, Campbell AK, Taiwo B. Economic Burden of HIV in a Commercially Insured Population in the United States. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:10-19. [PMID: 36721765 PMCID: PMC9865714 DOI: 10.36469/001c.56928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
Background: With advances in antiretroviral therapy (ART), people with HIV infection are living longer. Pre-exposure prophylaxis (PrEP) to reduce HIV infection risk continues to be underutilized in high-risk individuals. Recent data on economic burden for patients with newly diagnosed HIV-1 or initiated with PrEP are limited. Objectives: To assess characteristics, healthcare resource utilization (HRU), and costs among adults and adolescents either with newly diagnosed HIV-1 or initiated with PrEP. Methods: This retrospective observational study utilized data from the IBM MarketScan® Commercial Claims and Encounters database. Adults with newly diagnosed HIV-1 or those initiated with PrEP were included (index date was the first HIV diagnosis or PrEP prescription, respectively, between January 1, 2016, and April 30, 2021). Corresponding cohorts of adolescents were considered exploratory. Descriptive analyses were conducted to assess baseline demographics and clinical characteristics, and all-cause and HIV-related HRU and costs per patient per month (PPPM) during follow-up. Results: Data from 18 154 adults and 220 adolescents with newly diagnosed HIV and 34 123 adults and 175 adolescents initiated with PrEP were included. Approximately 70% of adolescents and 9% of adults receiving PrEP were female. Baseline depression/anxiety was present in 16.1% and 24.6% of adults and 14.5% and 45.1% of adolescents in the HIV and PrEP cohorts, respectively. Substance abuse in the HIV and PrEP cohorts, respectively, was reported in 10.1% and 7.0% of adults, and 2.7% and 17.7% of adolescents. During follow-up, among adults with newly diagnosed HIV, mean (SD) total all-cause and HIV-related PPPM costs were $2657 ($5954) and $1497 ($4463), respectively; pharmacy costs represented 47% of all-cause costs and 67% of HIV-related costs, but only 37% of patients had an HIV-related prescription. All-cause costs PPPM for adults with PrEP were $1761 ($1938), with pharmacy costs accounting for 71%. Conclusions: Despite advances in ART, patients with newly diagnosed HIV and at-risk patients receiving PrEP continue to incur HRU costs. The chronic nature of HIV warrants further exploration of factors contributing to disease burden and opportunities to improve prevention strategies.
Collapse
Affiliation(s)
- Cindy Y Chen
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
26
|
Golub SA, Starbuck L, Fikslin R, Gamarel KE. Psychometric Evaluation and Predictive Validity of an Adapted Adherence Self-Efficacy Scale for PrEP. AIDS Behav 2023; 27:218-230. [PMID: 35809144 DOI: 10.1007/s10461-022-03758-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Adherence to and sustainment of HIV pre-exposure prophylaxis (PrEP) are critical to its effectiveness. Adherence self-efficacy, i.e., confidence in one's ability to adhere to a particular medication, is a key psychological determinant of health behavior that strongly predicts HIV treatment adherence but has been understudied in PrEP research. This paper describes the psychometric evaluation and validation of the PrEP Adherence Self-Efficacy Scale (PrEP-ASES), adapted from the previously validated HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Data are drawn from two studies conducted at a community health center, one focused on gay and bisexual cisgender men and the other on transgender women. Factor analyses support a one-factor score (eigenvalue = 6.78) that explained 75.3% of the variance, with good test-retest reliability (rs > 0.40). In both studies, higher PrEP-ASES scores were associated with PrEP uptake, adherence, and sustainment. Findings support the utility of the PrEP-ASES in research and suggest the importance of addressing self-efficacy in PrEP programs and services.
Collapse
Affiliation(s)
- Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA.
- Basic and Applied Social Psychology PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA.
| | - Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Rachel Fikslin
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
- Basic and Applied Social Psychology PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
27
|
McElyea J, Bistransin K, Bana S, Alvarez KS, Brown LS, Persaud D, King H. Impact of a clinical pharmacist within an HIV PrEP program for patients experiencing homelessness. J Am Pharm Assoc (2003) 2023; 63:324-329. [PMID: 36184385 DOI: 10.1016/j.japh.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) continues to be a concern in the United States despite pre-exposure prophylaxis (PrEP) being a highly recommended preventative option. Homeless populations have a significantly increased risk of HIV acquisition, and recent literature found attrition to PrEP care being concentrated in demographics common to these populations. Pharmacist-led PrEP programs may be a feasible option to combat this attrition, as they have shown high rates of patient satisfaction and pharmacist comfortability in other populations. OBJECTIVES To evaluate PrEP uptake and the continuum of care before and after a Clinical Pharmacy Specialist (CPS) expanded HIV prevention services within a primary care setting for persons experiencing homelessness. METHODS We compared a retrospective cohort of patients experiencing homelessness who received an initial PrEP prescription during a pre-CPS period and those with an initial PrEP prescription after CPS. Charts were reviewed through the surrounding time period of a 3-month and a 6-month PrEP follow-up appointment. Outcomes evaluated included number of initial PrEP prescriptions, dispensations of PrEP, PrEP discontinuations, patient retention in PrEP care, and new HIV diagnoses. RESULTS A total of 40 patients were included, with 10 initial PrEP prescriptions in the pre-CPS population and 30 in the post-CPS one. Both groups largely represented those disproportionately impacted by HIV. After CPS, more patients were enrolled in patient assistance programs (100% vs. 44%; P < 0.01), and more patients picked up the first PrEP dispensation (80% vs. 40%; P = 0.04). The overall population had low dispensation rates and retention to care. Having no CPS management and a lack of medical appointment attendance trended toward attrition of care, and having no patient assistance program enrollment significantly led to attrition of care. CONCLUSION These findings may prompt further studies and adaptations to PrEP care among persons experiencing homelessness, including the utilization of pharmacists to improve patient outcomes.
Collapse
|
28
|
Narain KDC, Harawa N. Evidence for the Role of State-Level Economic Policy in HIV Risk Reduction: State Earned Income Tax Credit Generosity and HIV Risk Behavior Among Single Mothers. AIDS Behav 2023; 27:182-188. [PMID: 35776251 PMCID: PMC9852166 DOI: 10.1007/s10461-022-03754-x] [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] [Accepted: 06/08/2022] [Indexed: 01/24/2023]
Abstract
We investigated the impact of State-level Earned Income Tax Credit (SEITC) generosity on HIV risk behavior among single mothers with low education. We merged individual-level data from the Behavioral Risk Factor Surveillance System (2002-2018) with state-level data from the University of Kentucky Center for Poverty Research and conducted a multi-state, multi-year difference-in-differences (DID) analysis. We found that a refundable SEITC ≥ 10% of the Federal Earned Income Tax Credit was associated with 21% relative risk reduction in reporting any high-risk behavior for HIV in the last year, relative to no SEITC. We also found that a 10-percentage point increase in SEITC generosity was associated with 38% relative risk reduction in reporting any high-risk HIV behavior in the last year. SEITC policy may be an important strategy to reduce the burden of HIV infections among women with low socioeconomic status, particularly single mothers.
Collapse
Affiliation(s)
- Kimberly Danae Cauley Narain
- grid.19006.3e0000 0000 9632 6718Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA (DGSOM), University of California, Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Center for Health Advancement, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA USA ,Center for the Study of Racism, Social Justice, and Health Los Angeles, Los Angeles, CA USA
| | - Nina Harawa
- grid.19006.3e0000 0000 9632 6718Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA (DGSOM), University of California, Los Angeles, Los Angeles, CA USA ,Center for the Study of Racism, Social Justice, and Health Los Angeles, Los Angeles, CA USA ,grid.254041.60000 0001 2323 2312Department of Psychiatry, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA USA
| |
Collapse
|
29
|
Xiao P, Gumber S, Marzinke MA, Hoang T, Myers R, Date AA, Hanes J, Ensign LM, Wang L, Rohan LC, Cone R, Fuchs EJ, Hendrix CW, Villinger F. Hypo-osmolar rectal douche tenofovir formulation prevents simian/human immunodeficiency virus acquisition in macaques. JCI Insight 2022; 7:161577. [PMID: 36477356 PMCID: PMC9746910 DOI: 10.1172/jci.insight.161577] [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: 05/04/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
In spite of the rollout of oral pre-exposure prophylaxis (PrEP), the rate of new HIV infections remains a major health crisis. In the United States, new infections occur predominantly in men having sex with men (MSM) in rural settings where access to PrEP can be limited. As an alternative congruent with MSM sexual behavior, we have optimized and tested tenofovir (TFV) and analog-based iso-osmolar and hypo-osmolar (HOsm) rectal douches for efficacy against rectal simian/human immunodeficiency virus (SHIV) infection of macaques. Single TFV HOsm high-dose douches achieved peak plasma TFV levels similar to daily oral PrEP, while other formulations yielded lower concentrations. Rectal tissue TFV-diphosphate (TFV-DP) concentrations at the portal of virus entry, however, were markedly higher after HOsm douching than daily oral PrEP. Repeated douches led to significantly higher plasma TFV and higher TFV-DP concentrations in rectal tissue at 24 hours compared with single douches, without detectable mucosal or systemic toxicity. Using stringent repeated intrarectal SHIV exposures, single HOsm high-dose douches delivered greater protection from virus acquisition for more than 24 hours compared with oral PrEP. Our results demonstrate a rapid delivery of protective TFV doses to the rectal portal of virus entry as a potential low-cost and safe PrEP alternative.
Collapse
Affiliation(s)
- Peng Xiao
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Sanjeev Gumber
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Mark A Marzinke
- Division of Clinical Pharmacology, Department of Medicine.,Department of Pathology
| | - Thuy Hoang
- Center for Nanomedicine; and.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rohan Myers
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| | - Abhijit A Date
- Center for Nanomedicine; and.,Department of Pharmacology and Toxicology, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, Arizona, USA.,Department of Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona, USA
| | - Justin Hanes
- Center for Nanomedicine; and.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura M Ensign
- Center for Nanomedicine; and.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Lin Wang
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Lisa C Rohan
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
| | - Richard Cone
- Division of Clinical Pharmacology, Department of Medicine
| | - Edward J Fuchs
- Division of Clinical Pharmacology, Department of Medicine
| | - Craig W Hendrix
- Division of Clinical Pharmacology, Department of Medicine.,Center for Nanomedicine; and.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Francois Villinger
- New Iberia Research Center, University of Louisiana at Lafayette, New Iberia, Louisiana, USA
| |
Collapse
|
30
|
Xu Q, McMann T, Godinez H, Nali MC, Li J, Cai M, Merenda C, Lee C, Araojo R, Mackey TK. Impact of COVID-19 on HIV Prevention Access: A Multi-platform Social Media Infodemiology Study. AIDS Behav 2022; 27:1886-1896. [PMID: 36471205 PMCID: PMC9734820 DOI: 10.1007/s10461-022-03922-z] [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] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
This study seeks to identify and characterize key barriers associated with PrEP therapy as self-reported by users on social media platforms. We used data mining and unsupervised machine learning approaches to collect and analyze COVID-19 and PrEP-related posts from three social media platforms including Twitter, Reddit, and Instagram. Predominant themes detected by unsupervised machine learning and manual annotation included users expressing uncertainty about PrEP treatment adherence due to COVID-19, challenges related to accessibility of clinics, concerns about PrEP costs and insurance coverage, perceived lower HIV risk leading to lack of adherence, and misinformation about PrEP use for COVID-19 prevention.
Collapse
Affiliation(s)
- Qing Xu
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA
| | - Tiana McMann
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| | | | - Matthew C. Nali
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| | | | | | - Christine Merenda
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Christine Lee
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Richardae Araojo
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Tim K. Mackey
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| |
Collapse
|
31
|
Beer L, Tie Y, Dasgupta S, McManus T, Smith DK, Shouse RL. Trends in preexposure prophylaxis use among sex partners as reported by persons with HIV - United States, May 2015-June 2020. AIDS 2022; 36:2161-2169. [PMID: 36382435 PMCID: PMC11057891 DOI: 10.1097/qad.0000000000003366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate trends in the proportion of sexually active U.S. adults with HIV (PWH) reporting an HIV-discordant sexual partner taking preexposure prophylaxis (PrEP) and proportion of partners taking PrEP. DESIGN The Medical Monitoring Project is a complex sample survey of U.S. adults with diagnosed HIV. METHODS We used annual cross-sectional data collected during June 2015-May 2020 to estimate the annual percentage change (EAPC), overall and by selected characteristics, in reported partner PrEP use among PWH with HIV-discordant partners (N = 8707) and reported PrEP use among these partners (N = 15 844). RESULTS The proportion of PWH reporting PrEP use by one or more HIV-discordant sex partner rose 19.5% annually (11.3 to 24.4%). The prevalence rose from 6.0 to 17.4% (EAPC, 25.8%) among Black PWH, 10.1 to 26.0% (EAPC, 19.5%) among Hispanic/Latino PWH, and 20.8 to 34.6% (EAPC, 16.3%) among White PWH. Among MSM with HIV, the prevalence increased from 9.6 to 32.6% (EAPC, 28.2%) among Black MSM, 16.6 to 36.0% (EAPC, 15.6%) among Hispanic/Latino MSM, and 24.9 to 44.1% (EAPC, 17.9%) among White MSM. Among HIV-discordant sex partners, the proportion reported to be taking PrEP increased 21.1% annually (7.8 to 18.8%). Reported PrEP use rose from 4.9 to 14.2% (EAPC, 29.9%) among Black partners, 6.5 to 16.8% (EAPC, 20.3%) among Hispanic/Latino partners, and 12.7 to 26.1% (EAPC, 17.0%) among White partners. CONCLUSIONS One in five HIV-discordant sexual partners of PWH was reported to be taking PrEP. PrEP use rose among all examined populations, although the increases did not eliminate disparities in PrEP use.
Collapse
Affiliation(s)
- Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | | | | |
Collapse
|
32
|
McLean J, Bartram L, Zucker J, LaSota E, Carnevale C, Richards P, Perez E, Mori K, Mgbako O, Olender S, Cohall A, Gordon P, Sobieszczyk M. Back2PrEP: Rates of Bacterial Sexually Transmitted Infection Diagnosis Among Individuals Returning to HIV Pre-Exposure Prophylaxis Care: A Retrospective Review of a New York City Comprehensive HIV Prevention Program. AIDS Patient Care STDS 2022; 36:458-461. [PMID: 36383140 PMCID: PMC9805874 DOI: 10.1089/apc.2022.0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) effectively reduces new HIV diagnoses. High rates of incident bacterial sexually transmitted infections (STIs) have been observed in patients eligible for and adherent to PrEP. Observational studies generally report low long-term retention in PrEP care. Limited data exist on the rates of bacterial STI diagnosis upon re-engagement with PrEP services. We conducted a retrospective chart review within the HIV prevention program of an urban academic medical center in New York City. Eligible patients started PrEP from 2015 to 2019, then resumed PrEP services after a gap in care of at least 180 days. Demographic, clinical, and laboratory data were used to characterize the patient population and rates of bacterial STI diagnosis at re-engagement. In total, 286 patients were identified, with 316 qualifying re-engagement visits. Twenty-nine percent of patients had continued PrEP during the care gap, and 30% reported discontinuing medication due to a perceived change in risk. A new STI was diagnosed at 19% of re-engagement visits. There was no statistically significant difference in rates of new STI between individuals returning on or off PrEP, nor between those with perceived lower risk and those without. Individuals who fall out of PrEP services and subsequently re-engage remain at high risk of bacterial STI during the gap in care, regardless of whether PrEP medication is continued or the patient perceives themselves to be at lower HIV acquisition risk. Providers should strongly encourage patients discontinuing PrEP to remain engaged in sexual health services. Alternatives to clinic-based PrEP care must still include regular bacterial STI screening.
Collapse
Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Logan Bartram
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jason Zucker
- Divisions of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Elijah LaSota
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Caroline Carnevale
- HIV Prevention Program, New York Presbyterian/Columbia University Irving Medical Center Hospital Comprehensive Health Program, New York City, New York, USA
| | - Paul Richards
- HIV Prevention Program, New York Presbyterian/Columbia University Irving Medical Center Hospital Comprehensive Health Program, New York City, New York, USA
| | - Edward Perez
- HIV Prevention Program, New York Presbyterian/Columbia University Irving Medical Center Hospital Comprehensive Health Program, New York City, New York, USA
| | - Kanako Mori
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Ofole Mgbako
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York City, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Alwyn Cohall
- Sociomedical Sciences, Population and Family Health, and Pediatrics, Mailman School of Public Health and Columbia University Medical Center, New York City, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| |
Collapse
|
33
|
Valente PK, Bauermeister JA, Lin WY, Silva DTD, Hightow-Weidman L, Drab R, Mayer KH, Operario D, Rusley J, Biello KB. Preferences Across Pre-Exposure Prophylaxis Modalities Among Young Men Who Have Sex with Men in the United States: A Latent Class Analysis Study. AIDS Patient Care STDS 2022; 36:431-442. [PMID: 36367995 PMCID: PMC9910107 DOI: 10.1089/apc.2022.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Access to daily oral pre-exposure prophylaxis (PrEP) is suboptimal among young cisgender men who have sex with men (YMSM) in the United States. Next-generation modalities that do not involve daily oral regimens may mitigate some of the barriers to PrEP use. We identified latent classes of YMSM based on health care decision-making patterns and examined associations between latent classes and access to health care and PrEP modality preferences (i.e., daily and event-driven oral, rectal douches, broadly neutralizing antibodies, subcutaneous implants, and an injectable). Between October 2020 and June 2021, we administered an online survey to 737 YMSM. Latent class analysis (LCA) identified groups of YMSM based on communication with providers, stigma and mistrust in health care, and autonomy in sexual health decisions. Logistic regression examined associations between class membership and health care access, and exploded logit regression examined associations between class membership and ranked PrEP modality preferences. LCA identified three classes: shared decision-making (high communication with providers and high autonomy); provider-led decision-making (high communication and low autonomy); and patient-driven decision-making (low communication and high autonomy). Shared decision-making was associated with higher access to health care in comparison with the other classes. Across all classes, YMSM preferred daily oral PrEP over all next-generation PrEP modalities. Preferences for daily oral PrEP over next-generation PrEP modalities were particularly marked among the patient-driven decision-making class. Shared decision-making is associated with access to health care and HIV prevention and higher acceptability of next-generation PrEP modalities, and should be considered as part of future interventions to promote use of daily oral and next-generation PrEP.
Collapse
Affiliation(s)
- Pablo K. Valente
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Willey Y. Lin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Teixeira Da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Hightow-Weidman
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jack Rusley
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katie B. Biello
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| |
Collapse
|
34
|
Drallmeier T, Garrett EK, Meyr A, Salas J, Scherrer JF. Demographic factors, psychiatric and physical comorbidities associated with starting preexposure prophylaxis in a nationally distributed cohort. Prev Med 2022; 164:107344. [PMID: 36368340 DOI: 10.1016/j.ypmed.2022.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Due to a large number of small studies and limited control for confounding, existing evidence regarding patient characteristics associated with PrEP initiation is inconsistent. We used a large electronic health record cohort to determine which demographic, physical morbidity and psychiatric conditions are associated with PrEP initiation. Eligible adult (≥18 years) patients were selected from the Optum® de-identified Electronic Health Record dataset (2010-2018). Non-HIV sexually transmitted diseases and high risk sexual behavior was used to identify patients eligible for PrEP. A fully adjusted Poisson regression model estimated the association between age, gender, race, insurance status, comorbidity index, depression, anxiety, dysthymia, severe mental illness, substance use disorder and nicotine dependence/smoking and rate of PrEP initiation. The cohort (n = 30,909) was mostly under 40 years of age (64.3%), 67.6% were female and 58.2% were White. The cumulative incidence of PrEP initiation was 1.3% (n = 408). Patients ≥60 years of age, compared to 18-29 year olds and Black compared to White patients had significantly lower rates of PrEP initiation. Anxiety disorder was significantly associated with higher rate of PrEP initiation (RR = 1.67; 95%CI:1.20-2.33) and nicotine dependence/smoking with a lower rate (RR = 0.73; 95%CI:0.54-0.97). PrEP is underutilized, and a race disparity exists in PrEP initiation. In the context of existing research, nicotine dependence/smoking is the patient characteristic most consistently associated lower rates of starting PrEP. Given the high prevalence of smoking in PrEP eligible patients, physicians may want to integrate discussions of smoking cessation in patient-provider decisions to start PrEP.
Collapse
Affiliation(s)
- Theresa Drallmeier
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA.
| | - Elizabeth Keegan Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Ashley Meyr
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, USA; Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4(th) Floor, St. Louis, MO 63104, USA
| |
Collapse
|
35
|
Jimenez V, Thornton N, Tilchin C, Ghanem KG, Ruhs S, Hamill MM, Rompalo A, Jennings JM. Psychological distress and adherence to anti-retroviral therapy or pre-exposure prophylaxis regimens among Urban Black gay and bisexual men (MSM). Int J STD AIDS 2022; 33:1005-1012. [PMID: 36028928 DOI: 10.1177/09564624221123466] [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: 11/17/2022]
Abstract
BACKGROUND Urban Black gay, and bisexual men (MSM) bear a disproportionate burden of HIV in the U.S. Mental health is a barrier to adherence to both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). The objective was to determine the association between psychological distress and ART or PrEP adherence among urban Black MSM. METHODS Using data from a four-year prospective cohort study, adherence to ART was defined as > 95% and PrEP was defined as > 80% of doses taken in the past 30 days. Psychological distress measures included difficulty sleeping; feeling anxious; suicidality; feeling sad or depressed; feeling sick, ill, or not well in the past 3 months; high (vs. low) overall psychological distress was classified as above the median value. Associations were examined using Chi-square, Fisher's exact tests, and logistic regression. RESULTS Among 165 Black MSM, 44.2% (73) reported high psychological distress. 65.3% (47/72) of participants living with HIV and 39.8% (37/93) of HIV negative participants were ART or PrEP adherent, respectively. Education was significantly associated with PrEP adherence (p = 0.038). Non-injection drug use in the past 3 months (p = 0.008), difficulty sleeping (p = 0.010), feeling anxious (p = 0.003), and feeling sad or depressed (p < 0.001), and overall psychological distress (p < 0.001) were significantly associated with ART adherence. High psychological distress was significantly associated with a reduced odds of ART adherence (aOR 0.23; 95% CI = 0.08-0.70) adjusting for age and non-injection drug use. CONCLUSIONS Increased psychological distress was significantly associated with ART nonadherence and may represent an important barrier to viral suppression.
Collapse
Affiliation(s)
- Valeria Jimenez
- Krieger School of Arts and Sciences, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Nicole Thornton
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Carla Tilchin
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health, Behavior, and Society, 1500Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Khalil G Ghanem
- Division of Infectious Diseases, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Matthew M Hamill
- Division of Infectious Diseases, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.,STI/HIV Program, 217334Baltimore City Health Department, Baltimore, MD, USA
| | - Anne Rompalo
- Division of Infectious Diseases, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacky M Jennings
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, 1500Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health, Behavior, and Society, 1500Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, 1500Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
36
|
Ramchandani MS, Berzkalns A, Cannon CA, Dombrowski JC, Ocbamichael N, Khosropour CM, Barbee LA, Golden MR. A Demedicalized Model to Provide PrEP in a Sexual Health Clinic. J Acquir Immune Defic Syndr 2022; 90:530-537. [PMID: 35499503 PMCID: PMC9283215 DOI: 10.1097/qai.0000000000003005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexual health clinics (SHCs) serve large numbers of patients who might benefit from preexposure prophylaxis (PrEP). Integrating longitudinal PrEP care into SHCs can overburden clinics. We implemented an SHC PrEP program that task shifted most PrEP operations to nonmedical staff, disease intervention specialists (DIS). METHODS We conducted a retrospective cohort analysis of PrEP patients in an SHC in Seattle, WA, from 2014 to 2020 to assess the number of patients served and factors associated with PrEP discontinuation. Clinicians provide same-day PrEP prescriptions, whereas DIS coordinate the program, act as navigators, and provide most follow-up care. RESULTS Between 2014 and 2019, 1387 patients attended an initial PrEP visit, 93% of whom were men who have sex with men. The number of patients initiating PrEP per quarter year increased from 20 to 81. The number of PrEP starts doubled when the clinic shifted from PrEP initiation at scheduled visits to initiation integrated into routine walk-in visits. The percentage of visits performed by DIS increased from 3% in 2014 to 45% in 2019. Median duration on PrEP use was 11 months. PrEP discontinuation was associated with non-Hispanic black race/ethnicity [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.02 to 1.76], age <20 years (HR 2.17, 95% CI: 1.26 to 3.75), age between 20 and 29 years (HR 1.55, 95% CI: 1.06 to 2.28), and methamphetamine use (HR 1.98, 95% CI: 1.57 to 2.49). The clinic had 750 patients on PrEP in the final quarter of 2019. CONCLUSIONS A demedicalized SHC PrEP model that task shifts most operations to DIS can provide PrEP at scale to high priority populations.
Collapse
Affiliation(s)
- Meena S Ramchandani
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
| | - Anna Berzkalns
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
| | - Chase A Cannon
- Department of Medicine, University of Washington, Seattle, WA
| | - Julia C Dombrowski
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | | | - Lindley A Barbee
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
| | - Matthew R Golden
- Department of Medicine, University of Washington, Seattle, WA
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA; and
- Department of Epidemiology, University of Washington, Seattle, WA
| |
Collapse
|
37
|
Rosen JG, Zhang L, Pelaez D, Coleman JS, To C, Cooper L, Olatunde PF, Toomre T, Glick JL, Park JN. Provider Perspectives on HIV Pre-Exposure Prophylaxis Service Disruptions and Adaptations During the COVID-19 Pandemic in Baltimore, Maryland: A Qualitative Study. AIDS Patient Care STDS 2022; 36:313-320. [PMID: 35951445 PMCID: PMC9419971 DOI: 10.1089/apc.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic continues driving unprecedented disruptions to health care provision, including HIV pre-exposure prophylaxis (PrEP) services. We explored service provider experiences promoting and prescribing PrEP to marginalized populations during the COVID-19 pandemic in Baltimore, Maryland. In February to April 2021, we facilitated four virtual focus group discussions with 20 PrEP providers, representing various professional cadres and practice settings. Employing an iterative, team-based thematic analysis, we identified salient enablers and constraints to PrEP promotion, initiation, and maintenance in the COVID-19 era, along with innovative adaptations to PrEP service delivery. Discussants described attenuated demands for PrEP early in the pandemic, exemplified by high PrEP discontinuation rates. This was attributed to changes in clients' sexual behaviors and shifting priorities, including caregiving responsibilities, during the pandemic. Substantial systems-level disruptions impacting PrEP provision were identified, including outreach service suspension, personnel shortages, and facility restrictions on face-to-face visits. Providers emphasized that these disruptions, though occurring early in the pandemic, had protracted impacts on PrEP accessibility. The transition to telemedicine rendered health care services, including PrEP, more accessible/convenient to some clients and expeditious to providers. However, structural barriers to telehealth engagement (telephone/internet access), coupled with limitations of the virtual care environment (difficulty establishing rapport), impeded efforts to equitably promote and prescribe PrEP. Expanding the PrEP outreach workforce and availing alternatives to telemedicine (e.g., community-based PrEP provision, specimen self-collection) could facilitate PrEP care continuity, especially as COVID-19 transitions from an acute to a protracted health crisis.
Collapse
Affiliation(s)
- Joseph G Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leanne Zhang
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle Pelaez
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jenell S Coleman
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - C To
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lyra Cooper
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Praise F Olatunde
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Teagan Toomre
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Glick
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Research Excellence on Opioids and Overdose, Rhode Island Hospital, Providence, Rhode Island, USA
| |
Collapse
|
38
|
Gaps in HIV PrEP Care Following State Partner Services for Massachusetts Primary and Secondary Syphilis Cases, 2017-2018. Sex Transm Dis 2022; 49:657-661. [PMID: 35797587 DOI: 10.1097/olq.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition. We used a PrEP continuum of care to measure impact of field epidemiologist-facilitated referrals for PrEP-naïve infectious syphilis cases across multiple clinical and pharmacy sites of care. METHODS Retrospective analysis of 2017-2018 primary and secondary syphilis cases, medical charts, and pharmacy data to identify PrEP education, referral offer, referral acceptance, first visit, prescription pickup (PrEP initiation) and 2-3 months (PrEP persistence). HIV seroconversion was determined using database match at syphilis diagnosis date and at 12 months. Chi-square or Fisher's exact tests were used to compare demographic characteristics associated with steps with lower progression rates. RESULTS Of 1077 syphilis cases, partner services engaged 662/787 (84%) HIV-negative cases; 490 were PrEP-naïve, 266 received education, 166 were offered referral, 67 accepted referral, 30 attended an initial appointment, and 22 were prescribed PrEP. Of 16 with pharmacy data, 14 obtained medication, and 8 persisted on PrEP at 2-3 months. Continuum progression was lowest from (1) PrEP-naïve to receiving PrEP education, (2) offered referral to referral acceptance, and (3) referral acceptance to initial PrEP appointment. Males with male partners were more likely to receive PrEP education or accept a referral. Higher social vulnerability was associated with increased PrEP referral acceptance. CONCLUSIONS Few individuals accepted PrEP referrals and persisted on PrEP. Field and clinic data capture were inconsistent, possibly underestimating referral volume and impact of field engagement. Efforts aimed at increasing referral acceptance and clinic attendance may improve PrEP uptake especially among women and heterosexual men with syphilis.
Collapse
|
39
|
Streed CG, Morgan JR, Gai MJ, Larochelle MR, Paasche-Orlow MK, Taylor JL. Prevalence of HIV Preexposure Prophylaxis Prescribing Among Persons With Commercial Insurance and Likely Injection Drug Use. JAMA Netw Open 2022; 5:e2221346. [PMID: 35819784 PMCID: PMC9277489 DOI: 10.1001/jamanetworkopen.2022.21346] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/21/2022] [Indexed: 11/26/2022] Open
Abstract
Importance Although HIV preexposure prophylaxis (PrEP) implementation among persons who inject drugs has been inadequate, national HIV monitoring programs do not include data on PrEP, and specific trends in PrEP use are not well understood. Objective To estimate HIV PrEP uptake among commercially insured persons with opioid or stimulant use disorder by injection drug use (IDU) status. Design, Setting, and Participants This cross-sectional study used deidentified data from the MarketScan Commercial Claims and Encounters Database to identify a sample of 547 709 commercially insured persons without HIV but with opioid and/or stimulant use disorder, including 110 592 with evidence of IDU between January 1, 2010, and December 31, 2019. Data were analyzed from November 1, 2020, to July 1, 2021. Exposures Persons with opioid and/or stimulant use disorder and evidence of IDU were identified through claims data. Main Outcomes and Measures The outcome was receipt of tenofovir disoproxil fumarate and emtricitabine for PrEP as identified from filled pharmacy claims. Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with receipt of PrEP. Results The study cohort included 211 609 (28.6%) females and 336 100 (61.4%) males with a combined mean (SD) age of 34.8 (13.1) years, including 110 592 individuals with evidence of IDU. During the study period, 508 (0.09%) persons with opioid and/or stimulant use disorder, including 170 (0.15%) with evidence of IDU, received PrEP. Receipt of PrEP increased from 0.001 to 0.243 per 100 person-years from 2010 through 2019 among the entire cohort and from 0.000 to 0.295 per 100 person-years among those with IDU. In multivariable analysis, PrEP use was more likely among males (adjusted odds ratio [aOR] 8.72; 95% CI, 6.39-11.89), persons with evidence of IDU (aOR, 1.47; 95% CI, 1.21-1.79), and persons with evidence of sexual risk indications for PrEP (aOR, 23.68; 95% CI, 19.57-28.66). Conclusions and Relevance In this cross-sectional study of commercially insured persons with opioid and/or stimulant use disorder, HIV PrEP delivery remained low, including among those with evidence of IDU. PrEP should be consistently offered alongside substance use disorder treatment and other harm reduction and HIV prevention services.
Collapse
Affiliation(s)
- Carl G. Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
- Center for Transgender Medicine and Surgery, Boston Medical Center, Massachusetts
| | - Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts
| | - Mam Jarra Gai
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
| | - Marc R. Larochelle
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Massachusetts
| | - Michael K. Paasche-Orlow
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
| | - Jessica L. Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Massachusetts
- Grayken Center for Addiction, Boston Medical Center, Massachusetts
| |
Collapse
|
40
|
Parikh UM, Mellors JW. How could HIV-1 drug resistance impact preexposure prophylaxis for HIV prevention? Curr Opin HIV AIDS 2022; 17:213-221. [PMID: 35762376 PMCID: PMC9245149 DOI: 10.1097/coh.0000000000000746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review current laboratory and clinical data on the frequency and relative risk of drug resistance and range of mutations selected from approved and investigational antiretroviral agents used for preexposure prophylaxis (PrEP) of HIV-1 infection, including tenofovir disproxil fumarate (TDF)-based oral PrEP, dapivirine ring, injectable cabotegravir (CAB), islatravir, lenacapavir and broadly neutralizing antibodies (bNAbs). RECENT FINDINGS The greatest risk of HIV-1 resistance from PrEP with oral TDF/emtricitabine (FTC) or injectable CAB is from starting or continuing PrEP after undiagnosed acute HIV infection. By contrast, the dapivirine intravaginal ring does not appear to select nonnucleoside reverse transcriptase inhibitor resistance in clinical trial settings. Investigational inhibitors including islatravir, lenacapavir, and bNAbs are promising for use as PrEP due to their potential for sustained delivery and low risk of cross-resistance to currently used antiretrovirals, but surveillance for emergence of resistance mutations in more HIV-1 gene regions (gag, env) will be important as the same drugs are being developed for HIV therapy. SUMMARY PrEP is highly effective in preventing HIV infection. Although HIV drug resistance from PrEP use could impact future options in individuals who seroconvert on PrEP, the current risk is low and continued monitoring for the emergence of resistance and cross-resistance during product development, clinical studies, and product roll-out is advised to preserve antiretroviral efficacy for both treatment and prevention.
Collapse
Affiliation(s)
- Urvi M Parikh
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
41
|
Sexually Transmitted Infection Testing, Prevalence, and Treatment among Individuals Receiving HIV Pre-Exposure Prophylaxis within an Integrated Healthcare Delivery System. Sex Transm Dis 2022; 49:616-621. [PMID: 35724111 DOI: 10.1097/olq.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Initial and follow-up sexually transmitted infection (STI) and HIV testing is recommended when taking HIV preexposure prophylaxis (PrEP). We assessed STI services before and after PrEP initiation among persons aged ≥18 years. METHODS We conducted this retrospective cohort study at an US integrated healthcare delivery system. We measured HIV/STI testing rates, STI prevalence and treatment at 3 time points: (1) at PrEP initiation, (2) at 120 days, and (3) at 210 days. RESULTS Of 685 PrEP initiators, 67.2% continued PrEP use at 120 days and 49.5% at 210 days. Of PrEP users, HIV and STI testing were > 85% and > 80%, respectively, at all 3 time points. Prevalence for any chlamydia, rectal chlamydia, and any gonorrhea, rectal gonorrhea, or pharyngeal gonorrhea was always high at the 120 days and 210 days (e.g, 6.9%, 10.5%, 6.7%, 5.0%, and 5.2%, respectively, at the 120-days for continuous PrEP users). Over 90% of all individuals who tested positive for chlamydia and/or gonorrhea received antibiotic pharmacy fills within seven days at 120 days and 210 days. Monthly PrEP-related pharmacy cost was about $2259-$2659. The proportion of the total medical cost that was PrEP-related pharmacy was about 82% for PrEP continuous users. CONCLUSIONS Although HIV/STI testing rates were high, they can still be improved during HIV PrEP management. High STI prevalence after PrEP initiation in this study suggests that patients taking PrEP are at risk of acquiring an STI. Interventions to improve STI services during PrEP management are continuously needed.
Collapse
|
42
|
Cespedes M, Das M, Hojilla JC, Blumenthal J, Mounzer K, Ramgopal M, Hodge T, Torres TS, Peterson C, Shibase S, Elliott A, Demidont AC, Callaghan L, Watson CC, Carter C, Kintu A, Baeten JM, Ogbuagu O. Proactive strategies to optimize engagement of Black, Hispanic/Latinx, transgender, and nonbinary individuals in a trial of a novel agent for HIV pre-exposure prophylaxis (PrEP). PLoS One 2022; 17:e0267780. [PMID: 35657826 PMCID: PMC9165827 DOI: 10.1371/journal.pone.0267780] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Black and Hispanic/Latinx cisgender men who have sex with men (MSM), transgender women, transgender men, and gender nonbinary (TGNB) individuals have been historically underrepresented in HIV pre-exposure prophylaxis (PrEP) clinical trials. There is an urgent need for ongoing engagement with communities that have been the most impacted by HIV and diverse representation in clinical trials. Here we describe strategic approaches undertaken in the PURPOSE 2 trial to optimize engagement of underrepresented individuals. METHODS AND RESULTS PURPOSE 2 is an ongoing Phase 3 trial evaluating the safety and efficacy of lenacapavir as PrEP in cisgender MSM and TGNB individuals. In PURPOSE 2, we used a multipronged approach aimed at enriching participation of underrepresented individuals. We conducted a review to identify evidence-informed recommendations from literature, engaged with stakeholders, and established the Global Community Advisory and Accountability Group (GCAG) to represent the needs of the community. Insights from stakeholders and GCAG members resulted in an expansion of the study population to include transgender men, gender nonbinary persons, and adolescents, and evaluation of population-specific outcomes. Feedback from stakeholders and GCAG members also informed investigator and site selection; these were selected based on prior experience working with persons from diverse racial, ethnic and gender identities, and estimates of local HIV incidence. Site selection was also expanded to include community-based clinics with services tailored towards Black, Hispanic/Latinx, and TGNB populations. We established a study-wide recruitment goal of 50% Black MSM and 20% Hispanic/Latinx MSM in US sites and 20% transgender women globally. Site-specific recruitment goals were also developed based on local demographics and HIV incidence. Mandatory trainings included Good Participatory Practice guidelines, gender inclusivity, and antiracism. CONCLUSION While further work is needed to achieve equitable representation, the strategies we describe may serve as a framework for future clinical trials. TRIAL REGISTRATION Clinical Trial Number: NCT04925752.
Collapse
Affiliation(s)
- Michelle Cespedes
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Moupali Das
- Gilead Sciences, Foster City, CA, United States of America
| | | | - Jill Blumenthal
- Department of Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Karam Mounzer
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, United States of America
| | - Moti Ramgopal
- Midway Research Center, Fort Pierce, FL, United States of America
| | - Theo Hodge
- Washington Health Institute, Washington, DC, United States of America
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Charles Peterson
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States of America
| | | | - Ayana Elliott
- Gilead Sciences, Foster City, CA, United States of America
| | - A. C. Demidont
- Gilead Sciences, Foster City, CA, United States of America
| | | | | | | | - Alex Kintu
- Gilead Sciences, Foster City, CA, United States of America
| | | | - Onyema Ogbuagu
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, United States of America
| |
Collapse
|
43
|
Coyer L, Hoornenborg E. Reaching the full preventive potential of HIV pre-exposure prophylaxis. THE LANCET PUBLIC HEALTH 2022; 7:e488-e489. [DOI: 10.1016/s2468-2667(22)00116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022] Open
|
44
|
Marcus JL, Krakower DS. Making PrEP easy. THE LANCET HIV 2022; 9:e226-e228. [DOI: 10.1016/s2352-3018(22)00036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
|
45
|
Hojilla JC, Hurley LB, Marcus JL, Satre DD, Silverberg MJ, Zaritsky EF, Getahun D, Goodman M, Volk JE. HIV Pre-exposure Prophylaxis Continuum of Care Among Transgender Individuals in an Integrated Health care System. J Acquir Immune Defic Syndr 2022; 89:e30. [PMID: 34723924 PMCID: PMC8837673 DOI: 10.1097/qai.0000000000002853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J. Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Leo B. Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Eve F. Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Centre, Oakland, CA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan E. Volk
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Centre, San Francisco, CA, USA
| |
Collapse
|
46
|
Watson DL, Shaw PA, Petsis DT, Pickel J, Bauermeister JA, Frank I, Wood SM, Gross R. A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014-2019. J Int AIDS Soc 2022; 25:e25867. [PMID: 35192740 PMCID: PMC8863354 DOI: 10.1002/jia2.25867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Youth account for a disproportionate number of new HIV infections; however, pre-exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non-Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. METHODS We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient- and healthcare-level factors. RESULTS Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. CONCLUSIONS PrEP counselling and uptake among U.S. non-Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP-inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.
Collapse
Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Pamela A. Shaw
- Kaiser Permanente Washington Health Research InstituteSeattleWashingtonUSA
| | - Danielle T. Petsis
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julia Pickel
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family & Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ian Frank
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Sarah M. Wood
- Craig Dalsimer Division of Adolescent MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- PolicyLabChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Robert Gross
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of BiostatisticsEpidemiology and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| |
Collapse
|
47
|
Xu Q, Nali MC, McMann T, Godinez H, Li J, He Y, Cai M, Lee C, Merenda C, Araojo R, Mackey TK. Unsupervised Machine Learning to Detect and Characterize Barriers to Pre-exposure Prophylaxis Therapy: Multiplatform Social Media Study. JMIR INFODEMIOLOGY 2022; 2:e35446. [PMID: 37113799 PMCID: PMC10014091 DOI: 10.2196/35446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/18/2022] [Accepted: 03/07/2022] [Indexed: 04/29/2023]
Abstract
Background Among racial and ethnic minority groups, the risk of HIV infection is an ongoing public health challenge. Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV when taken as prescribed. However, there is a need to understand the experiences, attitudes, and barriers of PrEP for racial and ethnic minority populations and sexual minority groups. Objective This infodemiology study aimed to leverage big data and unsupervised machine learning to identify, characterize, and elucidate experiences and attitudes regarding perceived barriers associated with the uptake and adherence to PrEP therapy. This study also specifically examined shared experiences from racial or ethnic populations and sexual minority groups. Methods The study used data mining approaches to collect posts from popular social media platforms such as Twitter, YouTube, Tumblr, Instagram, and Reddit. Posts were selected by filtering for keywords associated with PrEP, HIV, and approved PrEP therapies. We analyzed data using unsupervised machine learning, followed by manual annotation using a deductive coding approach to characterize PrEP and other HIV prevention-related themes discussed by users. Results We collected 522,430 posts over a 60-day period, including 408,637 (78.22%) tweets, 13,768 (2.63%) YouTube comments, 8728 (1.67%) Tumblr posts, 88,177 (16.88%) Instagram posts, and 3120 (0.6%) Reddit posts. After applying unsupervised machine learning and content analysis, 785 posts were identified that specifically related to barriers to PrEP, and they were grouped into three major thematic domains: provider level (13/785, 1.7%), patient level (570/785, 72.6%), and community level (166/785, 21.1%). The main barriers identified in these categories included those associated with knowledge (lack of knowledge about PrEP), access issues (lack of insurance coverage, no prescription, and impact of COVID-19 pandemic), and adherence (subjective reasons for why users terminated PrEP or decided not to start PrEP, such as side effects, alternative HIV prevention measures, and social stigma). Among the 785 PrEP posts, we identified 320 (40.8%) posts where users self-identified as racial or ethnic minority or as a sexual minority group with their specific PrEP barriers and concerns. Conclusions Both objective and subjective reasons were identified as barriers reported by social media users when initiating, accessing, and adhering to PrEP. Though ample evidence supports PrEP as an effective HIV prevention strategy, user-generated posts nevertheless provide insights into what barriers are preventing people from broader adoption of PrEP, including topics that are specific to 2 different groups of sexual minority groups and racial and ethnic minority populations. Results have the potential to inform future health promotion and regulatory science approaches that can reach these HIV and AIDS communities that may benefit from PrEP.
Collapse
Affiliation(s)
- Qing Xu
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Matthew C Nali
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| | - Tiana McMann
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| | | | - Jiawei Li
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Yifan He
- S-3 Research San Diego, CA United States
| | - Mingxiang Cai
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Christine Lee
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Christine Merenda
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Richardae Araojo
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Tim Ken Mackey
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| |
Collapse
|