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Arnold T, Whiteley L, Giorlando KK, Barnett AP, Albanese AM, Leigland A, Sims-Gomillia C, Elwy AR, Edet PP, Lewis DM, Brock JB, Brown LK. A qualitative study identifying implementation strategies using the i-PARIHS framework to increase access to pre-exposure prophylaxis at federally qualified health centers in Mississippi. Implement Sci Commun 2024; 5:92. [PMID: 39198914 PMCID: PMC11350989 DOI: 10.1186/s43058-024-00632-6] [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: 05/22/2024] [Accepted: 08/21/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Mississippi (MS) experiences disproportionally high rates of new HIV infections and limited availability of pre-exposure prophylaxis (PrEP). Federally Qualified Health Centers (FQHCs) are poised to increase access to PrEP. However, little is known about the implementation strategies needed to successfully integrate PrEP services into FQHCs in MS. PURPOSE The study had two objectives: identify barriers and facilitators to PrEP use and to develop tailored implementation strategies for FQHCs. METHODS Semi-structured interviews were conducted with 19 staff and 17 PrEP-eligible patients in MS FQHCs between April 2021 and March 2022. The interview was guided by the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework which covered PrEP facilitators and barriers. Interviews were coded according to the i-PARIHS domains of context, innovation, and recipients, followed by thematic analysis of these codes. Identified implementation strategies were presented to 9 FQHC staff for feedback. RESULTS Data suggested that PrEP use at FQHCs is influenced by patient and clinic staff knowledge with higher levels of knowledge reflecting more PrEP use. Perceived side effects are the most significant barrier to PrEP use for patients, but participants also identified several other barriers including low HIV risk perception and untrained providers. Despite these barriers, patients also expressed a strong motivation to protect themselves, their partners, and their communities from HIV. Implementation strategies included education and provider training which were perceived as acceptable and appropriate. CONCLUSIONS Though patients are motivated to increase protection against HIV, multiple barriers threaten uptake of PrEP within FQHCs in MS. Educating patients and providers, as well as training providers, are promising implementation strategies to overcome these barriers.
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Affiliation(s)
- Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kayla K Giorlando
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA
| | - Andrew P Barnett
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ariana M Albanese
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA
| | - Courtney Sims-Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Precious Patrick Edet
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Demetra M Lewis
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - James B Brock
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Larry K Brown
- Department of Psychiatry, Rhode Island Hospital, One Hoppin Street, Coro West, 204, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Zack JL, Hull SJ, Coleman ME, Ye PP, Lotke PS, Visconti A, Beverley J, Brant A, Moriarty P, Scott RK. Age-related factors associated with intention to initiate pre-exposure prophylaxis among cisgender women in Washington D.C. Ther Adv Infect Dis 2024; 11:20499361241252351. [PMID: 38751758 PMCID: PMC11095193 DOI: 10.1177/20499361241252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) utilization among cisgender women (subsequently 'women') is low across age groups, relative to their risk of HIV acquisition. We hypothesize that age-related differences in psychosocial factors also influence women's intention to initiate oral PrEP in Washington, D.C. Methods A secondary analysis of a cross-sectional survey data was performed to evaluate factors influencing intention to initiate oral PrEP among women seen at a family planning and a sexual health clinic. A bivariate analysis was performed to identify differences by age group in demographic characteristics, indications for PrEP, and attitudes toward PrEP; we then performed additional bivariate analysis to assess these variables in relation to PrEP intention. Results Across age groups, perceived risk of HIV acquisition was not significantly different and was not associated with intention to initiate PrEP. Awareness of and attitude toward PrEP, injunctive norms, descriptive norms, and self-efficacy were not different across age, however there were significant age-associated differences in relation to PrEP intention. Specifically, among 18-24-year-olds, intention to start PrEP was associated with support from provider (p = 0.03), main sexual partner (p < 0.01), and peers (p < 0.01). For women 25-34 years old, having multiple sexual partners (p = 0.03) and support from casual sexual partners (p = 0.03) was also important. Among women 35-44 years old, prior awareness of PrEP (p = 0.02) and their children's support of PrEP uptake (p < 0.01) were associated with intention to initiate PrEP. Among 45-55 year-old women intention to initiate PrEP was positively associated with engaging in casual sex (p = 0.03) and negatively associated with stigma (p < 0.01). Conclusion Overall, there were more similarities than differences in factors influencing intention to initiate PrEP across age groups. Observed differences offer an opportunity to tailor PrEP delivery and HIV prevention interventions to increase awareness and uptake for cisgender women.
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Affiliation(s)
- Jennifer L. Zack
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA
| | - Shawnika J. Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Megan E. Coleman
- Whitman-Walker Health, Department of Clinical Investigations, Washington, DC, USA
| | - Peggy Peng Ye
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Pamela S. Lotke
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Adam Visconti
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Georgetown University Hospital, Department of Family Medicine, Washington, DC, USA
| | - Jason Beverley
- DC Health, DC Department of Health: HIV/AIDS, Hepatitis, STD & TB Administration (HAHSTA), Washington, DC, USA
| | - Ashley Brant
- Cleveland Clinic Foundation, Women’s Health Institute, Cleveland, OH, USA
| | - Patricia Moriarty
- MedStar Health Research Institute, Clinical Research, Hyattsville, MD, USA
| | - Rachel K. Scott
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
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Giddings R, Indravudh P, Medley GF, Bozzani F, Gafos M, Malhotra S, Terris-Prestholt F, Torres-Rueda S, Quaife M. Infectious Disease Modelling of HIV Prevention Interventions: A Systematic Review and Narrative Synthesis of Compartmental Models. PHARMACOECONOMICS 2023; 41:693-707. [PMID: 36988896 PMCID: PMC10163138 DOI: 10.1007/s40273-023-01260-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The HIV epidemic remains a major public health problem. Critical to transmission control are HIV prevention strategies with new interventions continuing to be developed. Mathematical models are important for understanding the potential impact of these interventions and supporting policy decisions. This systematic review aims to answer the following question: when a new HIV prevention intervention is being considered or designed, what information regarding it is necessary to include in a compartmental model to provide useful insights to policy makers? The primary objective of this review is therefore to assess suitability of current compartmental HIV prevention models for informing policy development. METHODS Articles published in EMBASE, Medline, Econlit, and Global Health were screened. Included studies were identified using permutations of (i) HIV, (ii) pre-exposure prophylaxis (PrEP), circumcision (both voluntary male circumcision [VMMC] and early-infant male circumcision [EIMC]), and vaccination, and (iii) modelling. Data extraction focused on study design, model structure, and intervention incorporation into models. Article quality was assessed using the TRACE (TRAnsparent and Comprehensive Ecological modelling documentation) criteria for mathematical models. RESULTS Of 837 articles screened, 48 articles were included in the review, with 32 unique mathematical models identified. The substantial majority of studies included PrEP (83%), whilst fewer modelled circumcision (54%), and only a few focussed on vaccination (10%). Data evaluation, implementation verification, and model output corroboration were identified as areas of poorer model quality. Parameters commonly included in the mathematical models were intervention uptake and effectiveness, with additional intervention-specific common parameters identified. We identified key modelling gaps; critically, models insufficiently incorporate multiple interventions acting simultaneously. Additionally, population subgroups were generally poorly represented-with future models requiring improved incorporation of ethnicity and sexual risk group stratification-and many models contained inappropriate data in parameterisation which will affect output accuracy. CONCLUSIONS This review identified gaps in compartmental models to date and suggests areas of improvement for models focusing on new prevention interventions. Resolution of such gaps within future models will ensure greater robustness and transparency, and enable more accurate assessment of the impact that new interventions may have, thereby providing more meaningful guidance to policy makers.
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Affiliation(s)
| | | | | | | | - Mitzy Gafos
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Matthew Quaife
- London School of Hygiene & Tropical Medicine, London, UK
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Bazzi AR, Bordeu M, Baumgartner K, Sproesser DM, Bositis CM, Krakower DS, Mimiaga MJ, Biello KB. Study protocol for an efficacy trial of the "PrEP for Health" intervention to increase HIV PrEP use among people who inject drugs. BMC Public Health 2023; 23:513. [PMID: 36932369 PMCID: PMC10021034 DOI: 10.1186/s12889-023-15429-w] [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] [Received: 02/15/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND HIV incidence has recently increased among people who inject drugs (PWID) across the United States, with outbreaks occurring in states with long-standing syringe service programs (SSPs) including Massachusetts (MA). Antiretroviral pre-exposure prophylaxis (PrEP) is an evidence-based HIV prevention strategy recommended for PWID, but uptake in this marginalized population is extraordinarily low. METHODS We describe the design and procedures for a National Institute on Drug Abuse (NIDA)-funded (R01) randomized controlled trial (RCT) testing the efficacy of "PrEP for Health," a multicomponent behavioral intervention to increase PrEP uptake, adherence, and persistence among HIV-negative PWID attending SSPs in two areas of the U.S. Northeast that are heavily affected by injection-related HIV transmission. Participants are equally randomized to receive the "PrEP for Health" intervention (involving individually tailored HIV and PrEP education, motivational interviewing, problem-solving skills and planning, and ongoing navigation support) or an enhanced standard of care (eSOC) control condition involving a brief educational video on the utility of PrEP for HIV prevention. Co-primary outcomes are PrEP uptake (using medical/pharmacy records) and adherence (using tenofovir quantification in hair samples); a secondary outcome is PrEP persistence (using medical/pharmacy records) over 12 months. Major assessments occur at baseline, 1-, 3-, 6-, and 12-month follow-up visits. Planned analyses will examine intervention efficacy, specific hypothesized conceptual mediators of the intervention effect (e.g., self-perceived HIV risk; PrEP knowledge, interest in use, motivation, and behavioral skills) and epidemiologically linked moderators (e.g., age; gender; condomless vaginal or anal sex). DISCUSSION Findings from our extensive preliminary research with the study population revealed that a multicomponent, theory-based intervention targeting PrEP knowledge, motivation, self-efficacy, behavioral skills, and structural barriers to PrEP access is urgently needed for PWID who are at risk of HIV acquisition. We also learned that SSPs represent a highly acceptable service setting for delivering such interventions. In this study, we are evaluating the efficacy of the "PrEP for Health" intervention. If efficacious, findings from our implementation evaluation could help guide its dissemination to diverse SSPs and possibly other community-based settings accessed by this population. TRIAL REGISTRATION ClinicalTrials.gov number NCT04430257, registered June 12, 2020.
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Affiliation(s)
- Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, San Diego, La Jolla, 92093, CA, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
- Herbert Wertheim School of Public Health, University of California, 9500 Gilman Drive, MTF 265E (Mail Code 0725), La Jolla, 92161, CA, USA.
| | | | | | | | - Christopher M Bositis
- Greater Lawrence Family Health Center, Lawrence, MA, USA
- Department of Family and Community Medicine, University of California, San Francisco, USA
| | - Douglas S Krakower
- Fenway Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew J Mimiaga
- Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Katie B Biello
- Fenway Health, Boston, MA, USA.
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, 02912, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
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Hollcroft MR, Gipson J, Barnes A, Mena L, Dombrowski JC, Ward LM, Khosropour CM. PrEP Acceptance among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi. J Int Assoc Provid AIDS Care 2023; 22:23259582231167959. [PMID: 37032460 PMCID: PMC10088405 DOI: 10.1177/23259582231167959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.
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Affiliation(s)
| | - June Gipson
- Open Arms Healthcare Center, Jackson, MS, USA
| | | | - Leandro Mena
- Open Arms Healthcare Center, Jackson, MS, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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Pichon LC, Teti M, McGoy S, Murry VM, Juarez PD. Engaging Black men who have sex with men (MSM) in the South in identifying strategies to increase PrEP uptake. BMC Health Serv Res 2022; 22:1491. [PMID: 36476363 PMCID: PMC9727972 DOI: 10.1186/s12913-022-08914-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Promotion, uptake, and adherence of pre-exposure prophylaxis (PrEP) is paramount to ending the HIV epidemic among young Black men who have sex with men in the South. The purpose of this study was to explore strategies needed for and barriers to PrEP uptake needed to achieve HIV prevention goals identified in the U.S. Department of Health & Human Services initiative to reduce new HIV infections in the United States by 90 percent by 2030. METHOD Young adults (n = 25) between the ages of 15-34 were recruited from community-based organizations in Memphis to participate in four focus group discussions. Discussion topics included motivations, barriers, and facilitators to PrEP use. Data were analyzed using thematic analysis. RESULTS All (100%) of participants self-identified as HIV-negative, Black (96%), men who have sex with men (96%), and currently prescribed PrEP/Truvada (60%). Themes identified for increasing uptake included 1) trusted peers, 2) relatable healthcare provider (e.g., Historically Black College and University (HBCU) trained, LGBTQ), and 3) use of social media. Mislabeling of PrEP as promiscuity promoting and limitations with PrEP marketing (e.g., solely LGBTQ) were recognized as barriers that perpetuated stigma. CONCLUSION Findings suggest the importance of increasing awareness among health professions students matriculating at HBCUs of their perceived role as relatable healthcare providers by Black MSM; working closely with couples; and crafting of PrEP messaging that is non-stigmatizing. Findings will inform public health interventions for young Black MSM and facilitate HIV prevention efforts with other groups disproportionally affected by HIV in the South.
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Affiliation(s)
- Latrice C. Pichon
- grid.56061.340000 0000 9560 654XSchool of Public Health, Division of Social and Behavioral Sciences, The University of Memphis, 3825 Desoto Ave 209 Robison Hall, Memphis, TN 38152 USA
| | - Michelle Teti
- grid.134936.a0000 0001 2162 3504Department of Public Health, The University of Missouri, 806 Lewis Hall, Columbia, MO 65211 USA
| | - Shanell McGoy
- grid.416951.e0000 0004 0437 4464Formerly Tennessee Department of Health, 710 James Robertson Pkwy, Nashville, TN 37243 USA
| | - Velma McBride Murry
- grid.412807.80000 0004 1936 9916Departments of Health Policy Human and Organizational Development, Vanderbilt University Medical Center & Peabody College, PMB 90 230 Appleton Place, Nashville, TN 37203 USA
| | - Paul D. Juarez
- grid.259870.10000 0001 0286 752XDepartment of Family & Community Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN 37208 USA
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Vakili J, Sizemore L, Rebeiro PF, Tyndall B, Talley P, Whaley K, Brantley M. Assessment of Tennessee's county-level vulnerability to hepatitis C virus and HIV outbreaks using socioeconomic, healthcare, and substance use indicators. PLoS One 2022; 17:e0270891. [PMID: 35925969 PMCID: PMC9352017 DOI: 10.1371/journal.pone.0270891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis C virus (HCV), and injection drug use are syndemic in the central Appalachian states. In Tennessee (TN), declines in HIV among persons who inject drugs (PWID) stalled, and HCV infection rates increased significantly from 2013-2017. To better target strategies to address the syndemic, county-level socioeconomic, opioid use, access to healthcare, and health factors were modeled to identify indicators predictive of vulnerability to an HIV/HCV outbreak among PWID in TN. METHODS Newly reported chronic HCV cases among persons aged 13-39 years in 2016-2017 were used as a proxy for county-level HIV/HCV vulnerability among TN's 95 counties. Seventy-five publicly available county-level measures from 2016-2017 were collected and reduced through multiple dimension reduction techniques. Negative binomial regression identified indicators associated with HCV which were used to calculate county-level vulnerability to a local HIV/HCV outbreak. RESULTS Thirteen county-level indicators were identified as strongly predictive of HIV/HCV vulnerability with the statistically significant indicators being percentage of the population aged 20-44 years, per capita income, teen birth rate, percentage of clients in TDMHSAS-funded opioid treatment and recovery, syphilis case rate, and percentage of homes with at least one vehicle. Based on the 13 indicators, we identified the distribution of vulnerability to an HIV/HCV outbreak among TN's counties. Eleven high vulnerability counties were identified, with the preponderance located in east and middle TN. CONCLUSION This analysis identified the county-level factors most associated with vulnerability to an HIV/HCV outbreak among PWID in TN. These results, alongside routine surveillance, will guide targeted prevention and linkage to care efforts for the most vulnerable communities.
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Affiliation(s)
- Jessica Vakili
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Lindsey Sizemore
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Peter F. Rebeiro
- Vanderbilt University School of Medicine, Departments of Medicine and Biostatistics, Nashville, TN, United States of America
| | - Ben Tyndall
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Pamela Talley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Kristyn Whaley
- Tennessee Department of Health, Nashville, TN, United States of America
| | - Meredith Brantley
- Tennessee Department of Health, Nashville, TN, United States of America
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Wang H, Shobowale O, den Daas C, Op de Coul E, Bakker B, Radyowijati A, Vermey K, van Bijnen A, Zuilhof W, Jonas KJ. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8829. [PMID: 35886681 PMCID: PMC9315833 DOI: 10.3390/ijerph19148829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called "Randstad", entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
| | - Oladipupo Shobowale
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
| | - Chantal den Daas
- Health Psychology, University of Aberdeen, Aberdeen AB24 3 FX, UK;
| | - Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands;
| | | | | | - Koenraad Vermey
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Arjan van Bijnen
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Wim Zuilhof
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
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Sharpless L, Kershaw T, Hatcher A, Alexander KA, Katague M, Phillips K, Willie TC. IPV, PrEP, and Medical Mistrust. J Acquir Immune Defic Syndr 2022; 90:283-290. [PMID: 35364598 PMCID: PMC9203922 DOI: 10.1097/qai.0000000000002956] [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: 10/11/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention method for women experiencing intimate partner violence (IPV). This study aimed to examine (1) relationships between physical, sexual, and psychological IPV and women's PrEP communication with a health care provider and domestic violence advocate; and (2) how IPV-specific medical mistrust modifies the association between IPV and PrEP communication. METHODS Data were from 2 studies conducted in Connecticut and Baltimore, MD on adult women experiencing IPV (N = 272). Logistic regressions examined associations between IPV, PrEP communication, and IPV-specific medical mistrust. RESULTS The average age was 25.7. The most common identity was non-Hispanic black (37.1%), followed by non-Hispanic white (33.8%), Hispanic (20.6%), and non-Hispanic another racial group (8.5%). Higher severity of psychological IPV was associated with more embarrassment to initiate a PrEP discussion with a health care provider (P = 0.009) or domestic violence advocate (P = 0.026). However, women with more severe psychological IPV were more willing to accept a PrEP recommendation from a health care provider (P = 0.033) or domestic violence advocate (P = 0.044). IPV-specific medical mistrust modified the association between physical IPV and willingness to accept a PrEP recommendation by a domestic violence advocate, such that women with physical IPV were significantly less likely to accept a PrEP recommendation by a domestic violence advocate, but only for women with high IPV-specific medical mistrust (P = 0.021). CONCLUSIONS PrEP initiation among women experiencing IPV may be strengthened by addressing and dismantling systems that perpetuate IPV-specific medical mistrust and stigma against IPV survivors.
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Affiliation(s)
- Laurel Sharpless
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill NC, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven CT, USA
| | - Abigail Hatcher
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill NC, USA
| | - Kamila A. Alexander
- Department of Community Public Health Nursing, Johns Hopkins School of Nursing, Baltimore MD, USA
| | - Marina Katague
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla CA, USA
| | - Karlye Phillips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | - Tiara C. Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
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Pichon LC, Teti M, Betts JE, Brantley M. 'PrEP'ing Memphis: A qualitative process evaluation of peer navigation support. EVALUATION AND PROGRAM PLANNING 2022; 90:101989. [PMID: 34419307 PMCID: PMC9523887 DOI: 10.1016/j.evalprogplan.2021.101989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND HIV PrEP (pre-exposure prophylaxis) navigation comprises intervention strategies used to improve PrEP uptake via education, linkage, and follow-up/ongoing engagement. During 2016-2019, the Tennessee Department of Health (TDH) implemented a CDC-funded demonstration project ("Project PrIDE") focused on PrEP navigation in Memphis community-based organizations (CBOs) and the Shelby County Health Department (HD). A process evaluation was conducted to determine facilitators and barriers to the implementation of the Memphis-based Project PrIDE PrEP navigation activities. METHODS A total of fourteen in-depth qualitative interviews were conducted, with nine PrEP navigators in evaluation year 1 (2018) and five of the original navigators in evaluation year 2 (2019), to understand the navigation processes using thematic analysis. RESULTS Facilitators of PrEP navigation included accessing clients at testing events, accompanying clients to first appointments, rapport building with patient and clinic staff, and maintaining consistent engagement with clients. Factors impeding PrEP navigation included difficulties assessing client readiness, tracking client navigation status, and stigmatizing clinic and social experiences for clients. CONCLUSIONS AND LESSONS LEARNED Findings have informed the scale-up of PrEP navigation implementation statewide, along with priority setting and resource allocation for the local Ending the HIV Epidemic (EHE) initiative in Memphis.
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Affiliation(s)
- Latrice C Pichon
- The University of Memphis School of Public Health, Division of Social and Behavioral Sciences, 3825 Desoto Avenue, 209 Robison Hall, Memphis, TN 38152, USA.
| | - Michelle Teti
- The University of Missouri Department of Public Health, 512 Clark Hall Columbia, MO 65211, USA.
| | - Joshua E Betts
- ICF, 2635 Century Center Parkway, Suite 1000, Atlanta, GA 30345, USA; CDC, Atlanta, GA, USA.
| | - Meredith Brantley
- Tennessee Department of Health, HIV/STD/Viral Hepatitis, 710 James Robertson Pkwy, Nashville, TN 37243, USA.
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Frank L, Starzyk E, Hoxworth T, Canon M, McGuinness C, Watkins A, Deem T, Orozco-Pacheco G. HIV PrEP implementation: A multi-level systems approach. EVALUATION AND PROGRAM PLANNING 2022; 90:101966. [PMID: 34127271 DOI: 10.1016/j.evalprogplan.2021.101966] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/21/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE CO-PrIDE was a three-year Pre-Exposure Prophylaxis (PrEP) demonstration project to increase access to PrEP for men who have sex with men and transgender people in the Denver/Aurora Metropolitan Statistical Area. CO-PrIDE implemented a multi-level framework featuring collaboration between health systems and community organizations to link clients to PrEP prescribers and provide support services intended to help clients overcome socioeconomic barriers to PrEP uptake. These services included payment assistance, insurance navigation, and healthcare navigation. CO-PrIDE implemented a participatory mixed-methods evaluation to understand the services associated with PrEP uptake. RESULTS From January 2016 to December 2018, navigators screened 10,129 clients for PrEP and offered supportive services. The results indicated that clients who received payment assistance were more likely to accept a PrEP prescription (aPR = 3.52, p < .0001). Additionally, clients were more likely to receive a PrEP prescription through a co-located health system model, meaning the clinical provider is located with the PrEP Navigator (aPR = 3.78, p < .001). CONCLUSIONS The primary factors associated with increased PrEP uptake included co-location of navigation and clinical PrEP services and providing navigation to payment assistance programs. The evaluation results suggest that a multi-level framework that includes diverse support services is needed to implement a sustainable PrEP program.
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Affiliation(s)
- Leslie Frank
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Erin Starzyk
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Tamara Hoxworth
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Megan Canon
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Colleen McGuinness
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Anita Watkins
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
| | - Thomas Deem
- Vivent Health 5250 Leetsdale Drive, Suite #300, Denver, CO, 80246, United States.
| | - Gerardo Orozco-Pacheco
- Colorado Department of Public Health and Environment 4300 Cherry Creek South Drive, Denver, CO, 80246, United States.
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Schumacher CM, Tao X, Chandran A, Fields E, Price A, Greenbaum A, Jennings JM. Reaching Those Most at Risk for HIV Acquisition: Evaluating Racial/Ethnic Disparities in the Preexposure Prophylaxis Care Continuum in Baltimore City, Maryland. J Acquir Immune Defic Syndr 2021; 87:1145-1153. [PMID: 33883471 PMCID: PMC9306005 DOI: 10.1097/qai.0000000000002712] [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] [Received: 12/02/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reducing HIV incidence requires addressing persistent racial/ethnic disparities in HIV burden. Our goal was to evaluate preexposure prophylaxis (PrEP) delivery, overall and relative to community need, among 7 clinical sites participating in a health department-led demonstration project to increase PrEP in Baltimore city, MD. METHODS PrEP care continuum stages (screened, indicated, referred, linked, evaluated, prescribed) were examined among HIV-negative individuals receiving services at participating sites between September 30, 2015 and September 29, 2019. Community need was defined using information on new HIV diagnoses (2016-2018). Differences in care continuum progression by demographics/priority population and comparison of demographic compositions between care continuum stages and new HIV diagnoses were examined using modified Poisson regression and χ2 tests, respectively. RESULTS Among 25,886 PrEP-screened individuals, the majority were non-Hispanic (NH) black (81.1%, n = 20,998), cisgender male (61.1%, n = 15,825), and heterosexual (86.7%, n = 22,452). Overall, 31.1% (n = 8063) were PrEP-indicated; among whom, 56.8% (n = 4578), 15.6% (n = 1250), 10.8% (n = 868), and 9.0% (n = 722) were PrEP-referred, linked, evaluated, and prescribed, respectively. Among 2870 men who have sex with men (MSM), 18.7% (n = 538) were PrEP-prescribed. Across all groups, the highest attrition was between PrEP-referred and PrEP-linked. NH-black race (vs. NH-white) was independently associated with lower likelihood of PrEP prescription (aPR, 0.89; 95% confidence interval, 0.81 to 0.98 controlling for age/gender). Relative to the demographic composition of new HIV diagnoses, fewer NH-blacks (80.2% vs. 54.3%) and more NH-whites (10.7% vs. 30.3%) and MSM were PrEP prescribed (55.2% vs. 74.5%). CONCLUSIONS This project showed promise delivering PrEP referrals and prescriptions overall and to MSM. Substantial improvement is needed to improve linkage overall and to decrease disparities in PrEP prescriptions among NH-blacks. Future work should focus on addressing service gaps that hinder PrEP utilization.
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Affiliation(s)
- Christina M Schumacher
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Xueting Tao
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins School of Medicine, Baltimore, MD
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
| | - Errol Fields
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | - Jacky M Jennings
- Department of Pediatrics, Center for Child and Community Health Research, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
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