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Moyano DL, Agulló-Tomás MS, Zorrilla-Muñoz YV. Género, infodemia y desinformación en salud. Revisión de alcance global, vacíos de conocimiento y recomendaciones. Glob Health Promot 2024:17579759231216945. [PMID: 38183208 DOI: 10.1177/17579759231216945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
OBJETIVO explorar el estado de la literatura científica sobre los aspectos de infodemia y desinformación en salud vinculados al género y a la interseccionalidad, detectar vacíos de conocimiento y brindar recomendaciones. MÉTODOS revisión de alcance global, con la detección de vacíos de conocimiento y recomendaciones. Se buscó en ocho bases de datos: MEDLINE (Pubmed), Anthropological Index Online, Studies on Women & Gender Abstracts, LILACS, Scielo, Global Index Medicus, Web of Science, Google académico y se hizo una búsqueda manual en Google de documentos de los últimos 10 años, sin restricciones de idioma y geográficas. Se realizó un análisis de contenido de los estudios incluidos. RESULTADOS 855 registros fueron identificados y 21 cumplieron con los criterios de inclusión. Predominan los estudios que tuvieron como primer autor/a una mujer (13/21), aunque en la autoría global se destacaron los hombres (10/21). El modelo binario fue el enfoque principal (16/21). La mayoría (18/21) se publicaron a partir del 2020. Se abordaron principalmente temas relacionados con la COVID-19 y la salud sexual y reproductiva (antes de la pandemia), y en menor medida la salud mental. Se identificaron interacciones entre diferencias de sexo/género en la desinformación/infodemia en salud especialmente en mujeres, colectivos de género diverso, personas mayores y población de bajo nivel socioeducativo. CONCLUSIONES existen brechas de conocimiento en el tema explorado, con escaso número de estudios, y limitaciones de alcances y del enfoque de género y/o feminista (más allá del binario). No obstante, los resultados tentativos constatan la presencia de inequidades de género e interseccionalidad en la desinformación en salud. PALABRAS CLAVE infodemia, desinformación, género, COVID-19, revisión sistemática.
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Affiliation(s)
- Daniela Luz Moyano
- Departamento de Ciencias de la Salud, Universidad Nacional de La Matanza, San Justo, Buenos Aires, Argentina
- Instituto Universitario de Estudios de Género, Universidad Carlos III de Madrid, Getafe, Madrid, España
| | - María Silveria Agulló-Tomás
- Instituto Universitario de Estudios de Género, Universidad Carlos III de Madrid, Getafe, Madrid, España
- Departamento de Análisis Social, Universidad Carlos III de Madrid, Getafe, Madrid, España
| | - Y Vanessa Zorrilla-Muñoz
- Instituto Universitario de Estudios de Género, Universidad Carlos III de Madrid, Getafe, Madrid, España
- Instituto de Bioingeniería, Universidad Miguel Hernández de Elche, Comunidad Valenciana, España
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Lozano A, Jaramillo J, Prado G, Safren SA, Harkness A. Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men. AIDS Care 2023; 35:1329-1337. [PMID: 37232132 PMCID: PMC10524698 DOI: 10.1080/09540121.2023.2216009] [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: 11/22/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration histories (U.S. born, recent immigrant, established immigrant). Next, we examined differences in barrier/facilitator ratings across these age and immigration status groups. Key overall determinants were cost, knowledge, and perceived benefit/need. However, there was variation in determinants across age groups (i.e., cost, affordability, navigation support, and normalization) and immigration statuses (i.e., language, immigration concerns, and HIV knowledge). There were also differences across service types; mistrust and concerns was a barrier related to PrEP but not HIV testing. We found unique and common multilevel factors across prevention services and subgroups. Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM.
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Affiliation(s)
- Alyssa Lozano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA, 33136
| | - Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, University of Miami, Miami, FL, USA, 33136
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL 33146
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146
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Chimukuche RS, Kawuma R, Mahapa N, Mkhwanazi S, Singh N, Siva S, Ruzagira E, Seeley J. Examining oral pre-exposure prophylaxis (PrEP) literacy among participants in an HIV vaccine trial preparedness cohort study. BMC Health Serv Res 2022; 22:1336. [PMID: 36357877 PMCID: PMC9649006 DOI: 10.1186/s12913-022-08730-8] [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: 11/08/2021] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. METHODS We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. RESULTS We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. CONCLUSION The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04066881.
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Affiliation(s)
| | - Rachel Kawuma
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Smanga Mkhwanazi
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nishanta Singh
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Samantha Siva
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Eugene Ruzagira
- HIV Epidemiology and Interventions Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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4
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Valente PK, Bauermeister JA, Lin WY, Silva DTD, Hightow-Weidman L, Drab R, Mayer KH, Operario D, Rusley J, Biello KB. Preferences Across Pre-Exposure Prophylaxis Modalities Among Young Men Who Have Sex with Men in the United States: A Latent Class Analysis Study. AIDS Patient Care STDS 2022; 36:431-442. [PMID: 36367995 PMCID: PMC9910107 DOI: 10.1089/apc.2022.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Access to daily oral pre-exposure prophylaxis (PrEP) is suboptimal among young cisgender men who have sex with men (YMSM) in the United States. Next-generation modalities that do not involve daily oral regimens may mitigate some of the barriers to PrEP use. We identified latent classes of YMSM based on health care decision-making patterns and examined associations between latent classes and access to health care and PrEP modality preferences (i.e., daily and event-driven oral, rectal douches, broadly neutralizing antibodies, subcutaneous implants, and an injectable). Between October 2020 and June 2021, we administered an online survey to 737 YMSM. Latent class analysis (LCA) identified groups of YMSM based on communication with providers, stigma and mistrust in health care, and autonomy in sexual health decisions. Logistic regression examined associations between class membership and health care access, and exploded logit regression examined associations between class membership and ranked PrEP modality preferences. LCA identified three classes: shared decision-making (high communication with providers and high autonomy); provider-led decision-making (high communication and low autonomy); and patient-driven decision-making (low communication and high autonomy). Shared decision-making was associated with higher access to health care in comparison with the other classes. Across all classes, YMSM preferred daily oral PrEP over all next-generation PrEP modalities. Preferences for daily oral PrEP over next-generation PrEP modalities were particularly marked among the patient-driven decision-making class. Shared decision-making is associated with access to health care and HIV prevention and higher acceptability of next-generation PrEP modalities, and should be considered as part of future interventions to promote use of daily oral and next-generation PrEP.
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Affiliation(s)
- Pablo K. Valente
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Willey Y. Lin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Teixeira Da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Hightow-Weidman
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jack Rusley
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katie B. Biello
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Truong JM, Chemnasiri T, Wirtz AL, Mon SHH, Varangrat A, Decker M, Janyam S, Linjongrat D, Sirivongrangson P, Hickey AC, Weir BW, Beyrer C. Diverse contexts and social factors among young cisgender men and transgender women who sell or trade sex in Bangkok and Pattaya, Thailand: formative research for a PrEP program implementation study. AIDS Care 2022; 34:1443-1451. [PMID: 35473429 PMCID: PMC9596612 DOI: 10.1080/09540121.2022.2067317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
HIV incidence is high and persistent among cisgender men who have sex with men (MSM) and transgender women (TGW) who have sex with men, particularly among those who sell or trade sex. In preparation for an open-label combination HIV pre-exposure prophylaxis (PrEP) program for these groups, we conducted formative research to explore the context of sex work/trade and factors that affect implementation of PrEP interventions. This study analyzed interviews with 20 young (aged 18-26 years) MSM and TGW who sell/trade sex and three sex work venue managers in Bangkok and Pattaya, Thailand. Participants described diverse contexts of sex work/trade, including in multiple informal and formal sex venues. Several participants reported mobility across provinces and out of the country, which led to intermittent sex work/trade. TGW sex workers reported challenges with access and cost of femininizing hormones and limited employment opportunities. Factors that could facilitate or challenge PrEP program implementation included HIV stigma, the role of venue management in sexual health practice, lack of PrEP knowledge, lower perceived HIV risk, and interest in personal health and wellbeing. Program implementers must consider myriad factors to successfully implement PrEP among young MSM and TGW engaged in sex work or trade in Thailand.
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Affiliation(s)
- Jasmine M. Truong
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tareerat Chemnasiri
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Andrea L. Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sandra Hsu Hnin Mon
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anchalee Varangrat
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Michele Decker
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Surang Janyam
- Service Workers in Group Foundation (SWING), Bangkok and Pattaya, Thailand
| | | | | | - Andrew C. Hickey
- Division of HIV Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Brian W. Weir
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lee JJ, Aguirre J, Munguia L, Robles G, Ramirez Hernandez K, Ramirez JI, Leyva Vera CA, Duran MC. Engagement of Latino immigrant men who have sex with men for HIV prevention through eHealth: preferences across social media platforms. ETHNICITY & HEALTH 2022; 27:1684-1697. [PMID: 34152248 PMCID: PMC8688577 DOI: 10.1080/13557858.2021.1943322] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/08/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVE eHealth has growing potential to enhance access to HIV prevention for hard to reach populations, including young Latino immigrant men who have sex with men (MSM) in the United States. We examined the feasibility and acceptability of using eHealth tools, specifically social media platforms, to facilitate HIV testing and pre-exposure prophylaxis (PrEP) uptake among this population. DESIGN We utilized a community sensitive approach to conduct 30 in-depth interviews and five focus groups with young Latino immigrant MSM in Seattle, WA. Data were analyzed using thematic analysis with both data-driven inductive and a priori deductive approaches. RESULTS Participants were open to receiving HIV information via social media platforms. Participants recommended that social media content be tailored with their language preferences, cultural norms, and beliefs about HIV testing and PrEP in mind. Further, participants emphasized that content avoid stigmatizing HIV or Latino MSM's complex identities. CONCLUSIONS Results have implications for utilizing social media platforms and developing HIV prevention interventions for Latino immigrant MSM. Findings highlight that HIV prevention content should acknowledge how identities as an emerging adult, Latino, immigrant, and MSM, warrant unique consideration.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | | | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | | | | | | | - Miriana C Duran
- Department of Health Services, University of Washington, Seattle, WA, USA
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7
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Schwartz S, Ortiz JC, Smith JD, Beres L, Mody A, Eshun-Wilson I, Benbow N, Mallela DP, Tan S, Baral S, Geng E. Data Velocity in HIV-Related Implementation Research: Estimating Time From Funding to Publication. J Acquir Immune Defic Syndr 2022; 90:S32-S40. [PMID: 35703753 PMCID: PMC9204847 DOI: 10.1097/qai.0000000000002963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given available effective biomedical and behavioral prevention and treatment interventions, HIV-related implementation research (IR) is expanding. The rapid generation and dissemination of IR to inform guidelines and practice has the potential to optimize the impact of the Ending the Epidemic Initiative and the HIV pandemic response more broadly. METHODS We leveraged a prior mapping review of NIH-funded awards in HIV and IR from January 2013 to March 2018 and identified all publications linked to those grants in NIH RePORTER through January 1, 2021 (n = 1509). Deduplication and screening of nonoriginal research reduced the count to 1032 articles, of which 952 were eligible and included in this review. Publication volume and timing were summarized; Kaplan-Meier plots estimated time to publication. RESULTS Among the 215 NIH-funded IR-related awards, 127 of 215 (59%) published original research directly related to the grant, averaging 2.0 articles (SD: 3.3) per award, largely in the early IR phases. Many articles (521 of 952, 55%) attributed to grants did not report grant-related data. Time from article submission to publication averaged 205 days (SD: 107). The median time-to-first publication from funding start was 4 years. Data dissemination velocity varied by award type, trending toward faster publication in recent years. Delays in data velocity included (1) time from funding to enrollment, (2) enrollment length, and (3) time from data collection completion to publication. CONCLUSION Research publication was high overall, and time-to-publication is accelerating; however, over 40% of grants have yet to publish findings from grant-related data. Addressing bottlenecks in the production and dissemination of HIV-related IR would reinforce its programmatic and policy relevance in the HIV response.
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Affiliation(s)
- Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Joel Chavez Ortiz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah, Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Laura Beres
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD
| | - Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Nanette Benbow
- Department of Psychiatry and Behavioral Sciences at the Northwestern University Feinberg School of Medicine
| | | | - Stephen Tan
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO
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Barriers to Pre-Exposure Prophylaxis Uptake Among Online Male Sex Workers in the US. AIDS Behav 2022; 26:1572-1586. [PMID: 34705151 PMCID: PMC9007820 DOI: 10.1007/s10461-021-03510-7] [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: 10/15/2021] [Indexed: 10/20/2022]
Abstract
Though barriers to HIV pre-exposure prophylaxis (PrEP) uptake among gay, bisexual, and other men who have sex with men (MSM) have received substantial research attention, less is known about what factors may be affecting PrEP uptake among male sex workers (MSWs), a population at high risk of HIV. This paper presents qualitative findings regarding why a subsample of MSM engaged in exchange sex (receiving money, drugs, shelter, or other goods in exchange for sex) with partners they met on dating/hookup websites and apps had never used PrEP. Analysis revealed several barriers to PrEP uptake including lack of awareness and knowledge about PrEP, scientific and medical concerns, issues related to individual risk perception and beliefs/preferences about risk management, practical and logistical barriers, and provider-level barriers. Nuances to these barriers are discussed, particularly as they relate to the specific type of sex work participants were engaged in. Implications for interventions are also discussed.
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9
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Garett R, Young SD. The Impact of Misinformation and Health Literacy on HIV Prevention and Service Usage. J Assoc Nurses AIDS Care 2022; 33:e1-e5. [PMID: 34939991 PMCID: PMC10993296 DOI: 10.1097/jnc.0000000000000298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are an increasing number of online resources people can use to gain access to information, including for health-related issues, such as for HIV prevention. Trend data show that the way individuals obtain news and information has changed from years past. Health literacy, therefore, is an important skill to ensure adequate understanding of the data available about HIV in the media and online. Unfortunately, the proliferation of misinformation is ubiquitous and may have deleterious effects on individual health behavior, and consequently, the public’s health. This commentary focuses on sources of online misinformation as it relates to HIV and how misinformation impacts seeking health services.
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Affiliation(s)
- Renee Garett
- Renee Garett, MSW, LCSW, is the Founding Director, ElevateU, Irvine, California, USA. Sean D. Young, PhD, MS, is an Associate Professor, Department of Emergency Medicine, and Executive Director, University of California Institute for Prediction Technology, Department of Informatics, University of California, Irvine, California, USA
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Marcus JL, Levine K, Sewell WC, Solleveld P, Mayer KH, Krakower DS. Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide for Human Immunodeficiency Virus Preexposure Prophylaxis at a Boston Community Health Center. Open Forum Infect Dis 2021; 8:ofab372. [PMID: 34631926 PMCID: PMC8496521 DOI: 10.1093/ofid/ofab372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Efforts to end the human immunodeficiency virus (HIV) epidemic may be
threatened if limited preexposure prophylaxis (PrEP) resources are funneled
from tenofovir disoproxil fumarate with emtricitabine (TDF/FTC) to tenofovir
alafenamide with emtricitabine (TAF/FTC) without proportional clinical
benefits. Methods The study population was patients at a Boston community health center who
were assigned male sex at birth, aged ≥18 years, and prescribed
TDF/FTC for PrEP in the 12 months before TAF/FTC approval (October 2019). We
determined the frequency of switching to TAF/FTC in the 12 months after
approval, including clinically indicated switching (ie, creatinine clearance
<60 mL/minute or reduced bone density), potentially unnecessary
switching (ie, no indications for switching and no cardiovascular risk
factors), and potentially harmful switching (ie, no indications for
switching and either obesity or dyslipidemia). Results Of 2892 TDF/FTC users, mean age was 38 years, 96.0% were cisgender men, and
78.9% were white. A total of 343 (11.9%) switched to TAF/FTC. Based on
documented renal, bone, and cardiovascular risk factors, we identified 24
(7.0%) with clinically indicated switching, 271 (79.0%) with potentially
unnecessary switching, and 48 (14.0%) with potentially harmful switching.
When indications for switching additionally included hypertension, diabetes,
and creatinine clearance 60–70 mL/minute, 27.1% of switching was
clinically indicated. Conclusions Few who switched to TAF/FTC had documented indications for switching,
although some appear to have been switched in anticipation of indications
developing. As generic TDF/FTC is further discounted, provider education and
patient decision aids are needed to facilitate selection of PrEP medications
that is both clinically sound and cost-effective.
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Affiliation(s)
- Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA
| | | | - Whitney C Sewell
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Patricia Solleveld
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.,The Fenway Institute, Boston, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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11
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D'Angelo AB, Westmoreland DA, Carneiro PB, Johnson J, Grov C. Why Are Patients Switching from Tenofovir Disoproxil Fumarate/Emtricitabine (Truvada) to Tenofovir Alafenamide/Emtricitabine (Descovy) for Pre-Exposure Prophylaxis? AIDS Patient Care STDS 2021; 35:327-334. [PMID: 34375141 DOI: 10.1089/apc.2021.0033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Safety differences between tenofovir alafenamide/emtricitabine (TAF) and tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)-formulated pre-exposure prophylaxis (PrEP) appear to have little clinical significance for most PrEP users. Furthermore, generic TDF-formulated PrEP is projected to decrease the price of PrEP. Thus, efforts to shift PrEP users to TAF-formulated PrEP should be considered in light of their potential to undermine efforts to scale-up PrEP nationally. Data are taken from Together 5,000, a US national cohort study predominantly composed of cisgender gay and bisexual men. In 2019-2020, 5034 participants completed their 24-month assessment, which measured whether participants were switching from TDF (Truvada) to TAF (Descovy) for PrEP, and why. Of those reporting PrEP-use (n = 1009), 277 reported using Descovy for PrEP, and 223 provided a reason for switching to Descovy. A content analysis was used to code participant's reasons for switching. Over half (56%) of participants reported that their doctor recommended switching to Descovy. Without mentioning a provider recommendation, 32% of participants reported that perceived improved safety of Descovy, compared with Truvada, motivated their decision to change their prescription. Other factors cited included the smaller size of the pill and "newness" of Descovy. Further, several participants mentioned negative advertising about Truvada as rationale for switching. Although scientific consensus supports the safety of both TDF/FTC and TAF, our results suggest that current messaging through physicians and other sources have emphasized superior safety of TAF-implying that TDF/FTC may not be safe in the long term. Efforts to shift users onto TAF may undermine public perception of TDF-formulated PrEP.
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Affiliation(s)
- Alexa B. D'Angelo
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Pedro B. Carneiro
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | | | - Christian Grov
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
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Holloway IW, Krueger EA, Meyer IH, Lightfoot M, Frost DM, Hammack PL. Longitudinal trends in PrEP familiarity, attitudes, use and discontinuation among a national probability sample of gay and bisexual men, 2016-2018. PLoS One 2020; 15:e0244448. [PMID: 33382743 PMCID: PMC7775083 DOI: 10.1371/journal.pone.0244448] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
This study explored familiarity with, attitudes toward, uptake and discontinuation of PrEP (Pre-exposure prophylaxis) among a national probability sample of gay and bisexual men. PrEP is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low within the United States. This study used a national probability sample of gay and bisexual men from three age cohorts of men (18-25, 34-41, and 52-59 years at wave 1) who completed three annual surveys between March 2016 and March 2018 (N at wave 1 = 624). Recruitment occurred through a Gallup dual-frame sampling procedure; results for this study came from eligible individuals who consented to be part of the self-administered online or mailed survey questionnaire. We used descriptive data with sampling weights to understand trends in PrEP familiarity, PrEP attitudes and PrEP use across all three time points. Next, PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N = 181). PrEP familiarity increased considerably between 2016 and 2018 among those eligible for PrEP (from 59.8% from wave 1 to 92.0% at wave 3). Favorable attitudes toward PrEP increased more modestly (from 68.3% at wave 1 to 72.7% at wave 3). While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use at wave 1 or wave 2, 33.3% subsequently discontinued PrEP use at a later wave. Findings indicate modest increases in PrEP use between 2016 and 2018 in a national probability sample of sexually-active gay and bisexual men. PrEP discontinuation was high and suggests the need for further research into gay and bisexual men's PrEP discontinuation and persistence.
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Affiliation(s)
- Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, United States of America
- Gay Sexuality and Social Policy Initiative, UCLA Luskin School of Public Affairs, Los Angeles, California, United States of America
- * E-mail:
| | - Evan A. Krueger
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, United States of America
| | - Ilan H. Meyer
- Williams Institute, UCLA School of Law, Los Angeles, California, United States of America
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - David M. Frost
- Department of Social Science, University College, London, United Kingdom
| | - Phillip L. Hammack
- Department of Psychology, University of California, Santa Cruz, California, United States of America
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