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Reback CJ, Blue T, Jalali A, Landovitz R, Li MJ, Mata RP, Ryan D, Jeng PJ, Murphy SM. Comparative- and Cost-Effectiveness Research Determining the Optimal Intervention for Advancing Transgender Women With HIV to Full Viral Suppression (Text Me, Alexis!): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2025; 14:e65313. [PMID: 39847410 PMCID: PMC11803334 DOI: 10.2196/65313] [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: 08/12/2024] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Many transgender women with HIV achieve suboptimal advancement through the HIV Care Continuum, including poor HIV health care usage, retention in HIV medical care, and rates of viral suppression. These issues are exacerbated by comorbid conditions, such as substance use disorder, which is also associated with reduced quality of life, increased overdose deaths, usage of high-cost health care services, engagement in a street economy, and cycles of incarceration. Thus, it is critical that efforts to End the HIV Epidemic include effective interventions to link and retain transgender women in HIV care through full viral suppression. OBJECTIVE This study builds on the promising findings from our two Health Resources and Services Administration-funded demonstration projects, The Alexis Project and Text Me, Girl!, which used peer health navigation (PHN) and SMS text messaging, respectively, for advancing transgender women with HIV to full viral suppression. Though the effectiveness of both interventions has been established, their comparative effectiveness, required resources or costs, cost-effectiveness, and heterogeneous effects on subgroups, including those with substance use disorder, have not been evaluated. Given the many negative personal and public health consequences of untreated or undertreated HIV, and that HIV services for transgender women are frequently delivered in resource-limited, community-based settings, a comprehensive economic evaluation is critical to inform decisions of stakeholders, such as providers, insurers, and policy makers. METHODS Text Me, Alexis! is a 3-arm randomized controlled trial. Participants (N=195) will be randomized (1:1:1) into: PHN alone (n=65), SMS text messaging alone (n=65), or PHN+SMS text messaging (n=65). Using the same time points as the Health Resources and Services Administration demonstration projects, the repeated-measures design will assess participants at baseline, 3, 6, 12, and 18 months post randomization. Over the course of the 90 days, participants in the PHN arm will receive unlimited navigation sessions; participants in the SMS text messaging arm will receive 270 theory-based SMS text messages (3 messages daily) that are targeted, tailored, and personalized specifically for transgender women with HIV; and participants in the PHN+SMS text messaging arm will receive a combined PHN and SMS text message intervention. The desired outcome of Text Me, Alexis! is viral suppression and cost-effectiveness. RESULTS Recruitment began on April 10, 2024, and the first participant was enrolled on April 11, 2024. Data collection is expected to be completed in July 2027. Primary outcome analyses will begin immediately following the conclusion of the follow-up evaluations. CONCLUSIONS Transgender women are a high-priority population for reaching End the HIV Epidemic goals. Findings have the potential to improve individual and population health outcomes by generating significant improvements in viral suppression among transgender women and guiding service provision and public policy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/65313.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., Baltimore, MD, United States
- Department of Family Medicine, University of California, Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA, United States
- Department of Family Medicine, Center for Behavioral and Addiction Medicine, Los Angeles, CA, United States
| | - Thomas Blue
- Friends Research Institute, Inc., Baltimore, MD, United States
| | - Ali Jalali
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, New York, NY, United States
| | - Raphael Landovitz
- Department of Family Medicine, University of California, Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA, United States
- Division of Infectious Diseases, University of California, Los Angeles, CA, United States
| | - Michael J Li
- Department of Family Medicine, University of California, Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA, United States
- Department of Family Medicine, Center for Behavioral and Addiction Medicine, Los Angeles, CA, United States
| | - Raymond P Mata
- Friends Research Institute, Inc., Baltimore, MD, United States
| | - Danielle Ryan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
- Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV, New York, NY, United States
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Chichetto NE, Canidate S, Gebru NM, McNeely KV, Ding DD, Hanna DB, Parikh Z, Shoptaw SJ, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Lahiri CD, Wise JM, Palella F, Levine A, Friedman MR, Plankey M. Impact of syndemic heavy drinking, smoking, and depression on mortality among MSM with and without HIV: A longitudinal study. Drug Alcohol Depend 2025; 266:112523. [PMID: 39662355 PMCID: PMC11729611 DOI: 10.1016/j.drugalcdep.2024.112523] [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: 07/12/2024] [Revised: 11/06/2024] [Accepted: 11/27/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Heavy drinking, smoking, and depression are common among men who have sex with men (MSM). The association of co-occurring longitudinal patterns of these conditions and mortality among MSM were tested, applying a syndemic framework - the interaction of two or more conditions that contribute to poor health outcomes. METHODS Longitudinal data from 1999 to 2018 from the Multicenter AIDS Cohort Study of 3046 MSM were analyzed. Group-based trajectories models (GBTM) of alcohol use, smoking, and depressive symptoms were developed. Syndemic phenotypes were defined based on overlapping high-risk group membership in the GBTM for each condition (i.e., heavy drinking, current smoking, severe depressive symptoms). Cox proportional hazards models estimated confounder-adjusted associations of syndemic phenotypes with mortality (National Death Index, n = 395; median follow-up 16.0 years). An interaction between HIV and syndemic phenotypes on mortality was tested. RESULTS Syndemic phenotypes included no high-risk conditions (63 %), heavy drinking only (3 %), smoking only (16 %), depressive symptoms only (10 %), and two or more high-risk trajectories (9 %, sustained syndemic). Among MSM, the syndemic was associated with greater mortality risk compared to no conditions (hazard ratio [HR] 4.48, 95 % confidence interval [CI] 3.21, 6.26) or any single condition (heavy drinking HR 1.84, CI 0.90, 3.75; smoking HR 2.70, CI 2.03, 3.59; depression HR 2.31, CI 1.69, 3.14). The interaction between syndemic phenotype and HIV on mortality risk was significant. CONCLUSIONS The long-term clustering of high-risk drinking, smoking, and depressive symptoms occurred in nearly 10 % of MSM and was associated with increased mortality risk, especially among MSM living with HIV.
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Affiliation(s)
- Natalie E Chichetto
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA.
| | - Shantrel Canidate
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA.
| | - Nioud M Gebru
- School of Public Health, Brown University, 121 S Main St, Providence, RI 02903, USA.
| | - Kayla V McNeely
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA.
| | - Delaney D Ding
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA.
| | - David B Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA.
| | - Zalak Parikh
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York 10461, USA.
| | - Steven J Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL 33136, USA.
| | - Jason M Lazar
- Department of Medicine, The State University of New York -Downstate Medical Center, 450 Clarkson Ave Suite J, Brooklyn, New York 11203, USA.
| | - Jorge R Kizer
- Department of Epidemiology & Population Health, San Francisco Veterans Affairs Health Care System, University of California, 4150 Clement St, San Francisco, CA 9412, USA.
| | - Mardge H Cohen
- Stroger Hospital/Cook County Health and Hospitals System, 1969 W Ogden Ave, Chicago, IL 60612, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Medical Office Tower, 550 Peachtree St NE Fl 7, Atlanta, GA 30308, USA.
| | - Jenni M Wise
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, Birmingham, AL 35294, USA.
| | - Frank Palella
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Andrew Levine
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| | - M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers School of Public Health, 683 Hoes Ln W, Piscataway, NJ 08854 USA.
| | - Michael Plankey
- School of Medicine, Georgetown University Medical Center, 3900 Reservoir Rd NW, Washington, DC 20007, USA.
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Jimenez DR, Beaulaurier R, Fava NM, Burke SL, Kiplagat S, Coudray M, De La Rosa M, Sastre F, Clarke R, Dévieux J, Cyrus E. "They Think Transgender is Like Something on the Side:" Perceptions of Transgender Women of Color of Cisgender Members of the LGBTQIA+ "Community". JOURNAL OF HOMOSEXUALITY 2024:1-30. [PMID: 39626102 DOI: 10.1080/00918369.2024.2433047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2024]
Abstract
Due to multiple minority statuses, transgender women of color are exposed to minority stress through distal (external) stressors from society causing proximal (internal) stress, leading to potentially negative physical and mental health outcomes. Often considered allies to the transgender community, cisgender members of the LGBTQIA+ "community" have historically presented different plights resulting in divergent rights, protections, and societal views. Guided by the minority stress framework, a secondary analysis of individual interviews and focus groups (n = 20) with transgender women of color was performed. Participants shared experiences of distal and proximal minority stressors when discussing the cisgender LGBTQIA+ "community" and mitigating resilience factors. Four main themes emerged: 1) preference for cisgender presentation; 2) discrimination and exclusion; 3) mistrust; and 4) resilience. This is the first study to demonstrate direct mental and physical health risks for transgender women of color associated with discrimination and exclusion by members of the cisgender LGBTQIA+ "community." Negative experiences resulted in health care avoidance, verbal assault, social exclusion, mistrust of providers, and barriers to transgender-affirming care. Future research must consider minority stress to advance the understanding of LGBTQIA+ within-group marginalization and foster equitable opportunities for transgender women of color and other gender minorities.
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Affiliation(s)
- D R Jimenez
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - R Beaulaurier
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - N M Fava
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - S L Burke
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - S Kiplagat
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - M Coudray
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - M De La Rosa
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - F Sastre
- Program in Human Services, Albizu University, Miami, FL, USA
| | - R Clarke
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - J Dévieux
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - E Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
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Wilson EC, Baguso GN, Quintana J, Suprasert B, Arayasirikul S. Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California. BMC Womens Health 2024; 24:56. [PMID: 38254161 PMCID: PMC10802058 DOI: 10.1186/s12905-024-02885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Substance use and mental distress are known barriers to HIV care engagement among trans women. Less is known about access and utilization of mental health and substance use care among trans women and the relationship between unmet behavioral health needs and HIV viral suppression. We examined the relationship between mental health and substance use on HIV viral load among trans women living with HIV. We also examined the relationship between mental health and substance use services needs with HIV care engagement and having a detectable viral load by comparing engagement in care cascades. METHODS Data are from a 2022 baseline assessment for an intervention with trans women living with HIV (n = 42) in San Francisco. Chi-Squared or Fisher's exact tests were conducted to determine associations between HIV viral load, mental health, and substance use. We also examine characteristics associated with each step in the HIV, mental health, and substance use care cascades. RESULTS Most participants were trans women of color (85.7%), 40 years of age or older (80.9%), with low income (88.1%), and almost half were unstably housed (47.6%). Of the 32 participants who screened positive for depression, anxiety and/or psychological distress, 56.3% were referred for mental health services in the past 12 months. Of those who were referred, 44.4% received mental health services. Of the 26 participants who screened positive for a substance use disorder, 34.6% were referred to substance use services in the past 12 months. Of those referred, 33.3% received substance use services in the past 3 months. Latina trans women had a low referral rate to meet their mental health needs (50%) and only 16.7% of African American/Black trans women who screened positive for a substance use disorder were referred for services, while trans women of other race/ethnicities had high referral and services utilization. No significant results were found between HIV viral load and screening positive for a mental health disorder. Methamphetamine use was statistically associated with having a detectable HIV viral load (p = 0.049). CONCLUSIONS We identified significant unmet mental health and substance use services needs and noted racial/ethnic disparities in the context of high HIV care engagement among trans women living with HIV. We also found that methamphetamine use was a barrier to having an undetectable viral load for trans women living with HIV. To finally end the HIV epidemic, integration of behavioral health screening, linkage, and support are needed in HIV care services for populations most impacted by HIV, especially trans women. TRIAL REGISTRATION NCT, NCT 21-34,978. Registered January 19, 2022.
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Affiliation(s)
- Erin C Wilson
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA.
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
| | - Glenda N Baguso
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
| | - Jerry Quintana
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
| | - Bow Suprasert
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
| | - Sean Arayasirikul
- Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, USA
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, USA
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Ross EJ, Williams RS, Viamonte M, Reynolds JM, Duncan DT, Paul RH, Carrico AW. Overamped: Stimulant Use and HIV Pathogenesis. Curr HIV/AIDS Rep 2023; 20:321-332. [PMID: 37971597 DOI: 10.1007/s11904-023-00672-y] [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: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation. RECENT FINDINGS Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health. Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.
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Affiliation(s)
- Emily J Ross
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Renessa S Williams
- University of Miami School of Nursing and Health Sciences, Coral Gables, FL, USA
| | | | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dustin T Duncan
- Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, #407, Miami, FL, 33199, USA.
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Barrington C, Goldenberg T, Donastorg Y, Gomez H, Perez M, Kerrigan D. Stigma and HIV Treatment Outcomes Among Transgender Women Sex Workers in the Dominican Republic. AIDS Behav 2023; 27:2774-2784. [PMID: 36723770 DOI: 10.1007/s10461-023-04001-7] [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: 01/18/2023] [Indexed: 02/02/2023]
Abstract
Trans women experience multiple forms of intersecting stigma due to trans identity, HIV, and sex work, which can negatively affect their health. There is limited understanding of the relationships between stigma and HIV care and treatment outcomes. We assessed associations between multiple forms and types of stigma and HIV treatment outcomes among trans women who conduct sex work in Santo Domingo, Dominican Republic using cross-sectional survey data. Most participants had received HIV care (91%) and were currently taking anti-retroviral therapy (ART) (84%). Only 64% were virally suppressed. Nearly one-third (32%) had interrupted ART at some point; those who had never interrupted ART were more likely to be suppressed. Drug use was associated with ART interruption. Higher enacted HIV stigma was associated with current ART use. Higher enacted HIV stigma and higher anticipated sex work stigma were associated with ART adherence. Higher trans stigma was associated with being virally suppressed. Findings highlight the importance of addressing multiple forms of stigma at the individual and clinic levels to improve and sustain viral suppression. Future research is needed to assess if unexpected associations between stigma and HIV outcomes reflect processes of resilience. Future research is also needed to assess the pathways between drug use, ART interruption, and viral suppression among trans women.
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Affiliation(s)
- Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 27599, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, US.
| | - Tamar Goldenberg
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, US
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, US
| | - Yeycy Donastorg
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Martha Perez
- HIV Vaccine Research Unit, Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, US
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Jain JP, Hill M, Gamarel KE, Santos GM, Johnson MO, Neilands TB, Dilworth SE, Reback CJ, Sevelius J. Socio-ecological Barriers to Viral Suppression Among Transgender Women Living with HIV in San Francisco and Los Angeles, California. AIDS Behav 2023; 27:2523-2534. [PMID: 36682008 PMCID: PMC10362091 DOI: 10.1007/s10461-023-03979-4] [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] [Accepted: 01/05/2023] [Indexed: 01/23/2023]
Abstract
Troubling disparities in viral suppression persist among transgender (trans) women living with HIV in the US. We utilized baseline data from a randomized controlled trial of a behavioral intervention among trans women living with HIV in San Francisco and Los Angeles, to identify the socio-ecological correlates of biologically confirmed viral suppression (< 200 HIV-1 RNA copies/mL). Among 253 participants, the mean age was 43 (SD = 11), 46% identified as Black or African American and 35% were virally non-suppressed. In adjusted Poisson regression models, the following barriers to viral suppression were identified: injection drug use [adjusted risk ratio (aRR) 0.78, 95% CI 0.65-0.93, Z = - 2.64, p = 0.008], methamphetamine use (aRR 0.65, 95% CI 0.51-0.83, Z = - 3.45, p = 0.001), amphetamine use (aRR 0.62, 95% CI 0.44-0.87, Z = - 2.75, p = 0.006), homelessness (aRR 0.79, 95% CI 0.63-0.98, Z = - 2.06, p = 0.039), and sex work (aRR 0.60, 95% CI 0.41-0.86, Z = - 2.77, p = 0.009). These findings underscore the importance of interventions that address the socio-ecological barriers to viral suppression among trans women in urban settings.
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Affiliation(s)
- Jennifer P Jain
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Miranda Hill
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Samantha E Dilworth
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Cathy J Reback
- Friends Research Institute, Los Angeles, CA, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Jae Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry, Columbia University, New York, USA
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Gormley M, Loughran C, Conte J, Dunn Navarra AM. Trends in U.S. HIV Peer Health Worker Training Strategies and Approaches: A Scoping Review of the Literature. J Assoc Nurses AIDS Care 2023; 34:331-348. [PMID: 37224079 DOI: 10.1097/jnc.0000000000000415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
ABSTRACT Peer health workers (peers) are commonly engaged interventionists in the HIV care spectrum. The objective of this scoping review was to examine the range of evidence on training strategies and approaches for peer-led HIV behavioral interventions in the United States. Four electronic databases (Medline, CINAHL, EMBASE, and PsycINFO) were searched for peer-reviewed published literature (2010-2021) of peer-led HIV behavioral interventions directed to improving antiretroviral therapy adherence and/or retention in care. Eighteen studies met the inclusion criteria. Eleven studies referenced manualized training materials, and nine used role-play as part of their curricula. Peer training content and duration varied across studies, as well as evaluation of intervention fidelity, and peer competency. Findings highlight heterogeneity in peer training strategies and approaches. The expansion and sustainability of peer engagement in the HIV care continuum will require greater consensus among members of the research community on best practices for training.
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Affiliation(s)
- Maurade Gormley
- Maurade Gormley, PhD, CPNP, is an Assistant Professor, School of Nursing, University of Connecticut, Storrs, Connecticut, USA. Claire Loughran, MPH, is a Project Manager, Rory Meyers College of Nursing, New York University, New York, New York, USA. Jill Conte, MA, MSLS, is an Associate Curator, Division of Libraries, New York University, New York, New York, USA. Ann-Margaret Dunn Navarra, PhD, CPNP-PC, FAAN, is an Associate Professor, Rory Meyers College of Nursing, New York University, New York, New York, USA
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Baguso GN, Santiago-Rodriguez E, Gyamerah AO, Wilson EC, Chung C, McFarland W, Wesson P. Mental Distress and Use of Stimulants: Analysis of a Longitudinal Cohort of Transgender Women. LGBT Health 2023; 10:228-236. [PMID: 36301245 PMCID: PMC10079245 DOI: 10.1089/lgbt.2021.0192] [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: 11/12/2022] Open
Abstract
Purpose: The purpose of our study was to examine the effects of mental distress (depression, anxiety, and post-traumatic stress disorder [PTSD]), incarceration, and hate crime on stimulant use (methamphetamine, crack, and cocaine) among transgender women. Methods: We conducted a secondary analysis of longitudinal data collected from 2016 to 2018 with 429 transgender women in the San Francisco Bay Area. Generalized estimating equation log-binomial regressions were used to calculate relative risks of stimulant use associated with mental distress, incarceration, and hate crime. Results: At baseline, transgender women experienced transphobic hate crime (46.4%), incarceration (53.0%), mental distress (69.2%), and stimulant use (28.4%). Transgender women who used stimulants reported lower education (45.1%, χ2 = 14.3, p = 0.001) and significantly more had been incarcerated (62.3%, χ2 = 5.9, p = 0.015), and reported diagnoses of depression (67.8%, χ2 = 6.1, p = 0.014), anxiety (62.8%, χ2 = 4.3, p = 0.039), and PTSD (43.8%, χ2 = 6.7, p = 0.010). Longitudinal multivariate analysis found that depression (adjusted relative risk [aRR] = 1.46, 95% confidence interval [CI] 1.09-1.95), anxiety (aRR = 1.42, 95% CI = 1.05-1.93), and PTSD (aRR = 1.38, 95% CI = 1.02-1.87) were associated with methamphetamine use but not with crack or cocaine use. Incarceration was associated with methamphetamine use and crack use, whereas experiencing hate crime was associated with crack use. Conclusions: Mental distress, incarceration, and hate crime were key exposures of stimulant use among transgender women. Intervention targets for reducing stimulant use should consider working upstream by addressing underlying stressors impacting mental health for transgender women, including laws to protect transgender women from hate crime and to reduce their disproportionate representation in the criminal justice system.
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Affiliation(s)
- Glenda N. Baguso
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Edda Santiago-Rodriguez
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Akua O. Gyamerah
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Erin C. Wilson
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California
| | | | - Willi McFarland
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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10
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Clinical and Behavioral Outcomes for Transgender Women Engaged in HIV Care: Comparisons to Cisgender Men and Women in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort. AIDS Behav 2023; 27:2113-2130. [PMID: 36609705 DOI: 10.1007/s10461-022-03947-4] [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: 12/05/2022] [Indexed: 01/08/2023]
Abstract
Describe health of transgender women (TW) with HIV vs. cisgender men and women (CM, CW) in a U.S. HIV care cohort. Data were from Centers for AIDS Research Network of Integrated Clinical Systems (CNICS), 2005-2022. TW were identified using clinical data/identity measures. PWH (n = 1285) were included in analyses (275 TW, 547 CM, 463 CW). Cross-sectional multivariable analyses compared HIV outcomes/co-morbidities between TW/CM and TW/CW, and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated. TW had poorer adherence (> 90% adherent; aOR 0.57; 95%CI 0.38, 0.87) and were more likely to miss ≥ 3 visits in the past year than CM (aOR 1.50, 95%CI 1.06, 2.10); indicated more anxiety compared to both CM and CW (p ≤ 0.001, p = 0.02); hepatitis C infection (p = 0.03) and past-year/lifetime substance treatment (p = 0.004/p = 0.001) compared to CM; and substance use relative to CW. TW with HIV differed in HIV clinical outcomes and co-morbidities from CM and CW.
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11
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Krulic T, Brown G, Bourne A. A Scoping Review of Peer Navigation Programs for People Living with HIV: Form, Function and Effects. AIDS Behav 2022; 26:4034-4054. [PMID: 35672548 PMCID: PMC9640407 DOI: 10.1007/s10461-022-03729-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/01/2022]
Abstract
This scoping review maps recent research into peer navigation programs for people living with HIV. Four databases were systematically searched in June 2020. Results were screened according to defined criteria and were not restricted to any design, outcome or country. Six papers drew from randomised control trials, five from quasi-experimental or pragmatic trials, and four panel, eight qualitative, three mixed method and one cross-sectional designs were included for review. Programs incorporated health systems navigation and social support. Authors provided strong theoretical bases for peers to enhance program effects. Studies primarily reported program effects on continuum of care outcomes. Further research is required to capture the role HIV peer navigators play in preventing disease and promoting quality of life, mental health, and disease self-management in diverse settings and populations. Peer programs are complex, social interventions. Future work should evaluate detailed information about peer navigators, their activities, the quality of peer engagement as well as employee and community support structures to improve quality and impact.
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Affiliation(s)
- Timothy Krulic
- , Living Positive Victoria, Melbourne, Australia.
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building NR6, Bundoora, VIC, 3086, Australia.
| | - Graham Brown
- The Centre for Social Impact, UNSW, Sydney, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Hsiang E, Gyamerah A, Baguso G, Jain J, McFarland W, Wilson EC, Santos GM. Prevalence and correlates of substance use and associations with HIV-related outcomes among trans women in the San Francisco Bay Area. BMC Infect Dis 2022; 22:886. [PMID: 36435761 PMCID: PMC9701418 DOI: 10.1186/s12879-022-07868-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Trans women face tremendous social inequities as well as disproportionate rates of HIV and substance use, yet disaggregated substance use data specific to trans women remain limited. METHODS We conducted a secondary analysis of baseline data from the Trans*National Study (2016-2017) surveying trans women in the San Francisco Bay Area (n = 629). Multivariable logistic regression was used to analyze socio-demographic and environmental correlates of substance use, and bivariate associations between substance use and HIV-associated outcomes are presented alongside prevalence data. RESULTS Over half (52.9%) reported using substances in the prior year, most frequently marijuana, methamphetamine, and crack/cocaine. Those with unmet gender-affirming health care needs, lack of insurance, or a history of experiencing racial violence, transphobic violence, adult housing instability, or extreme poverty had higher odds of substance use. Sex work and condomless anal sex were also independently associated with substance use. CONCLUSIONS Among this sample of trans women, substance use and substance use concurrent with sex were highly prevalent, and associated with a number of socioeconomic and health care needs. These findings corroborate the need for holistic and intersectional efforts to reduce substance use and HIV risk.
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Affiliation(s)
- Elaine Hsiang
- Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, M24, Box 203, San Francisco, CA, 94143, USA.
| | - Akua Gyamerah
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA
| | - Glenda Baguso
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
| | - Jennifer Jain
- grid.266102.10000 0001 2297 6811Department of Psychiatry, University of California, San Francisco, San Francisco, CA USA
| | - Willi McFarland
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
| | - Erin C. Wilson
- grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA USA
| | - Glenn-Milo Santos
- grid.266102.10000 0001 2297 6811Department of Community Health Systems, University of California, San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Center for Public Health Research, San Francisco Department of Public Health, University of California, San Francisco, San Francisco, CA USA
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13
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Sevelius JM, Dilworth SE, Reback CJ, Chakravarty D, Castro D, Johnson MO, McCree B, Jackson A, Mata RP, Neilands TB. Randomized Controlled Trial of Healthy Divas: A Gender-Affirming, Peer-Delivered Intervention to Improve HIV Care Engagement Among Transgender Women Living With HIV. J Acquir Immune Defic Syndr 2022; 90:508-516. [PMID: 35502891 PMCID: PMC9259040 DOI: 10.1097/qai.0000000000003014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender women are disproportionately affected by HIV and are less likely to be optimally engaged in care than other groups because of psychosocial challenges. With community collaboration, we developed Healthy Divas, an individual-level intervention to increase healthcare empowerment and gender affirmation to improve engagement in HIV care. Healthy Divas comprises 6 peer-led individual sessions and one group workshop facilitated by a healthcare provider with expertise in HIV care and transgender health. SETTING/METHODS To test the intervention's efficacy, we conducted a randomized controlled clinical trial in San Francisco and Los Angeles among transgender women living with HIV; control was no intervention. Transgender field staff conducted recruitment. Assessments occurred at baseline and 3, 6, 9, and 12 months postrandomization. The primary outcome was engagement in HIV care, defined as the sum of (1) self-reported HIV care provider visit, past 6 months, (2) knowledge of most recent CD4 count, (3) self-reported antiretroviral therapy adherence ≥90%, and (4) self-reported antiretroviral therapy adherence ≥80%. RESULTS We enrolled 278 participants; almost half (46%) were African American/Black and one-third (33%) were Hispanic/Latina. At 6 months, participants in the intervention arm had over twice the odds of being in a higher HIV care engagement category than those in the control arm (aOR = 2.17; 95% CI: 1.06 to 4.45; P = 0.04); there were no significant study arm differences in the outcome at the other time points. CONCLUSIONS This trial demonstrates the short-term efficacy of an urgently needed behavioral intervention to improve engagement in HIV care among transgender women living with HIV; ongoing intervention may be needed to maintain positive impact over time. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03081559.
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Affiliation(s)
- Jae M. Sevelius
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Samantha E. Dilworth
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Cathy J. Reback
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Danielle Castro
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Breonna McCree
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Akira Jackson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Raymond P. Mata
- Friends Community Center, Friends Research Institute, Los Angeles, CA; and
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA
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14
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Fletcher JB, Reback CJ. Associations Between Gender Identity Control, Gender Identity Non-Verification, and Health Risks among Trans Women of Color Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2003-2014. [PMID: 35445282 PMCID: PMC10462393 DOI: 10.1007/s10508-021-02264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
This study applied Identity Theory (IT) metrics to data gathered from a sample of trans women of color living with HIV to determine whether measures of identity control and/or identity non-verification were associated with trans women's self-reported health risks. From February 2014 through August 2016, 139 HIV-positive trans women were enrolled. Cross-sectional time-series regressions indicated that identity control and identity non-verification were both associated with self-reported behavioral and health outcomes. Increased gender identity control was associated with decreased drug and alcohol use (multiple Logit [L]; all p < .05) and decreased likelihood of self-reported infection with a sexually transmitted infection (STI; multiple L; all p < .05); increased perceived identity non-verification was associated with increased severity of depression symptoms (b = 0.09) as well as increased odds of engagement in exchange sex (L = 0.32), increased drug and alcohol use (multiple L p > .05), and increased likelihood of self-reported infection with viral STIs (Lgenital warts = 0.49; Lherpes = 0.69). These findings indicate IT may be a useful theoretical framework through which to understand and analyze behavior among trans women of color living with HIV. Identity verification dynamics in particular may be useful mechanisms to explain engagement in several potentially harmful behaviors.
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Affiliation(s)
- Jesse B Fletcher
- Friends Research Institute Inc., 6910 Santa Monica Blvd., Los Angeles, CA, 90038, USA.
| | - Cathy J Reback
- Friends Research Institute Inc., 6910 Santa Monica Blvd., Los Angeles, CA, 90038, USA
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA, USA
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15
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Higa DH, Crepaz N, Mullins MM, Adegbite-Johnson A, Gunn JKL, Denard C, Mizuno Y. Strategies to improve HIV care outcomes for people with HIV who are out of care. AIDS 2022; 36:853-862. [PMID: 35025818 PMCID: PMC10167711 DOI: 10.1097/qad.0000000000003172] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of five intervention strategies: patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes among persons with HIV (PWH) who are out of care (OOC). DESIGN A systematic review with meta-analysis. METHODS We searched CDC's Prevention Research Synthesis (PRS) Project's cumulative HIV database to identify intervention studies conducted in the U.S., published between 2000 and 2020 that included comparisons between groups or prepost, and reported at least one relevant outcome (i.e. re-engagement or retention in HIV care, and viral suppression). Effect sizes were meta-analyzed using random-effect models to assess intervention effectiveness. RESULTS Thirty-nine studies reporting on 42 unique interventions met the inclusion criteria. Overall, intervention strategies are effective in improving re-engagement in care [odds ratio (OR) = 1.79;95% confidence interval (95% CI): 1.36-2.36, k = 14], retention in care (OR = 2.01; 95% CI: 1.64-2.64, k = 22), and viral suppression (OR = 2.50;95% CI: 1.87-3.34, k = 27). Patient navigation, appointment help/alerts, psychosocial support, and transportation/appointment accompaniment improved all three HIV care outcomes. Data-to-care improved re-engagement and retention but had insufficient evidence for viral suppression. CONCLUSION Several strategies are effective for improving HIV care outcomes among PWH who are OOC. More work is still needed for consistent definitions of OOC and HIV care outcomes, better reporting of intervention and cost data, and identifying how best to implement and scale-up effective strategies to engage and retain OOC PWH in care and reach the ending the HIV epidemic goals.
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Affiliation(s)
- Darrel H Higa
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Nicole Crepaz
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | - Mary M Mullins
- Division of HIV Prevention, Centers for Disease Control and Prevention
| | | | - Jayleen K L Gunn
- Division of HIV Prevention, Centers for Disease Control and Prevention
- U.S. Public Health Service
| | | | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention
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16
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Schafer KR, Tanner AE, Mann-Jackson L, Alonzo J, Song EY, Rhodes SD. Stigma, Social Support, and Substance Use in Diverse Men Who Have Sex With Men and Transgender Women Living with HIV in the US Southeast. South Med J 2022; 115:26-32. [PMID: 34964058 PMCID: PMC8726574 DOI: 10.14423/smj.0000000000001345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) rates in the southeast United States are high and substance use is common among people living with HIV (PLWH). This study used baseline data from the weCare intervention study to examine factors associated with the use of alcohol, tobacco, and marijuana among racially and ethnically diverse young gay, bisexual, and other men who have sex with men (GBMSM) and transgender women in the southeast who were newly diagnosed as having HIV, not linked to care, out of care, and/or not virally suppressed. METHODS Self-reported data were collected from 196 GBMSM and transgender women living with HIV via Audio Computer-Assisted Self-Interview at enrollment. Measures assessed demographics; stigma; social support; basic and clinical service needs; HIV disclosure; social media use; and recent use of alcohol, tobacco, and marijuana. Logistic regression identified correlates of past 30-day substance use. RESULTS In multivariable analysis, increased age and needing basic support services were associated with past 30-day tobacco, cigarette, electronic cigarette, and/or hookah use. Increased HIV-related stigma and needing basic support services were associated with past 30-day marijuana use. Being White and needing clinical support services were associated with infrequent or no past 30-day marijuana use. CONCLUSIONS HIV-related stigma and needing basic support services were associated with substance use among GBMSM and transgender women living with HIV in the southeastern United States. Routine screening for basic needs could identify GBMSM and transgender women living with HIV at risk for substance use and offer insight into intervention leverage points.
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Affiliation(s)
- Katherine R Schafer
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Amanda E Tanner
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Lilli Mann-Jackson
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Jorge Alonzo
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Eunyoung Y Song
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
| | - Scott D Rhodes
- From the Department of Internal Medicine, Section on Infectious Diseases, the Department of Social Sciences and Health Policy, and the CTSI Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina, the Department of Public Health Education, University of North Carolina, Greensboro, and Health Quality Partners, Doylestown Health, Doylestown, Pennsylvania
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17
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Reback CJ, Fletcher JB, Kisler KA. Text Messaging Improves HIV Care Continuum Outcomes Among Young Adult Trans Women Living with HIV: Text Me, Girl! AIDS Behav 2021; 25:3011-3023. [PMID: 34164763 PMCID: PMC10445544 DOI: 10.1007/s10461-021-03352-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Young adult trans women living with HIV in the US exhibit suboptimal advancement through the HIV Care Continuum relative to national averages. From December 2016 through May 2018, 134 young adult trans women living with HIV enrolled in Text Me, Girl!, a theory-based, trans-specific text-messaging intervention designed to improve HIV Care Continuum outcomes. Participants (N = 130) averaged 29.5 years, were predominantly Latinx (43%) or African American/Black (40%). Clustered logistic and ordinal logistic multivariable models (n = 105; 366 observations) indicate that through 18-month follow-up, increased exposure to the text-messaging intervention was associated with significant (p < 0.05) increased retention to HIV care (adjusted odds ratio [aOR] 1.33) and biomarker-confirmed viral suppression (aOR 1.51); retention in the intervention was associated with significantly increased likelihood of ART uptake (aOR 2.95) and "excellent" ART adherence (aOR 10.44). Text Me, Girl! offers promising evidence that a unidirectional, automated text-messaging intervention can improve HIV care outcomes among young adult trans women living with HIV.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA.
- Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, CA, USA.
| | - Jesse B Fletcher
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
| | - Kimberly A Kisler
- Friends Research Institute, Inc., 6910 Santa Monica Boulevard, Los Angeles, CA, 90038, USA
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18
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Traynor SM, Metsch LR, Gooden L, Stitzer M, Matheson T, Tross S, Carrico AW, Jain MK, Del Rio C, Feaster DJ. Self-efficacy as a mediator of patient navigation interventions to engage persons living with HIV and substance use. Drug Alcohol Depend 2021; 221:108567. [PMID: 33610093 PMCID: PMC8067954 DOI: 10.1016/j.drugalcdep.2021.108567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND People living with HIV who report substance use (PLWH-SU) face many barriers to care, resulting in an increased risk for poor health outcomes and the potential for ongoing disease transmission. This study evaluates the mechanisms by which Patient Navigation (PN) and Contingency Management (CM) interventions may work to address barriers to care and improve HIV outcomes in this population. METHODS Mediation analysis was conducted using data from a randomized, multi-site trial testing PN interventions to improve HIV care outcomes among 801 hospitalized PLHW-SU. Direct and indirect effects of PN and PN + CM were evaluated through five potential mediators-psychosocial conditions, healthcare avoidance, financial hardship, system barriers, and self-efficacy for HIV treatment adherence-on engagement in HIV care and viral suppression. RESULTS The PN + CM intervention had an indirect effect on improving engagement in HIV care at 6 months by increasing self-efficacy for HIV treatment adherence (β = 0.042, 95% CI = 0.008, 0.086). PN + CM also led to increases in viral suppression at 6 months (β = 0.090, 95% CI = 0.023, 0.168) and 12 months (β = 0.069, 95% CI = 0.009, 0.129) via increases in self-efficacy, although the direct effects were not significant. No mediating effects were observed for PN alone. CONCLUSION PN + CM interventions for PLWH-SU can increase an individual's self-efficacy for HIV treatment adherence, which in turn improves engagement in care at 6 months and may contribute to viral suppression over 12 months. Building self-efficacy may be a key factor in the success of such interventions and should be considered as a primary goal of PN + CM in practice.
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Affiliation(s)
- Sharleen M Traynor
- University of Miami Miller School of Public Health, Department of Public Health Sciences, 1120 NW 14th Street, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 2971 Broadway, 612 Lewisohn Hall, New York, NY, 10027, USA
| | - Lauren Gooden
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 2971 Broadway, 612 Lewisohn Hall, New York, NY, 10027, USA
| | - Maxine Stitzer
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD, 21224, USA
| | - Tim Matheson
- San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, USA
| | - Susan Tross
- Columbia University, Department of Psychiatry, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Adam W Carrico
- University of Miami Miller School of Public Health, Department of Public Health Sciences, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Mamta K Jain
- University of Texas Southwestern Medical Center, Department of Internal Medicine, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Carlos Del Rio
- Emory University School of Medicine, Division of Infectious Diseases, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Daniel J Feaster
- University of Miami Miller School of Public Health, Department of Public Health Sciences, 1120 NW 14th Street, Miami, FL, 33136, USA
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19
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Social-Environmental Resilience, PrEP Uptake, and Viral Suppression among Young Black Men Who Have Sex with Men and Young Black Transgender Women: the Neighborhoods and Networks (N2) Study in Chicago. J Urban Health 2020; 97:728-738. [PMID: 32468507 PMCID: PMC7560645 DOI: 10.1007/s11524-020-00425-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Young black men who have sex with men (YBMSM) and young black transgender women (TGW) have experienced a stark disparity in HIV prevention and care. Resilience, collective resources to adapt stressors or adversities, may improve HIV prevention and care outcomes. The present study investigated the association of resilience-based factors with PrEP uptake and viral suppression from a socioecological perspective among YBMSM and young black TGW. Data were from the baseline cycle of the Neighborhoods and Networks (N2) Study, an ongoing cohort study of 16-34-year-old YBMSM and young black TGW in Chicago (n = 324). Confidant network-level and neighborhood affiliation variables were created to measure the social-environmental context of resilience. All analyses were stratified by participants' HIV status (184 HIV-negative participants and 140 HIV-positive participants). Among HIV-negative participants, having a parental figure within an individual's confidant network was significantly associated with a greater likelihood of PrEP use. Among HIV-positive participants, confidant network members' awareness of an individual's HIV status was associated with viral suppression. Social support resources from confidant networks could improve HIV prevention and care engagement among YBMSM and young black TGW. Understanding the social and environmental contexts of resilience resource is critical for HIV prevention and care engagement.
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20
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Reback CJ, Rünger D. Technology use to facilitate health care among young adult transgender women living with HIV. AIDS Care 2020; 32:785-792. [PMID: 31405287 PMCID: PMC7012713 DOI: 10.1080/09540121.2019.1653439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
Little is known about how young adult transgender women living with HIV use digital technologies to facilitate their health care. This study examined the use of digital technologies to search for health information and support HIV care among young adult transgender women living with HIV (N = 130) in Los Angeles County, California. About half used the Internet "all the time" to search for transgender-specific resources (TSR; 53.8%) and for sexual health information (SHI; 51.5%). Less than half (39.2%) received digital HIV care reminders and, of those taking ART medication (n = 63), 36.5% received digital medication reminders. Internet information search was associated with Hispanic/Latina ethnicity (TSR: OR = 0.23, 95% CI [0.09, 0.58]; SHI: OR = 0.29, 95% CI [0.12, 0.73]) and higher (≥ $500) past-month income (TSR: OR = 2.67, 95% CI [1.13, 6.34]; SHI: OR = 2.67, 95% CI [1.14, 6.26]); receiving digital medication reminders with post-secondary educational attainment (OR = 5.70, 95% CI [1.04, 31.19]) and higher income (OR = 6.73, 95% CI [1.52, 29.67]). Receiving analog, but not digital, HIV care reminders was associated with engagement in HIV care (OR = 2.37, 95% CI [1.13, 5.00]) and ART uptake (OR = 2.18, 95% CI [1.06, 4.48]. Digital technology use was common for health-related searches but not for supporting HIV care.
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Affiliation(s)
- Cathy J. Reback
- Friends Research Institute, Inc., Los Angeles, California
- Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, California
| | - Dennis Rünger
- Center for HIV Identification, Prevention and Treatment Services, University of California Los Angeles, Los Angeles, California
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Reback CJ, Clark KA, Rünger D, Fehrenbacher AE. A Promising PrEP Navigation Intervention for Transgender Women and Men Who Have Sex with Men Experiencing Multiple Syndemic Health Disparities. J Community Health 2019; 44:1193-1203. [PMID: 31317438 PMCID: PMC6859945 DOI: 10.1007/s10900-019-00705-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transgender women and MSM experience many stigma-related syndemic conditions that exacerbate HIV incidence and prevalence rates. While PrEP is an effective biomedical intervention to reduce HIV transmission, uptake and adherence of PrEP is low among transgender women and MSM experiencing multiple syndemic health disparities. This study tested the feasibility, acceptability and effectiveness of A.S.K.-PrEP (AssistanceServicesKnowledge-PrEP), a five-session peer navigator program, designed to link transgender women and MSM to PrEP. From September 2016 to March 2018, 187 participants (transgender women = 58; MSM = 129) enrolled. Results demonstrated that approximately 90% of transgender women and MSM were linked to PrEP; MSM linked more quickly [KW χ2(1) = 10.9, p < .001]. Most transgender women (80%) and MSM (70%) reported they were still taking PrEP at the 90-day follow-up evaluation. Findings indicated that A.S.K.-PrEP is a promising intervention for PrEP linkage, uptake and preliminary adherence among transgender women and MSM.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, Inc., 1419 N. La Brea Ave., Los Angeles, CA, 90028, USA.
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Kirsty A Clark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dennis Rünger
- Friends Research Institute, Inc., 1419 N. La Brea Ave., Los Angeles, CA, 90028, USA
| | - Anne E Fehrenbacher
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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