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Fan C, Yin Z, Li C, Dai Y, Zhao H, Marley G, Li Q, Wu S, Huang H, Hazra A, Lio J, Liang K, Li L, Sherer R, Tucker JD, Tang W. Impact of Peer Referral on Pre-Exposure Prophylaxis Adherence and Persistence Among Men Who Have Sex with Men: A Cohort Study in China. AIDS Behav 2025; 29:1831-1840. [PMID: 39928073 DOI: 10.1007/s10461-025-04651-9] [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: 01/29/2025] [Indexed: 02/11/2025]
Abstract
Peer referral leverages social networks to connect individuals with health services, potentially enhancing pre-exposure prophylaxis (PrEP) use. This study aims to investigate the impact of peer referral on PrEP adherence and persistence among men who have sex with men (MSM) in China. This study is nested in a 12-month PrEP (FTC/TDF) demonstration trial in China from September 2021 to December 2023. Peer referral was defined as participants being referred by peers already enrolled in the trial. PrEP adherence was measured as taking four or more pills per week for daily users or following the 2 + 1 + 1 event-driven regimen at least 75% of the time. PrEP persistence was defined as the time from initiation to discontinuation. We collected data from the first 6 months of follow-up and used generalized estimating equations and Cox regression models to evaluate the association between peer referral and PrEP adherence and persistence. A total of 1,131 MSM initiated PrEP, with 121 (10.7%) referred by peers. At month 6, adherence rates were 75.0% for peer-referred MSM and 67.1% for non-peer-referred MSM. Peer-referred MSM had higher adherence than non-peer-referred MSM (aRR = 1.11, 95% CI: 1.01-1.22). Regarding persistence, 812 (71.8%) MSM continued using PrEP at 6 months of follow-up, and peer-referred MSM were more likely to persist with PrEP (aHR = 1.85, 95% CI: 1.17-2.91). These findings demonstrate the potential of peer referral in promoting PrEP use among MSM, suggesting the value of powerful peer-based interventions like peer navigation in future PrEP outreach.
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Affiliation(s)
- Chengxin Fan
- School of Public Health, Nanjing Medical University, No. 101 Longmian St, Nanjing, 211166, China
- University of North Carolina Project-China, Guangzhou, China
| | - Zhuoheng Yin
- University of North Carolina Project-China, Guangzhou, China
| | - Chunyan Li
- Tokyo College, The University of Tokyo, Tokyo, Japan
| | - Yifan Dai
- University of North Carolina Project-China, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
- Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Heping Zhao
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | - Quanmin Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Songjie Wu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | | | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Lio
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Renslow Sherer
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weiming Tang
- School of Public Health, Nanjing Medical University, No. 101 Longmian St, Nanjing, 211166, China.
- University of North Carolina Project-China, Guangzhou, China.
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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McFall AM, Solomon SS, Lau B, Latkin C, Srikrishnan AK, Anand S, Vasudevan CK, Kumar MS, Lucas GM, H Mehta S. Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India. Drug Alcohol Depend 2023; 249:110834. [PMID: 37352733 PMCID: PMC10330670 DOI: 10.1016/j.drugalcdep.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Injection drug use drives HIV epidemics in many low-resource settings, yet many people who inject drugs (PWID) living with HIV are not diagnosed. We assessed the ability of respondent-driven sampling (RDS) - which uses peer network connections - to identify undiagnosed PWID living with HIV compared to a facility-based strategy in India. METHODS In six Indian cities from 2014 to 2017, integrated care centers (ICCs) provided HIV testing. From 2016 to 2017, RDS samples of PWID in these same cities were conducted. Using biometric matching, characteristics associated with identification by RDS only and both RDS and ICC, compared to ICC only were explored. Undiagnosed individuals tested positive and did not report a prior diagnosis. The number needed to recruit (NNR) (average number recruited to find one undiagnosed PWID living with HIV) and the identification rate (average number undiagnosed PWID identified per week) assessed the efficiency of RDS vs. ICCs. RESULTS There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities. CONCLUSIONS RDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.
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Affiliation(s)
- Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, MD, United States
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
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Andrawis A, Tapa J, Vlaev I, Read D, Schmidtke KA, Chow EPF, Lee D, Fairley CK, Ong JJ. Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review. Curr HIV/AIDS Rep 2022; 19:358-374. [PMID: 35930186 PMCID: PMC9508055 DOI: 10.1007/s11904-022-00615-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This scoping review summarises the literature on HIV prevention and management interventions utilizing behavioural economic principles encapsulated in the MINDSPACE framework. RECENT FINDINGS MINDSPACE is an acronym developed by the UK's behavioural insights team to summarise nine key influences on human behaviour: Messenger, Incentives, Norms, Default, Salience, Priming, Affect, Commitment, and Ego. These effects have been used in various settings to design interventions that encourage positive behaviours. Currently, over 200 institutionalised behavioural insight teams exist internationally, which may draw upon the MINDSPACE framework to inform policy and improve public services. To date, it is not clear how behavioural insights have been applied to HIV prevention and management interventions. After screening 899 studies for eligibility, 124 were included in the final review. We identified examples of interventions that utilised all the MINDSPACE effects in a variety of settings and among various populations. Studies from high-income countries were most common (n = 54) and incentives were the most frequently applied effect (n = 100). The MINDSPACE framework is a useful tool to consider how behavioural science principles can be applied in future HIV prevention and management interventions. Creating nudges to enhance the design of HIV prevention and management interventions can help people make better choices as we strive to end the HIV/AIDS pandemic by 2030.
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Affiliation(s)
- Alexsandra Andrawis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - James Tapa
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ivo Vlaev
- Warwick Business School, Coventry, UK
| | | | | | - Eric P F Chow
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - David Lee
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Melbourne, Australia
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- , Carlton, Australia
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Huff HV, Carcamo PM, Diaz MM, Conklin JL, Salvatierra J, Aponte R, Garcia PJ. HIV and Substance Use in Latin America: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7198. [PMID: 35742448 PMCID: PMC9222977 DOI: 10.3390/ijerph19127198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 12/13/2022]
Abstract
This scoping review aims to explore the interplay between substance use (SU) and HIV in Latin America (LA). Database searches yielded 3481 references; 196 were included. HIV prevalence among people who used substances (PWUS) ranged from 2.8-15.2%. SU definitions were variable throughout studies, and thus data were not easily comparable. In 2019, only 2% of new HIV infections were attributed to injection drug use (IDU) in LA. Factors associated with HIV among PWUS included being female, IDU and homelessness, and PWUS were likely to engage in risky sexual behaviors, start antiretroviral treatment late, have poor adherence, have treatment failure, be lost to follow-up, have comorbidities, and experience higher mortality rates and lower quality of life, as has been reported in PLWH with SU in other regions. Five intervention studies were identified, and only one was effective at reducing HIV incidence in PWUS. Interventions in other regions have varying success depending on context-specific characteristics, highlighting the need to conduct more research in the LA region. Though progress has been made in establishing SU as a major concern in people living with HIV (PLWH), much more is yet to be done to reduce the burden of HIV and SU in LA.
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Affiliation(s)
- Hanalise V. Huff
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- School of Public Health, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; (P.M.C.); (P.J.G.)
| | - Paloma M. Carcamo
- School of Public Health, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; (P.M.C.); (P.J.G.)
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7025, Chapel Hill, NC 27599, USA;
| | - Jamie L. Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, 335 South Columbia Street, Campus Box 7585, Chapel Hill, NC 27599, USA;
| | - Justina Salvatierra
- University Library Office, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; (J.S.); (R.A.)
| | - Rocio Aponte
- University Library Office, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; (J.S.); (R.A.)
| | - Patricia J. Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru; (P.M.C.); (P.J.G.)
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Dickson-Gomez J, Tarima S, Glasman L, Cuellar W, de Mendoza LR, Bodnar G. Cumulative Effects of Adding a Small Group Intervention to Social Network Testing on HIV Testing Rates Among Crack Users in San Salvador, El Salvador. AIDS Behav 2021; 25:2316-2323. [PMID: 33515335 PMCID: PMC8165071 DOI: 10.1007/s10461-021-03160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
The present study evaluates a combination prevention intervention for crack users in San Salvador, El Salvador that included social network HIV testing, community events and small group interventions. We examined the cumulative effects of the social network HIV testing and small group interventions on rates of HIV testing, beyond the increase that we saw with the introduction of the social network HIV testing intervention alone. HIV test data was converted into the number of daily tests and analyzed the immediate and overtime impact of small group interventions during and in the twelve weeks after the small group intervention. The addition of the small group interventions to the baseline of monthly HIV tests resulted in increased rates of testing lasting 7 days after the small group interventions suggesting a reinforcing effect of small group interventions on testing rates.
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Ong’wen P, Samba BO, Moghadassi M, Okoko N, Bukusi EA, Cohen CR, Wolf HT. Chain Peer Referral Approach for HIV Testing Among Adolescents in Kisumu County, Kenya. AIDS Behav 2020; 24:484-490. [PMID: 31267295 DOI: 10.1007/s10461-019-02560-2] [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: 10/26/2022]
Abstract
New HIV infections among adolescents continues to be a large public health burden in sub-Saharan Africa, with few adolescents accessing HIV testing and counseling (HTC) services. We evaluated the effect of a peer referral program among adolescents in Kisumu county, Kenya in accessing HTC. Female adolescents aged 15 to 19 years were recruited from three health clinics in Kisumu County. They, in turn, recruited their peers for HTC by handing out referral cards. Referrals would then recruit their peers and this peer-referral repeated for approximately 5 months. The 252 female index seeds showed a relatively higher-risk profile for HIV compared to the 792 referral participants. The referral system yielded an increased proportion of first-time adolescent testers from 13.1% among index seeds to 42.7% among the second wave of referrals. However, the peer referral system ultimately did not increase the absolute number of adolescents Queryaccessing HTC. Future strategies should consider these findings to better target those with undiagnosed HIV infection.
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Dickson-Gomez J, Tarima S, Glasman LR, Lechuga J, Bodnar G, de Mendoza LR. Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador. AIDS Behav 2019; 23:1147-1157. [PMID: 30341555 DOI: 10.1007/s10461-018-2314-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.
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Affiliation(s)
- Julia Dickson-Gomez
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Sergey Tarima
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura R Glasman
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julia Lechuga
- Department of Psychology, College of Education, Lehigh University, Bethlehem, PA, USA
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
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