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Barrington C, Davis DA, Angeles G, Pajarito Rompich AY, Santa Luce R, Shelus V, Northbrook S. HIV Treatment and Mental Health Outcomes Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV in a Pilot Multicomponent Intervention in Guatemala City. HEALTH EDUCATION & BEHAVIOR 2023; 50:758-769. [PMID: 37088978 PMCID: PMC10638854 DOI: 10.1177/10901981231164598] [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: 04/25/2023]
Abstract
Globally, gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by HIV, but few interventions address mental health and HIV outcomes among GBMSM living with HIV. The purpose of this study was to pilot a multicomponent intervention, integrating emotional well-being (EW) and health navigation for GBMSM living with HIV in Guatemala City. We implemented a 12-month intervention, including a four-session EW component and a health navigation component among newly diagnosed and reengaged GBMSM with HIV (n = 112). We conducted socio-behavioral surveys at baseline and endline to measure patient characteristics and HIV, and mental health outcomes as well as viral load testing. We documented participation in EW sessions and used a smartphone application to track navigation mode, frequency, and content. Using first-difference estimation modeling, we assessed associations between participation in EW and navigation and mental health (depression and anxiety symptoms) and HIV outcomes (HIV treatment adherence, viral suppression). Acceptability was high for EW (86%) and navigation (99%). During the intervention, viral suppression increased significantly and anxiety and depression decreased significantly. Participation in EW sessions and greater navigation frequency and duration were associated with being suppressed, whereas higher emotional navigator support was associated with being unsuppressed. Participation in EW sessions was associated with reduced anxiety. Findings suggest that multicomponent interventions integrating individual counseling and navigation may promote EW and sustained viral suppression. Future intervention research is needed to confirm whether HIV and mental health outcomes are attributable to the intervention and to assess mechanisms of influence.
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Affiliation(s)
- Clare Barrington
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gustavo Angeles
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Victoria Shelus
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sanny Northbrook
- U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
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Rogers BG, Harkness A, Satyanarayana S, Pachankis J, Safren SA. Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:741-750. [PMID: 35536492 PMCID: PMC10463180 DOI: 10.1007/s10508-021-02263-7] [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: 04/22/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Pre-exposure prophylaxis for HIV or "PrEP" holds great promise for reducing HIV incidence. However, in certain geographic settings, like Miami, a US HIV epicenter, uptake of PrEP has been paradoxically very low compared to other areas of the country. The goal of the current study was to examine factors associated with low uptake of PrEP in young sexual minority men in Miami. Qualitative data were extracted from conversations during voluntary HIV/STI counseling and testing sessions with 24 young sexual minority men, most of whom identified as racial/ethnic minorities. These sessions were completed as part of a baseline visit for a combined mental and sexual health intervention trial. Thematic analysis of transcripts revealed barriers and facilitators associated with PrEP uptake at multiple levels (individual, interpersonal, and economic and healthcare systems barriers). Individual-level themes included concerns about the safety of PrEP, risk compensation, and taking daily oral medication; and potential benefits of PrEP as a backup plan to condom use to reassure and reduce worry about HIV. Interpersonal-level themes included lack of knowledgeable and affirming medical providers, changing norms within the community around "safe sex," and PrEP use in serodiscordant partnerships. Economic and healthcare systems barriers included challenges to accessing PrEP because of a lack of insurance and high out-of-pocket cost. These data can be used to inform the development of interventions aligned with Ending the HIV Epidemic priorities to increase PrEP use among young sexual minority men living in an HIV epicenter.
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Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, 11 Fourth Street, Providence, RI, 02906, USA.
- Department of Medicine, Infectious Diseases, The Miriam Hospital, Providence, RI, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA.
| | - Audrey Harkness
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Satyanand Satyanarayana
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - John Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Steven A Safren
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
- The Fenway Institute, Boston, MA, USA
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Zhang T, Yu Z, Song D, Chen Y, Yao T, Peixoto E, Huang H, Zhang H, Yang J, Gong H, Chen J, Liu Y, Li C, Yu M, Cui Z, Ma J. Sexual Behavior Transition and Acute and Early HIV Infection Among Men Who Have Sex With Men: Evidence from an Open Cohort in China, 2011-2019. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3557-3568. [PMID: 35904694 DOI: 10.1007/s10508-022-02320-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 12/14/2021] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
The present study examined how sexual behaviors transit over time among men who have sex with men (MSM) and whether these transitions were associated with acute and early HIV (AEH) infection. An open cohort study was conducted using snowball sampling to recruit MSM via physical venues and Internet venues from 2011 to 2019, in China. Cox models were used to estimate the correlates of risk factors and AEH infection. We used Latent Transition Analysis (LTA) to describe behavioral profile and explore latent behavioral "trans-phenotypes," then examined the effect between different "trans-phenotypes" and AEH infection risk and explored the effect of characteristics as possible predictors of sexual behavior transition. Of 6502 MSM, a total of 1974 individuals with negative human immunodeficiency virus (HIV) tests at baseline and at least 2 visit records were included in the final analysis from 2011 to 2019. During an average 1.84 years of follow-up, 64 AEH infections were documented. In the multivariable Cox model, the association between condom use in last anal sex (HR: 0.095, 0.038-0.205), fewer sexual partners (HR: 0.375, 0.205-0.712), low frequency of condom use (HR: 3.592, 1.186-11.272), and AEH acquisition were found. The percentage of MSM with "maintain/develop safety-profile," "consistent risky-profile," and "safety-profile to risky-profile" were 52.48, 40.17, and 7.35%, respectively. Compared with "maintain\develop safety-profile," "consistent or develop risky-profile" had an increasing likelihood of AEH infection. Meanwhile, male sex workers (MSWs) or older MSM were more likely to consist or transit in "risky-profile." Having middle education is a risk factor to transit in "risky-profile" for MSM with "safety-profile" at baseline. In addition, MSM who accept health services in the past year engaged in higher proportion of developing safety-profile. Approximately half of MSM maintain or develop risky behavior with the increasing likelihood of AEH acquisition in China, which suggested that targeted and intensive interventions should be prioritized to maintain safety-profile. Clinical Trial Number: ChiCTR2000039500.
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Affiliation(s)
- Tiantian Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Zeyang Yu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Desheng Song
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yang Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Tingting Yao
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Elissa Peixoto
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Huijie Huang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Honglu Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, Tianjin, China
| | - Hui Gong
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jiageng Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Yuanyuan Liu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Changping Li
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Zhuang Cui
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China.
| | - Jun Ma
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
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Yu Z, Zhang TT, Wang X, Chang Q, Huang H, Zhang H, Song D, Yu M, Yang J, Liu Y, Li C, Cui Z, Ma J. Sexual behaviour changes and HIV infection among men who have sex with men: evidence from an open cohort in China. BMJ Open 2022; 12:e055046. [PMID: 36171031 PMCID: PMC9528664 DOI: 10.1136/bmjopen-2021-055046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The HIV epidemic in key populations such as men who have sex with men (MSM) is a public health issue of worldwide concern. China has seen an increase in newly diagnosed HIV infections through male-male sexual contact in the past decade. In a long-term cohort, how the complex behaviour pattern of MSM changed and the association with the HIV risk are unclear at present. METHODS This study was conducted from October 2011 to December 2019 in Tianjin. MSM were recruited by snowball sampling through online and offline ways. Demographic and sexual behavioural data were collected for analysis. Three indicators (condom use in last anal sex, frequency of condom use during anal sex and the number of sexual partners) were used to define the behaviour change. Participants with zero, one, and two or three risk indicators were categorised into behaviour types of 'protective', 'moderate', and 'fragile', respectively. Change in behaviour type between baseline and each visit was considered. Time-varying Cox models were performed to evaluate HIV infection risk. RESULTS Of 2029 MSM included in the study, 127 were new HIV diagnoses. The overall incidence rate was 3.36 per 100 person-years. The percentage of 'protective' and 'moderate' behaviour types had a conspicuous growth trend as the follow-up. Furthermore, the HIV incidence rate in each visit among different behaviour transition types showed a general downward trend as the number of total follow-up times increased. Individuals who remained in 'fragile' (adjusted HR (aHR): 25.86, 95% CI: 6.92 to 96.57) or changed from 'protective' to 'moderate' (aHR: 4.79, 95% CI: 1.18 to 19.47), 'protective' to 'fragile' (aHR: 23.03, 95% CI: 6.02 to 88.13), and 'moderate' to 'fragile' (aHR: 25.48, 95% CI: 6.79 to 95.40) between baseline and the last follow-up had a higher HIV risk. Gained risk indicators were associated with the increase of HIV risk (gained one indicator, aHR: 2.67, 95% CI: 1.68 to 4.24; gained two or three indicators, aHR: 4.99, 95% CI: 3.00 to 8.31) while losing just one risk indicator could halve the risk (aHR: 0.43, 95% CI: 0.21 to 0.90). CONCLUSIONS Among MSM in Tianjin, it is necessary to get timely behaviour change for those with high-incidence behaviour patterns while sustaining for those with low-incidence patterns. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR2000039500).
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Affiliation(s)
- Zeyang Yu
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Tian-Tian Zhang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Xiaomeng Wang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Qinxue Chang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Huijie Huang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Honglu Zhang
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Desheng Song
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Centers for Disease Control and Prevention, No. 6 Huayue Road, Hedong District, Tianjin, China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, No. 43, Shuimu Tiancheng Tuanjie Ring Road, Hongqiao District, Tianjin, China
| | - Yuanyuan Liu
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Changping Li
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Zhuang Cui
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
| | - Jun Ma
- School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, China
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Zhou Y, Huang S, Cui M, Guo Z, Tang H, Lyu H, Ni Y, Lu Y, Feng Y, Wang Y, Jing F, Huang S, Li J, Xu Y, Mei W. Comparison between HIV self-testing and facility-based HIV testing approach on HIV early detection among men who have sex with men: A cross-sectional study. Front Immunol 2022; 13:857905. [PMID: 36177052 PMCID: PMC9513029 DOI: 10.3389/fimmu.2022.857905] [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: 01/19/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022] Open
Abstract
Background To assess whether HIV self-testing (HIVST) has a better performance in identifying HIV-infected cases than the facility-based HIV testing (HIVFBT) approach. Methods A cross-sectional study was conducted among men who have sex with men (MSM) by using an online questionnaire (including information on sociodemographic, sexual biography, and HIV testing history) and blood samples (for limiting antigen avidity enzyme immunoassay, gene subtype testing, and taking confirmed HIV test). MSM who were firstly identified as HIV positive through HIVST and HIVFBT were compared. Chi-square or Fisher’s exact test was used to explore any association between both groups and their subgroups. Results In total, 124 MSM HIV cases were identified from 2017 to 2021 in Zhuhai, China, including 60 identified through HIVST and 64 through HIVFBT. Participants in the HIVST group were younger (≤30 years, 76.7% vs. 46.9%), were better educated (>high school, 61.7% vs. 39.1%), and had higher viral load (≥1,000 copies/ml, 71.7% vs. 50.0%) than MSM cases identified through HIVFBT. The proportion of early HIV infection in the HIVST group was higher than in the HIVFBT group, identified using four recent infection testing algorithms (RITAs) (RITA 1, 46.7% vs. 25.0%; RITA 2, 43.3% vs. 20.3%; RITA 3, 30.0% vs. 14.1%; RITA 4, 26.7% vs. 10.9%; all p < 0.05). Conclusions The study showed that HIVST has better HIV early detection among MSM and that recent HIV infection cases mainly occur in younger and better-educated MSM. Compared with HIVFBT, HIVST is more accessible to the most at-risk population on time and tends to identify the case early. Further implementation studies are needed to fill the knowledge gap on this medical service model among MSM and other target populations.
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Affiliation(s)
- Yi Zhou
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
- Faculty of Medicine, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Shaoli Huang
- Zhejiang University-University of Edinburgh Institute, Zhejiang University-University, Hangzhou, China
| | - Mingting Cui
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Zhihui Guo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Haotong Tang
- Faculty of Medicine, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Hang Lyu
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Yuxin Ni
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Ying Lu
- Dermatology Hospital of South Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Yunlong Feng
- Department of Public Health and Preventive Medicine, School of Medicine Jinan University, Guangzhou, China
| | - Yuyu Wang
- Department of Public Health and Preventive Medicine, School of Medicine Jinan University, Guangzhou, China
| | - Fengshi Jing
- Institute for Healthcare Artificial Intelligence, Guangdong Second Provincial General Hospital, Guangzhou, China
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Shanzi Huang
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Jiarun Li
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
| | - Yao Xu
- Department of Paediatrics, School of Clinical Science, Monash University, Melbourne, VIC, Australia
- *Correspondence: Wenhua Mei, ; Yao Xu,
| | - Wenhua Mei
- Department of HIV Prevention, Zhuhai Center for Disease Control and Prevention, Zhuhai, China
- *Correspondence: Wenhua Mei, ; Yao Xu,
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Kazemian P, Ding DD, Scott JA, Feser MK, Biello K, Thomas BE, Dange A, Bedoya CA, Balu V, Rawat S, Kumarasamy N, Mimiaga MJ, O'Cleirigh C, Weinstein MC, Kumar JP, Kumar S, Mayer KH, Safren SA, Freedberg KA. The cost-effectiveness of a resilience-based psychosocial intervention for HIV prevention among MSM in India. AIDS 2022; 36:1223-1232. [PMID: 35471644 PMCID: PMC9283429 DOI: 10.1097/qad.0000000000003231] [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: 11/25/2022]
Abstract
OBJECTIVE MSM in India are at a high risk for HIV infection given psychosocial challenges, sexual orientation stress, and stigma. We examined the cost-effectiveness of a novel resilience-based psychosocial intervention for MSM in India. DESIGN We parameterized a validated microsimulation model (CEPAC) with India-specific data and results from a randomized trial and examined two strategies for MSM: status quo HIV care ( SQ ), and a trial-based psychosocial intervention ( INT ) focused on building resilience to stress, improving mental health, and reducing condomless anal sex (CAS). METHODS We projected lifetime clinical and economic outcomes for MSM without HIV initially. Intervention effectiveness, defined as reduction in self-reported CAS, was estimated at 38%; cost was $49.37/participant. We used a willingness-to-pay threshold of US$2100 (2019 Indian per capita GDP) per year of life saved (YLS) to define cost-effectiveness. We also assessed the 5-year budget impact of offering this intervention to 20% of Indian MSM. RESULTS Model projections showed the intervention would avert 2940 HIV infections among MSM over 10 years. Over a lifetime horizon, the intervention was cost-effective (ICER = $900/YLS). Results were most sensitive to intervention effectiveness and cost; the intervention remained cost-effective under plausible ranges of these parameters. Offering this intervention in the public sector would require an additional US$28 M over 5 years compared with SQ . CONCLUSION A resilience-based psychosocial intervention integrated with HIV risk reduction counseling among MSM in India would reduce HIV infections and be cost-effective. Programs using this approach should be expanded as a part of comprehensive HIV prevention in India.
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Affiliation(s)
- Pooyan Kazemian
- Department of Operations, Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| | - Delaney D Ding
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary K Feser
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Katie Biello
- Center for Health Promotion and Health Equity
- Department of Behavioral and Social Sciences
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Beena E Thomas
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu
| | | | - C Andres Bedoya
- Behavioral Medicine Program, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Vinoth Balu
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu
| | | | - Nagalingeswaran Kumarasamy
- CART Clinical Research Site, Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, Tamil Nadu, India
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Epidemiology, UCLA Fielding School of Public Health
- Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, California
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Behavioral Medicine Program, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jacob Prem Kumar
- National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, Tamil Nadu
| | | | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| | - Steven A Safren
- Center for HIV and Research in Mental Health
- Health Promotion and Care Research Program
- Department of Psychology, University of Miami, Miami, Florida
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Policy and Management
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
- Division of General Internal Medicine
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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Lloyd AR, Savage R, Eaton EF. Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents. AIDS 2021; 35:2237-2247. [PMID: 34387219 PMCID: PMC8563394 DOI: 10.1097/qad.0000000000003051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 2017 alone, 783 000 children aged 12-17 years misused opioids with 14 000 using heroin. Opioid misuse and opioid use disorder (OUD) in adolescents and young adults are significant barriers to ending the HIV epidemic. To address these synergistic scourges requires dedicated practitioners and improved access to life-saving evidence-based treatment. Adolescents and young adults make up over one in five new HIV diagnoses even though they are less likely to be tested or know they are infected. Adolescents and young adults living with HIV are less likely to be retained in care or achieve virological suppression. OUD further leads to increased rates of risky behaviours (like sex without condoms), deceased retention in HIV care and decreased rates of viral suppression in this vulnerable population. Medications for opioid use disorder (MOUD) are recommended for adolescents and young adults with severe OUD and help retain youth in HIV treatment and decrease risk of death. However, due to stigma and lack of experience prescribing MOUD in adolescents, MOUD is often perceived as a last line option. MOUD remains difficult to access for adolescents with a shortage of providers and decreased options for treatment as compared to adults. Addiction treatment is infection prevention, and integrated addiction and HIV services are recommended to improve health outcomes. A multipronged approach including patient education, provider training and policy changes to improve access to treatment and harm reduction are urgently needed confront the drug use epidemic in youth.
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Affiliation(s)
- Audrey R Lloyd
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Rebekah Savage
- Division of Adolescent Medicine, University of Alabama at Birmingham
| | - Ellen F Eaton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabamas, USA
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Abstract
HIV-prevention program planning, implementation, and evaluation began in the United States shortly after reports of a mysterious, apparently acquired, immune deficiency syndrome appeared in summer 1981. In San Francisco, New York City, and elsewhere, members of LGBT communities responded by providing accurate information, giving support, and raising money. During the first decade of the AIDS pandemic (1981–1990), social and behavioral scientists contributed by designing theory-based and practical interventions, combining interventions into programs, and measuring impact on behavior change and HIV incidence. In the second decade (1991–2000), federal, state, and local agencies and organizations played a more prominent role in establishing policies and procedures, funding research and programs, and determining the direction of intervention efforts. In the third decade (2001–2010), biomedical interventions were prioritized over behavioral interventions and have dominated attempts in the fourth decade (2011–2020) to integrate biomedical, behavioral, and structural interventions into coherent, efficient, and cost-effective programs to end AIDS.
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Pitpitan EV, MacKinnon DP, Eaton LA, Smith LR, Wagman J, Patterson TL. Using Novel Approaches to Evaluate Behavioral Interventions: Overlooked Significant HIV Prevention Effects in the HPTN 015 Project EXPLORE. J Acquir Immune Defic Syndr 2021; 87:1128-1135. [PMID: 33901103 PMCID: PMC8496973 DOI: 10.1097/qai.0000000000002711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mediated and moderated processes that lead to intervention efficacy may underlie results of trials ruled as nonefficacious. The overall purpose of this study was to examine such processes to explain the findings of one of the largest, rigorously conducted behavioral intervention randomized controlled trials, EXPLORE. METHODS Four thousand two hundred ninety-five HIV-negative men who have sex with men (MSM) in the United States were randomized in a 2-armed trial. Participants completed follow-up and an HIV test every 6 months up to 48 months. We used multiple and causal mediation analyses to test 5 mediators, including safer sex self-efficacy and condomless receptive anal sex with HIV-positive or status-unknown partners on our primary outcome (HIV seroconversion). We also examined whether intervention effects on the mediators would be moderated by robust correlates of HIV among MSM, including stimulant use. RESULTS There were significant effects of the intervention on all hypothesized mediators. Stimulant use moderated the effect on condomless receptive anal sex In stratified multiple mediation models, we found that among MSM with low stimulant use, the intervention significantly prevented HIV by reducing condomless receptive anal sex with HIV-positive or status-unknown partners. Among MSM with higher stimulant use, there were no indirect effects of the intervention on HIV through any of the hypothesized mediators. CONCLUSION The results suggest that the null effect found in the original EXPLORE trial might have occurred as a function of previously unexplored mediated and moderated processes. This study illustrates the value of testing mediated and moderated pathways in randomized trials, even in trials ruled out as nonefficacious.
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Santos GM, Ikeda J, Coffin P, Walker JE, Matheson T, McLaughlin M, Jain J, Vittinghoff E, Batki SL. Pilot study of extended-release lorcaserin for cocaine use disorder among men who have sex with men: A double-blind, placebo-controlled randomized trial. PLoS One 2021; 16:e0254724. [PMID: 34265007 PMCID: PMC8282062 DOI: 10.1371/journal.pone.0254724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To determine if men who have sex with men (MSM) with cocaine use disorder (CUD) and actively-using cocaine could be enrolled and retained in a pharmacologic intervention trial of lorcaserin—a novel 5-HT2cR agonist—and determine the degree to which participants would adhere to study procedures. Methods This was a phase II randomized, double-blind, placebo-controlled pilot study with 2:1 random parallel group assignment to daily extended-release oral lorcaserin 20 mg versus placebo (clinicaltrials.gov identifier-NCT03192995). Twenty-two of a planned 45 cisgender MSM with CUD were enrolled and had weekly follow-up visits during a 12-week treatment period, with substance use counseling, urine specimen collection, and completion of audio-computer assisted self-interview (ACASI) behavioral risk assessments. Adherence was measured by medication event monitoring systems (MEMS) caps and self-report. This study was terminated early because of an FDA safety alert for lorcaserin’s long-term use. Results Eighty-six percent completed the trial, with 82% of weekly study follow-up visits completed. Adherence was 55.3% (lorcaserin 51.6% vs. placebo 66.2%) by MEMS cap and 56.9% (56.5% vs. placebo 57.9%) by self-report and did not differ significantly by treatment assignment. Intention-to-treat analyses (ITT) did not show differences in cocaine positivity by urine screen between the lorcaserin and placebo groups by 12 week follow-up (incidence risk ratio [IRR]: 0.96; 95%CI = 0.24–3.82, P = 0.95). However, self-reported cocaine use in timeline follow-back declined more significantly in the lorcaserin group compared to placebo (IRR: 0.66; 95%CI = 0.49–0.88; P = 0.004). Conclusion We found that it is feasible, acceptable, and tolerable to conduct a placebo-controlled pharmacologic trial for MSM with CUD who are actively using cocaine. Lorcaserin was not associated with significant reductions in cocaine use by urine testing, but was associated with significant reductions in self-reported cocaine use. Future research may be needed to continue to explore the potential utility of 5-HT2cR agonists.
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Affiliation(s)
- Glenn-Milo Santos
- Department of Community Health Systems, University of California, San Francisco, CA, United States of America
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States of America
- * E-mail:
| | - Janet Ikeda
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Phillip Coffin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States of America
- Division of HIV, Infectious Disease & Global Medicine, University of California, San Francisco, CA, United States of America
| | - John E. Walker
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Tim Matheson
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Matthew McLaughlin
- Center on Substance Use and Health, San Francisco Department of Public Health, San Francisco, CA, United States of America
| | - Jennifer Jain
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Steven L. Batki
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States of America
- San Francisco VA Health Care System (SFVAHCS), San Francisco, CA, United States of America
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11
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Basil RC, Brown TT, Haberlen S, Rubin LH, Plankey M, Becker JT, Lake JE, Palella FJ, Sarkar S. The relationship between diabetes and depressive symptoms in men with or at risk of HIV infection. HIV Med 2021; 22:37-46. [PMID: 32975014 PMCID: PMC8211402 DOI: 10.1111/hiv.12958] [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: 02/14/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to compare the prevalence of comorbid diabetes and depressive symptoms in men living with HIV (MLWH) with that in men without HIV infection and to determine associations between glycaemic control and depressive symptoms. METHODS Participants included 920 MLWH and 840 men without HIV infection from the Multicenter AIDS Cohort Study (MACS) with available data regarding glycaemic status [categorized as normal for fasting blood glucose (FBG) < 100 mg/dL, prediabetes for FBG 100-125 mg/dL, and diabetes, defined by self-report, diabetes medication use or FBG ≥ 126 mg/dL on at least two consecutive visits, with diabetes classified as controlled if Hemoglobin A1c (HbA1C) < 7.5% and uncontrolled if HbA1C ≥ 7.5%]. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) score, with CES-D ≥ 16 scores classified as elevated depressive symptoms. A modified Poisson regression model with robust variance was used and adjusted for covariates including HIV serostatus. RESULTS Compared to men without HIV infection, MLWH had a higher mean CES-D score, but a similar prevalence of diabetes (11.3% versus 12.8%, respectively; P = 0.33). The concomitant prevalence of diabetes and elevated depressive symptoms did not differ by HIV serostatus (P = 0.215). In an adjusted analysis, men with uncontrolled diabetes had a greater prevalence of depressive symptoms compared to men with normoglycaemia (prevalence ratio = 1.43; 95% confidence interval 1.11, 1.84). The association between glycaemic status and depressive symptoms did not differ by HIV serostatus (P = 0.22 for interaction). CONCLUSIONS Both controlled and uncontrolled diabetes were independently associated with a greater prevalence of depressive symptoms, regardless of HIV serostatus. These results highlight the importance of identifying depression in people with diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | - Frank J. Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL
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12
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Shuper PA, Joharchi N, Bogoch II, Loutfy M, Crouzat F, El-Helou P, Knox DC, Woodward K, Rehm J. Alcohol consumption, substance use, and depression in relation to HIV Pre-Exposure Prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men. BMC Public Health 2020; 20:1782. [PMID: 33256651 PMCID: PMC7706215 DOI: 10.1186/s12889-020-09883-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background Although HIV pre-exposure prophylaxis (PrEP) substantially diminishes the likelihood of HIV acquisition, poor adherence can decrease the HIV-protective benefits of PrEP. The present investigation sought to identify the extent to which alcohol consumption, substance use, and depression were linked to PrEP nonadherence among gay, bisexual, and other men-who-have-sex-with-men (gbMSM). Methods gbMSM (age ≥ 18, prescribed PrEP for ≥3 months) were recruited from two clinics in Toronto, Canada for an e-survey assessing demographics; PrEP nonadherence (4-day PrEP-focused ACTG assessment); hazardous and harmful alcohol use (AUDIT scores of 8–15 and 16+, respectively); moderate/high risk substance use (NIDA M-ASSIST scores > 4); depression (CESD-10 scores ≥10); and other PrEP-relevant factors. The primary outcome, PrEP nonadherence, entailed missing one or more PrEP doses over the past 4 days. A linear-by-linear test of association assessed whether increasing severity of alcohol use (i.e., based on AUDIT categories) was linked to a greater occurrence of PrEP nonadherence. Univariate logistic regression was employed to determine factors associated with PrEP nonadherence, and factors demonstrating univariate associations at the p < .10 significance level were included in a multivariate logistic regression model. Additive and interactive effects involving key significant factors were assessed through logistic regression to evaluate potential syndemic-focused associations. Results A total of 141 gbMSM (Mean age = 37.9, white = 63.1%) completed the e-survey. Hazardous/harmful drinking (31.9%), moderate/high risk substance use (43.3%), and depression (23.7%) were common; and one in five participants (19.9%) reported PrEP nonadherence. Increasing alcohol use level was significantly associated with a greater likelihood of nonadherence (i.e., 15.6, 25.0, and 44.4% of low-risk, hazardous, and harmful drinkers reported nonadherence, respectively (χ2(1) = 4.79, p = .029)). Multivariate logistic regression demonstrated that harmful alcohol use (AOR = 6.72, 95%CI = 1.49–30.33, p = .013) and moderate/high risk cocaine use (AOR = 3.11, 95%CI = 1.01–9.59, p = .049) independently predicted nonadherence. Furthermore, an additive association emerged, wherein the likelihood of PrEP nonadherence was highest among those who were hazardous/harmful drinkers and moderate/high risk cocaine users (OR = 2.25, 95%CI = 1.19–4.25, p = .013). Depression was not associated with nonadherence. Conclusions Findings highlight the need to integrate alcohol- and substance-focused initiatives into PrEP care for gbMSM. Such initiatives, in turn, may help improve PrEP adherence and reduce the potential for HIV acquisition among this group.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Narges Joharchi
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada
| | - Isaac I Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.,Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Women's College Hospital, 76 Grenville St., Toronto, ON, M5S 1B2, Canada.,Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada
| | - Frederic Crouzat
- Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada
| | - Philippe El-Helou
- Department of Medicine, Division of Infectious Diseases, McMaster University, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Canada
| | - David C Knox
- Maple Leaf Medical Clinic, 14 College St., Toronto, ON, M5G 1K2, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada
| | - Kevin Woodward
- Department of Medicine, Division of Infectious Diseases, McMaster University, 1200 Main St. W., Hamilton, ON, L8N 3Z5, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.,PAHO/WHO Collaborating Centre for Addiction and Mental Health, 33 Russell St., Toronto, ON, M5S 2S1, Canada.,Epidemiological Research Unit, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, 8-2 Trubetskaya str., Moscow, Russian Federation, 119991.,Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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13
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Achterbergh RCA, van Rooijen MS, van den Brink W, Boyd A, de Vries HJC. Enhancing help-seeking behaviour among men who have sex with men at risk for sexually transmitted infections: the syn.bas.in randomised controlled trial. Sex Transm Infect 2020; 97:11-17. [PMID: 32737210 PMCID: PMC7841480 DOI: 10.1136/sextrans-2020-054438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives Men who have sex with men (MSM) are at increased risk for STIs and mental disorders. Syndemic theory holds that psychosocial issues co-occur and interact, and thus increase sexual risk behaviour. Psychosocial issue identification, referral and management might reduce risk behaviour. Methods In the syndemic-based intervention study, an open-label randomised controlled trial, MSM were enrolled at the STI outpatient clinic of the Public Health Service of Amsterdam. We screened participants using validated questionnaires on the following problem domains: alcohol and substance use, sexual compulsivity, anxiety, depression, attention deficit hyperactivity disorder, alexithymia, intimate partner violence and childhood sexual abuse. Individuals were randomly assigned (1:1) to receive either tailored, face-to-face feedback and help-seeking advice on mental health screening, or no feedback and no help-seeking advice. Participants were followed trimonthly for a year. The primary outcomes were self-reported and confirmed help-seeking behaviour. Results We included 155 MSM: 76 in the intervention group and 79 in the control group. At inclusion, 128 participants (83.1%) scored positive in at least one problem domain. We found no significant differences in self-reported or confirmed help-seeking behaviour between the intervention and the control group: 41% vs 29% (p=0.14) and 28% vs 22% (p=0.44), respectively. There were also no differences in STI incidence and condomless anal sex acts between the two groups. Conclusion Screening showed high prevalence of problems related to mental health and substance use, while tailored feedback, advice and referral did not significantly increase help-seeking behaviour. Other interventions are needed to tackle the high burden of mental disorders among MSM. Trial registration number NCT02859935.
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Affiliation(s)
| | - Martijn S van Rooijen
- STI Outpatient Clinic, Infectious Diseases Department, Public Health Sevice of Amsterdam, Amsterdam, North Holland, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
| | - Anders Boyd
- Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Noord-Holland, The Netherlands.,Stichting HIV Monitoring, Amsterdam, Noord-Holland, The Netherlands
| | - Henry John Christiaan de Vries
- STI Outpatient Clinic, Infectious Diseases Department, Public Health Sevice of Amsterdam, Amsterdam, North Holland, The Netherlands .,Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
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14
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Chen YQ, Peng L, Wang Y, Appelmans E, Dasgupta S, Fleming TR. Trial designs for evaluating combination HIV prevention approaches. HIV Res Clin Pract 2020; 21:72-82. [PMID: 32698705 PMCID: PMC7608072 DOI: 10.1080/25787489.2020.1798083] [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] [Received: 01/11/2019] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Combination HIV prevention approaches that include both biomedical and non-biomedical interventions often hold greater promise to improve health outcomes and reduce the risk of HIV transmission. OBJECTIVES Evaluate the relative properties of four leading candidate trial designs - 'single-factor', 'multi-arm', 'all-in-one', and 'factorial' designs - for assessing individual and/or combination prevention intervention approaches. METHODS Monte-Carlo simulations are conducted, assuming a putative combination approach could choose its components from two candidate biomedical interventions, i.e. Treatment-as-Prevention (TasP) and Pre-exposure Prophylaxis (PrEP), and three candidate behavioral interventions, i.e. linkage-to-care, counseling, and use of condoms. Various scenarios for individual components' effect sizes, their possible interaction, and the sample size based on real clinical studies are considered. RESULTS The all-in-one and factorial designs used to assess a combination approach and the multi-arm design used to assess multiple individual components are consistently more powerful than single-factor designs. The all-in-one design is powerful when the individual components are effective without negative interaction, while the factorial design is more consistently powerful across a broad array of settings. CONCLUSIONS The multi-arm design is useful for evaluating single factor regimens, while the all-in-one and factorial designs are sensitive in assessing the overall efficacy when there is interest in combining individual component regimens anticipated to have complementary mechanisms. The factorial design is a preferred approach when assessing combination regimens due to its favorable power properties and since it is the only design providing direct insights about the contribution of individual components to the combination approach's overall efficacy and about potential interactions.
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Affiliation(s)
- Ying Qing Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lili Peng
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yixin Wang
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eline Appelmans
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sayan Dasgupta
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Thomas R. Fleming
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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15
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Nguyen AC, Young LE, Beymer MR, Suen SC. Developing targeted HIV risk predictors for young black men who have sex with men: a two-city comparative study. Int J STD AIDS 2020; 31:335-344. [PMID: 32089091 DOI: 10.1177/0956462419886472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV burden in the United States is geographically and demographically heterogeneous. While efforts over the last few decades have reduced HIV incidence, young black men who have sex with men (YBMSM) account for a significant portion of new HIV diagnoses compared to any other race and age group. The Centers for Disease Control and Prevention has allocated funding to help reduce HIV in the YBMSM community; however, their recommended screening/treatment criteria do not emphasize demographic specificity. To better guide more applicable screening guidelines specifically for YBMSM, we examine demographic, behavioral, sexual network, and biological predictors of HIV status among YBMSM in two demographically distinct cities with high HIV burden in the United States: Chicago, IL and Los Angeles, CA. We perform multivariable logistic regressions to identify predictors of HIV in these populations. We found that having a history of syphilis was the only statistically significant predictor across both cities despite inclusion of other characteristics previously shown to be associated with HIV among YBMSM. Syphilis history could be a powerful HIV risk indicator for YBMSM and, therefore, should be integrated into clinical screening practices for critical biomedical prevention options like HIV pre-exposure prophylaxis.
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Affiliation(s)
- Anthony C Nguyen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Lindsay E Young
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Matthew R Beymer
- Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
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Liu J, Zhong X, Lu Z, Peng B, Zhang Y, Liang H, Dai J, Zhang J, Huang A. Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020464. [PMID: 31936800 PMCID: PMC7014070 DOI: 10.3390/ijerph17020464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022]
Abstract
This study aimed to explore the prevalence and influencing factors of anxiety and depression among human immunodeficiency virus negative (HIV-negative) men who have sex with men (MSM) based on anal sex roles, so as to provide a scientific basis for the management of mental health conditions. Data were obtained from the baseline in a cohort study with a two-year follow-up period in western China. The Self-Rating Anxiety Scale and Center for Epidemiological Studies Depression Scale were used to assess anxiety and depression symptoms, respectively. The prevalence of anxiety and depression in 1771 MSM was 26.03% and 37.83%. Among them, 182 anal sex role “0” MSM who only had receptive anal sex with men reported the highest prevalence of anxiety and depression (31.32% and 46.15%), 467 anal sex role “1” MSM who only had insertive anal sex with men (22.27% and 32.76%), and 1122 anal sex role “0.5” MSM who engaged equally in both insertive and receptive anal sex intercourse with men (26.74% and 38.59%), respectively. Logistic regression analysis revealed that the influencing factors of anxiety include anal sex role “0”/”0.5”, low educational level, female sexual partners, frequently searching partners on the Internet, sexually transmitted diseases (STD) diagnosed by doctors, and no HIV counseling. Anal sex role “0”/”0.5”, rural area, casual male partners, female partners, STD diagnosed by doctors, frequently searching partners on the Internet, no HIV counseling, no condom use, and daily alcohol use were found to be associated with depression. In conclusion, early identification and intervention of anxiety and depression symptoms in HIV-negative MSM should be carried out, especially for anal sex role “0” MSM. Furthermore, key intervention and psychological counseling should be taken into consideration for MSM with a low education level, high-risk behaviors, and high-risk perceptions.
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Affiliation(s)
- Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
- Correspondence:
| | - Zhuo Lu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Bin Peng
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Yan Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning 520021, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang 830011, China
| | - Juying Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Sichuan University, Chengdu 610041, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing 400016, China
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17
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Behavioural Prevention Strategies for STI Control. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Development and Validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States. AIDS Behav 2020; 24:274-283. [PMID: 31352633 DOI: 10.1007/s10461-019-02616-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Accurate HIV risk assessment among men who have sex with men (MSM) is important to help providers assess risk, and target HIV prevention interventions. We sought to develop an evidence-based HIV risk assessment tool for US MSM that is inclusive of Black MSM. Data from four large longitudinal cohorts of MSM were used to develop (EXPLORE), and validate (VAX004, HPTN061, and HVTN505). These data included visits in which participants self-reported HIV risk behavior and underwent HIV testing. We developed a pooled logistic model for incident HIV infection based on self-reported risk behaviors during the 6 months before each study visit. A total of 4069 MSM were used for the development cohort, and 8047 MSM in the three validation cohorts through 2013. The final model includes age (< 35, ≥ 35); Black race and Latino ethnicity; numbers of HIV-negative anal sex partners; number of insertive or receptive anal intercourse episodes; having 1 HIV-negative partner only; self-reported substance use; and bacterial sexually transmitted infection diagnosis. The model showed good discrimination in internal validation (C-statistic = 79.5). The external validation cohorts also showed good discrimination, with C-statistics of 73.1, 71.0, 71.9 in VAX004, HPTN061, and HVTN505 respectively, and acceptable calibration. We developed and validated an HIV risk assessment tool for MSM, which showed good predictive ability, including among the largest cohort of HIV-uninfected Black MSM in the US. This tool is available online (mysexpro.org) and can be used by providers to support targeting of HIV prevention interventions such as pre-exposure prophylaxis for MSM.
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Lachowsky NJ, Fulcher K, Lal A, Crosby R. Adaptation, feasibility and performance of a brief clinic-based intervention to improve prevention practices among sexual minority men. CANADIAN JOURNAL OF HUMAN SEXUALITY 2019. [DOI: 10.3138/cjhs.2018-0043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
| | - Karyn Fulcher
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
| | - Allan Lal
- School of Public Health and Social Policy, University of Victoria, Victoria, BC
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC
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Moore DJ, Jain S, Dubé MP, Daar ES, Sun X, Young J, Corado K, Ellorin E, Milam J, Collins D, Blumenthal J, Best BM, Anderson P, Haubrich R, Morris SR. Randomized Controlled Trial of Daily Text Messages to Support Adherence to Preexposure Prophylaxis in Individuals at Risk for Human Immunodeficiency Virus: The TAPIR Study. Clin Infect Dis 2019; 66:1566-1572. [PMID: 29228144 DOI: 10.1093/cid/cix1055] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022] Open
Abstract
Background Adherence is critical for efficacy of tenofovir disoproxil fumarate/emtricitabine (FTC) as preexposure prophylaxis (PrEP). Methods Between February 2013 and February 2016, 398 men who have sex with men and transgender women were randomized 1:1 to receive individualized texting for adherence building (iTAB) or standard care (SoC) for 48 weeks. The primary endpoint was dried blood spot (DBS) tenofovir diphosphate (TFV-DP) concentrations at both week 12 and the last on-drug visit of >719 fmol/punch (ie, adequate adherence). Secondary outcomes included DBS TFV-DP concentrations of >1246 fmol/punch (ie, near-perfect adherence) and plasma FTC >350 ng/mL (consistent with dosing within the past 24 hours). Results Concentrations >719 fmol/punch of TFV-DP were found in 88.6% of participants at week 12 and 82.5% at week 48. For the primary endpoint, the study arms did not differ (72.0% in iTAB and 69.2% in SoC; P > .05). For the secondary composite endpoint of >1246 fmol/punch the iTAB arm was superior to SoC (33.5% vs 24.8%; P = .06), reaching statistical significance when adjusting for age (odds ratio, 1.56 [95% confidence interval, 1.00-2.42]; P < .05). At week 48, iTAB was superior to SoC for near-perfect adherence (51.0% vs 37.4%; P = .02). At week 12, iTAB was superior to SoC for dosing in past 24 hours by plasma FTC (47.5% vs 33.3%; P = .007), but not at weeks 24, 36, and 48 (all P > .05). Conclusions Automated text messaging is a low-burden tool that improves durability of near-perfect PrEP adherence. Clinical Trials Registration NCT01761643.
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Affiliation(s)
| | | | - Michael P Dubé
- University of Southern California, Keck School of Medicine, Los Angeles
| | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center; Long Beach, California
| | | | | | - Katya Corado
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center; Long Beach, California
| | | | - Joel Milam
- University of Southern California, Keck School of Medicine, Los Angeles
| | - Deborah Collins
- Long Beach Department of Health and Human Services, Long Beach, California
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21
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Janes H, Brown MD, Glidden DV, Mayer KH, Buchbinder SP, McMahan VM, Schechter M, Guanira J, Casapia M. Evaluating the impact of policies recommending PrEP to subpopulations of men and transgender women who have sex with men based on demographic and behavioral risk factors. PLoS One 2019; 14:e0222183. [PMID: 31536518 PMCID: PMC6752862 DOI: 10.1371/journal.pone.0222183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Developing guidelines to inform the use of antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention in resource-limited settings must necessarily be informed by considering the resources and infrastructure needed for PrEP delivery. We describe an approach that identifies subpopulations of cisgender men who have sex with men (MSM) and transgender women (TGW) to prioritize for the rollout of PrEP in resource-limited settings. METHODS We use data from the iPrEx study, a multi-national phase III study of PrEP for HIV prevention in MSM/TGW, to build statistical models that identify subpopulations at high risk of HIV acquisition without PrEP, and with high expected PrEP benefit. We then evaluate empirically the population impact of policies recommending PrEP to these subpopulations, and contrast these with existing policies. RESULTS A policy recommending PrEP to a high risk subpopulation of MSM/TGW reporting condomless receptive anal intercourse over the last 3 months (estimated 3.3% 1-year HIV incidence) yields an estimated 1.95% absolute reduction in 1-year HIV incidence at the population level, and 3.83% reduction over 2 years. Importantly, such a policy requires rolling PrEP out to just 59.7% of MSM/TGW in the iPrEx population. We find that this policy is identical to that which prioritizes MSM/TGW with high expected PrEP benefit. It is estimated to achieve nearly the same reduction in HIV incidence as the PrEP guideline put forth by the US Centers for Disease Control, which relies on the measurement of more behavioral risk factors and which would recommend PrEP to a larger subset of the MSM/TGW population (86% vs. 60%). CONCLUSIONS These findings may be used to focus future mathematical modelling studies of PrEP in resource-limited settings on prioritizing PrEP for high-risk subpopulations of MSM/TGW. The statistical approach we took could be employed to develop PrEP policies for other at-risk populations and resource-limited settings.
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Affiliation(s)
- Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Marshall D. Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California School of Medicine, San Francisco, California, United States of America
| | - Kenneth H. Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, and The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Susan P. Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Vanessa M. McMahan
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Mauro Schechter
- Projeto Praça Onze, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juan Guanira
- Asociación Civil Impacta Salud y Educación, Lima, Peru
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22
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O'Cleirigh C, Safren SA, Taylor SW, Goshe BM, Bedoya CA, Marquez SM, Boroughs MS, Shipherd JC. Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial. AIDS Behav 2019; 23:2421-2431. [PMID: 30993478 PMCID: PMC7271561 DOI: 10.1007/s10461-019-02482-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.
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Affiliation(s)
- Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
- The Fenway Institute of Fenway Health, Boston, MA, USA.
| | - Steven A Safren
- The Fenway Institute of Fenway Health, Boston, MA, USA
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - S Wade Taylor
- The Fenway Institute of Fenway Health, Boston, MA, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Brett M Goshe
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Samantha M Marquez
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA
- The Fenway Institute of Fenway Health, Boston, MA, USA
| | | | - Jillian C Shipherd
- VA Boston Healthcare System, Boston, MA, USA
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- Department of Veterans Affairs, LGBT Health Program, Washington, DC, USA
- Boston University School of Medicine, Boston, MA, USA
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23
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Nguyen LH, Tran BX, Rocha LEC, Nguyen HLT, Yang C, Latkin CA, Thorson A, Strömdahl S. A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men. AIDS Behav 2019; 23:2253-2272. [PMID: 31401741 DOI: 10.1007/s10461-019-02626-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.
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24
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Pachankis JE, McConocha EM, Reynolds JS, Winston R, Adeyinka O, Harkness A, Burton CL, Behari K, Sullivan TJ, Eldahan AI, Esserman DA, Hatzenbuehler ML, Safren SA. Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men's mental and sexual health. BMC Public Health 2019; 19:1086. [PMID: 31399071 PMCID: PMC6688287 DOI: 10.1186/s12889-019-7346-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men's exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men's health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men's co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. METHODS This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline. DISCUSSION Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men's depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men. TRIAL REGISTRATION Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069 .
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Affiliation(s)
- John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Erin M. McConocha
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Jesse S. Reynolds
- Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Roxanne Winston
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Oluwaseyi Adeyinka
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, USA
| | - Charles L. Burton
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Kriti Behari
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Timothy J. Sullivan
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Adam I. Eldahan
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Mark L. Hatzenbuehler
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, USA
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25
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Efficacy of a Clinic-Based Safer Sex Program for Human Immunodeficiency Virus-Uninfected and Human Immunodeficiency Virus-Infected Young Black Men Who Have Sex With Men: A Randomized Controlled Trial. Sex Transm Dis 2019; 45:169-176. [PMID: 29419709 DOI: 10.1097/olq.0000000000000721] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test the efficacy of a single-session, clinic-based intervention designed to promote condom use among young black men who have sex with men (YBMSM). METHODS Six hundred YBMSM were enrolled in a randomized controlled trial, using a 12-month observation period. An intent-to-treat analysis was performed, with multiple imputation for missing data. RESULTS Compared with the reference group, human immunodeficiency virus (HIV)-infected men in the intervention group had 64% greater odds of reporting consistent condom use for anal receptive sex over 12 months (estimated odds ratio, 1.64; 95% confidence interval, 1.23-2.17, P = 0.001). Also, compared with the reference group, HIV-uninfected men in the intervention group had more than twice the odds of reporting consistent condom use for anal receptive sex over 12 months (estimated odds ratio, 2.14; 95% confidence interval, 1.74-2.63, P < 0.001). Significant intervention effects relative to incident sexually transmitted diseases were not observed. CONCLUSIONS A single-session, clinic-based, intervention may help protect HIV-uninfected YBMSM against HIV acquisition and HIV-infected YBMSM from transmitting the virus to insertive partners.
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26
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Fleming TR, DeGruttola V, Donnell D. Designing & Conducting Trials To Reliably Evaluate HIV Prevention Interventions. ACTA ACUST UNITED AC 2019; 11. [PMID: 33777327 DOI: 10.1515/scid-2019-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While much has been achieved, much remains to be accomplished in the science of preventing the spread of HIV infection. Clinical trials that are properly designed, conducted and analyzed are of integral importance in the pursuit of reliable insights about HIV prevention. As we build on previous scientific breakthroughs, there will be an increasing need for clinical trials to be designed to efficiently achieve insights without compromising their reliability and generalizability. Key design features should continue to include: 1) the use of randomization and evidence-based controls, 2) specifying the use of intention-to-treat analyses to preserve the integrity of randomization and to increase interpretability of results, 3) obtaining direct assessments of effects on clinical endpoints such as the risk of HIV infection, 4) using either superiority designs or non-inferiority designs with rigorous non-inferiority margins, and 5) enhancing generalizability through the choice of a relative risk rather than risk difference metric. When interventions have complementary and potentially synergistic effects, factorial designs should be considered to increase efficiency as well as to obtain clinically important insights about interaction and the contribution of component interventions to the efficacy and safety of combination regimens. Key trial conduct issues include timely enrollment of participants at high HIV risk recruited from populations with high viral burden, obtaining 'best real-world achievable' levels of adherence to the interventions being assessed and ensuring high levels of retention. High quality of trial conduct occurs through active rather than passive monitoring, using pre-specified targeted levels of performance with defined methods to achieve those targets. During trial conduct, active monitoring of the performance standards not only holds the trial leaders accountable but also can assist in the development and implementation of creative alternative approaches to increase the quality of trial conduct. Designing, conducting and analyzing HIV prevention trials with the quality needed to obtain reliable insights is an ethical as well as scientific imperative.
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Affiliation(s)
- Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, WA, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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27
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Crowell TA, Baral SD, Schwartz S, Nowak RG, Kokogho A, Adebajo S, Keshinro B, Makanjuola O, Michael NL, Robb ML, Charurat ME, Ake JA. Time to change the paradigm: limited condom and lubricant use among Nigerian men who have sex with men and transgender women despite availability and counseling. Ann Epidemiol 2018; 31:11-19.e3. [PMID: 30642695 DOI: 10.1016/j.annepidem.2018.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE This study characterized availability and uptake of condoms and condom-compatible lubricants (CCLs) at community-engaged condom education and distribution programs serving cisgender men who have sex with men and transgender women in Abuja and Lagos, Nigeria. METHODS Condoms and water-based CCLs were freely available to participants in the TRUST/RV368 cohort. Factors associated with their consistent use were assessed using Poisson regression with robust error variance to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS From March 2013-November 2017, 2090 cisgender men who have sex with men and transgender women enrolled with HIV prevalence 40.4% and incidence 12.8 cases per 100 person-years. Fifteen months after enrollment, the proportion who reported consistent condom and CCL use increased during receptive anal sex (21.7%-67.1%, P < .001) and insertive anal sex (25.4%-67.8%, P < .001). Multivariable analyses demonstrated independent impact of 15 months in care on uptake during both receptive (RR 2.62 [95% CI 2.29-3.00]) and insertive (RR 2.27 [95% CI 2.01-2.57]) sex. CONCLUSIONS Engagement in care improved condom and CCL uptake over time but inconsistent use remained common. Novel approaches to further increase uptake must be pursued alongside complementary strategies, such as sustained access to antiretroviral therapy for those living with HIV and provision of pre and postexposure prophylaxis for those at risk.
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Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
| | - Stefan D Baral
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Afoke Kokogho
- HJF Medical Research International, Abuja, Nigeria; U.S. Army Medical Research Directorate - Africa/Nigeria, Abuja, Nigeria
| | | | - Babajide Keshinro
- HJF Medical Research International, Abuja, Nigeria; U.S. Army Medical Research Directorate - Africa/Nigeria, Abuja, Nigeria
| | | | - Nelson L Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Merlin L Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Manhattan E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
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28
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Baggaley RF, Owen BN, Silhol R, Elmes J, Anton P, McGowan I, van der Straten A, Shacklett B, Dang Q, Swann EM, Bolton DL, Boily MC. Does per-act HIV-1 transmission risk through anal sex vary by gender? An updated systematic review and meta-analysis. Am J Reprod Immunol 2018; 80:e13039. [PMID: 30175479 DOI: 10.1111/aji.13039] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022] Open
Abstract
Quantifying HIV-1 transmission risk per-act of anal intercourse (AI) is important for HIV-1 prevention. We updated previous reviews by searching Medline and Embase to 02/2018. We derived pooled estimates of receptive AI (URAI) and insertive AI (UIAI) risk unprotected by condoms using random-effects models. Subgroup analyses were conducted by gender, study design, and whether antiretroviral treatment (ART) had been introduced by the time of the study. Two new relevant studies were identified, one of which met inclusion criteria, adding three new cohorts and increasing number of individuals/partnerships included from 1869 to 14 277. Four studies, all from high-income countries, were included. Pooled HIV-1 risk was higher for URAI (1.25%, 95% CI 0.55%-2.23%, N = 5, I2 = 87%) than UIAI (0.17%, 95 % CI 0.09%-0.26%, N = 3, I2 = 0%). The sole heterosexual URAI estimate (3.38%, 95% CI 1.85%-4.91%), from a study of 72 women published in a peer-reviewed journal, was significantly higher than the men-who-have-sex-with-men (MSM) pooled estimate (0.75%, 95% CI 0.56%-0.98%, N = 4, P < 0.0001) and higher than the only other heterosexual estimate identified (0.4%, 95% CI 0.08%-2.0%, based on 59 women, excluded for being a pre-2013 abstract). Pooled per-act URAI risk varied by study design (retrospective-partner studies: 2.56%, 95% CI 1.20%-4.42%, N = 2 (one MSM, one heterosexual); prospective studies: 0.71%, 95% CI 0.51%-0.93%, N = 3 MSM, P < 0.0001). URAI risk was lower for studies conducted in the ART era (0.75%, 95% CI 0.52%-1.03%) than pre-ART (1.67%, 95% CI 0.44%-3.67%) but not significantly so (P = 0.537). Prevention messages must emphasize that HIV-1 infectiousness through AI remains high, even in the ART era. Further studies, particularly among heterosexual populations and in resource-limited settings, are required to elucidate whether AI risk differs by gender, region and following population-level ART scale-up.
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Affiliation(s)
- Rebecca F Baggaley
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Branwen N Owen
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Anton
- Department of Medicine, UCLA Center for HIV Prevention Research, David Geffen School of Medicine at UCLA, UCLA AIDS Institute, Los Angeles, California
| | - Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Barbara Shacklett
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, California.,Division of Infectious Diseases, Department of Medicine, School of Medicine, University of California Davis, Sacramento, California
| | - Que Dang
- Vaccine Research Program, Division of AIDS, National Institutes of Health, Bethesda, Maryland
| | - Edith M Swann
- Vaccine Research Program, Division of AIDS, National Institutes of Health, Bethesda, Maryland
| | - Diane L Bolton
- U.S. Military HIV Research Program, The Henry M. Jackson Foundation, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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29
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Safren SA, Blashill AJ, Lee JS, O’Cleirigh C, Tomassili J, Biello KB, Mimiaga MJ, Mayer KH. Condom-use self-efficacy as a mediator between syndemics and condomless sex in men who have sex with men (MSM). Health Psychol 2018; 37:820-827. [PMID: 29927272 PMCID: PMC6107409 DOI: 10.1037/hea0000617] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Among men who have sex with men (MSM), HIV sexual risk and poor self-care behavior is associated with syndemics, or co-occurring psychosocial problems. Though prior research has demonstrated an additive total effect of syndemics on HIV risk behavior and infection, mostly within cross-sectional designs, it is possible that these associations are not direct but rather that syndemics disrupt relevant individual-level mediating psychological variables. One of the more common individual-level psychological variables that predicts health behavior generally, and HIV risk behavior specifically, is self-efficacy. This study sought to examine the potential effects of syndemics on condomless sex via condom-use self-efficacy as an intermediary variable. METHOD In high-risk MSM (N = 197), across 3 time points (baseline, 3 months, and 6 months) we used latent growth curve modeling to test the degree to which self-efficacy mediated the relationship between syndemics (heavy alcohol use, substance use disorder, sexual compulsivity, depression, social anxiety, intimate partner violence, childhood sexual abuse) and condomless anal sex. RESULTS The baseline analyses were consistent with an indirect effect of the association between syndemics and condomless sex through self-efficacy. Prospective longitudinal mediation was partially supported, such that baseline syndemics were associated with lower baseline self-efficacy, which in turn predicted higher increases in condomless anal sex across time. CONCLUSIONS These findings provide preliminary evidence (due to the partial support for the longitudinal model) that syndemics themselves may not be directly causal in their association with condomless sex, but the association may be through modifiable social-cognitive mechanisms such as condom self-efficacy. (PsycINFO Database Record
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Affiliation(s)
- Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Fenway Institute at Fenway Health, Boston, MA, USA
| | - Aaron J. Blashill
- Fenway Institute at Fenway Health, Boston, MA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jasper S. Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Fenway Institute at Fenway Health, Boston, MA, USA
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Julia Tomassili
- Department of Psychology, Sacramento State University, Sacramento, CA, USA
| | - Katie B. Biello
- Fenway Institute at Fenway Health, Boston, MA, USA
- Department of Behavioral & Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Matthew J Mimiaga
- Fenway Institute at Fenway Health, Boston, MA, USA
- Department of Behavioral & Social Health Sciences and Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Kenneth H. Mayer
- Fenway Institute at Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Shuper PA, MacLachlan DJ, Joharchi N, Guimond TH, Maxwell J, Adam BD. HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride. AIDS Behav 2018; 22:2797-2806. [PMID: 29680936 DOI: 10.1007/s10461-018-2117-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24 h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n = 105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n = 99), those who engaged in serodiscordant condomless anal sex (n = 22) were more likely to be HIV+ (AOR = 10.14, 95% CI 1.48-69.35); report multiple sex partners (AOR = 9.05, 95% CI 1.70-48.12); and possess lower condom efficacy (AOR = 0.47, 95% CI 0.23-0.93) and social support (AOR = 0.08, 95% CI 0.01-0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.
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Affiliation(s)
- Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Narges Joharchi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Tim H Guimond
- St. Michael's Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Barry D Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Canada
- Ontario HIV Treatment Network, Toronto, Canada
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Butt ZA, Shrestha N, Gesink D, Murti M, Buxton JA, Gilbert M, Balshaw RF, Wong S, Kuo M, Wong J, Yu A, Alvarez M, Samji H, Roth D, Consolacion T, Hull MW, Ogilvie G, Tyndall MW, Krajden M, Janjua NZ. Effect of opioid-substitution therapy and mental health counseling on HIV risk among hepatitis C-infected individuals. Clin Epidemiol 2018; 10:1127-1145. [PMID: 30214316 PMCID: PMC6124790 DOI: 10.2147/clep.s173449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Understanding differences in HIV incidence among people living with hepatitis C virus (HCV) can help inform strategies to prevent HIV infection. We estimated the time to HIV diagnosis among HCV-positive individuals and evaluated factors that could affect HIV-infection risk in this population. Patients and methods The British Columbia Hepatitis Testers Cohort includes all BC residents (~1.5 million: about a third of all residents) tested for HCV and HIV from 1990 to 2013 and is linked to administrative health care and mortality data. All HCV-positive and HIV-negative individuals were followed to measure time to HIV acquisition (positive test) and identify factors associated with HIV acquisition. Adjusted HRs (aHRs) were estimated using Cox proportional-hazard regression. Results Of 36,077 HCV-positive individuals, 2,169 (6%) acquired HIV over 266,883 years of follow-up (overall incidence of 8.1 per 1,000 person years). Overall median (IQR) time to HIV infection was 3.87 (6.06) years. In Cox regression, injection-drug use (aHR 1.47, 95% CI 1.33–1.63), HBV infection (aHR 1.34, 95% CI 1.16–1.55), and being a man who has sex with men (aHR 2.78, 95% CI 2.14–3.61) were associated with higher risk of HIV infection. Opioid-substitution therapy (OST) (aHR 0.59, 95% CI 0.52–0.67) and mental health counseling (aHR 0.48, 95% CI 0.43–0.53) were associated with lower risk of HIV infection. Conclusion Injection-drug use, HBV coinfection, and being a man who has sex with men were associated with increased HIV risk and engagement in OST and mental health counseling were associated with reduced HIV risk among HCV-positive individuals. Improving access to OST and mental health services could prevent transmission of HIV and other blood-borne infections, especially in settings where access is limited.
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Affiliation(s)
- Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, BC,
| | - Nabin Shrestha
- School of Population and Public Health, University of British Columbia, Vancouver, BC,
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto.,Public Health Ontario, Toronto, ON
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Robert F Balshaw
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Stanley Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Margot Kuo
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Jason Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Amanda Yu
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Maria Alvarez
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Hasina Samji
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | - David Roth
- Clinical Prevention Services, British Columbia Centre for Disease Control
| | | | - Mark W Hull
- Division of AIDS, Faculty of Medicine, University of British Columbia.,AIDS Research Program, British Columbia Centre for Excellence in HIV/AIDS
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mark W Tyndall
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
| | - Mel Krajden
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control.,BCCDC Public Health Laboratory, Vancouver, BC, Canada
| | - Naveed Z Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, BC, .,Clinical Prevention Services, British Columbia Centre for Disease Control
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Mimiaga MJ, Thomas B, Mayer KH, Regenauer KS, Dange A, Andres Bedoya C, Rawat S, Balu V, O’Cleirigh C, Biello KB, Anand V, Swaminathan S, Safren SA. A randomized clinical efficacy trial of a psychosocial intervention to strengthen self-acceptance and reduce HIV risk for MSM in India: study protocol. BMC Public Health 2018; 18:890. [PMID: 30021566 PMCID: PMC6052541 DOI: 10.1186/s12889-018-5838-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in India are a key group at risk for HIV acquisition and transmission. They are also an extremely marginalized and stigmatized population, facing immense psychosocial stressors including, but not limited to, stigma, homophobia, discrimination, criminalization, low self-esteem, low self-acceptance, distress, and, as a result, high rates of mental health problems. Although these multi-level psychosocial problems may put MSM at high risk for HIV acquisition and transmission, currently HIV prevention interventions in India do not address them. This paper describes the design of a psychosocial intervention to reduce HIV risk for MSM in India. METHODS Funded by the National Institute of Mental Health, this study is a two-arm randomized clinical efficacy trial of a self-acceptance based psychosocial HIV prevention intervention, informed by the minority stress model and syndemic theory, that was developed with extensive community-based formative work and input from the Indian MSM community and key informants who are knowledgeable about the experiences faced by MSM in India. Participants are MSM in Chennai and Mumbai who endorsed recent sexual behaviors placing them at high risk for HIV/sexually transmitted infection (STI) acquisition and transmission. Enrolled participants are equally randomized to either 1) the experimental condition, which consists of four group and six individual counseling sessions and includes standard of care HIV/STI testing and counseling, or 2) the standard of care condition, which includes HIV/STI testing and counseling alone. The primary outcomes are changes in the frequency of condomless anal sex acts and STI incidence (syphilis seropositivity and urethral, rectal, and pharyngeal gonorrhea and chlamydia infection. Major study assessment visits occur at baseline, 4-, 8-, and 12-months. DISCUSSION HIV prevention interventions that address the psychosocial stressors faced by MSM in India are needed; this study will examine the efficacy of such an intervention. If the intervention is successful, it may be able to reduce the national HIV/AIDS burden in India while empowering a marginalized and highly stigmatized group. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02556294 , registered 22 September 2015.
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Affiliation(s)
- Matthew J. Mimiaga
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
- Center for Health Equity Research, Brown University, Providence, RI USA
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI USA
| | - Beena Thomas
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Beth Israel Deaconness Medical Center, Boston, MA USA
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Kristen S. Regenauer
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - C. Andres Bedoya
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | | | - Vinoth Balu
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Conall O’Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Katie B. Biello
- Departments of Behavioral & Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI USA
| | | | | | - Steven A. Safren
- The Fenway Institute, Fenway Health, Boston, MA USA
- Department of Psychology, University of Miami, Coral Gables, FL USA
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Abstract
OBJECTIVE Few studies have examined condom effectiveness for HIV prevention among MSM. We estimated condom effectiveness per partner in four cohorts of MSM during 1993-2003 (JumpStart, Vaccine Preparedness Study, VAX004 and Project Explore). METHODS We used logistic regression to estimate the increase in odds of new HIV infection per HIV-positive partner for condom-protected receptive anal intercourse (PRAI; partners with whom condoms were always used) and condomless (unprotected) receptive anal intercourse (URAI; partners with whom condoms were sometimes or never used). To estimate condom effectiveness for preventing HIV transmission, we applied the concept of excess odds, the odds ratio minus 1. The condom failure rate was estimated as the excess odds per PRAI partner divided by the excess odds per URAI partner. Condom effectiveness was then 1 minus the failure rate. RESULTS The excess odds of HIV infection per HIV-positive partner were 83% for URAI and 7% for PRAI. The resulting failure rate (9%) indicated per-partner condom effectiveness of 91% (95% confidence interval 69-101). CONCLUSION The increase in odds of new HIV infection per HIV-positive partner for receptive anal intercourse was reduced by 91% for each partner with whom condoms were always used.
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Biomedical prevention: what is the current status? ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.
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Considerations for Using the HIRI-MSM Screening Tool to Identify MSM Who Would Benefit Most From PrEP. J Acquir Immune Defic Syndr 2018; 76:e58-e61. [PMID: 28903127 DOI: 10.1097/qai.0000000000001472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago. AIDS 2018; 32:383-392. [PMID: 29194116 DOI: 10.1097/qad.0000000000001710] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identification of clients at greatest risk of acquiring HIV is critical for preexposure prophylaxi (PrEP) implementation. Young black MSM (YBMSM) have high incidence of HIV. We examined published guidelines in identifying eligible PrEP candidates, including seroconverters, in a representative cohort of YBMSM. METHODS The uConnect cohort included YBMSM aged 16-29 years during PrEP roll-out in Chicago from 2013 and 2016. YBMSM with indications for PrEP were determined using Center for Disease Control and Prevention (CDC) guidelines, the HIV incidence risk index for MSM (HIRI-MSM) scoring tool, and Gilead recommendations with calculation of sensitivities, specificities, and area under the curve (AUC) for HIV seroconversion over 18 months. Incidence rate ratios (IRRs) using Poisson regression were modeled to compare individual and network factors associated with seroconversion. RESULTS In the study cohort, 300 HIV uninfected YBMSM contributed 390.4 person-years of follow-up [mean age (SD), 22.3 years (3.07)]. HIV incidence was 8.5 cases per 100 person-years (95% confidence interval, 6.0-11.9). One network factor was associated with seroconversion: having partners more than 10 years older (IRR = 4.4, 95% confidence interval, 1.6-11.8). Overall, 49% of the cohort had an indication for PrEP using CDC guidelines; 72% using HIRI-MSM, and 86% using Gilead recommendations. HIV seroconverters (n = 33) were identified as PrEP eligible prior to seroconversion with sensitivities/AUCs for CDC (52%/0.51), HIRI-MSM (85%/0.57), and Gilead guidelines (94%/0.54). CONCLUSION Low sensitivity of CDC guidelines and limited AUC of HIRI-MSM and Gilead screening tools are of concern for PrEP implementation among most at risk populations such as YBMSM. Consideration of demographics, local epidemiology, and network factors may better guide identification of clients who could benefit most from PrEP.
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Performance of the BioPlex 2200 HIV Ag-Ab assay for identifying acute HIV infection. J Clin Virol 2018; 99-100:67-70. [PMID: 29346085 DOI: 10.1016/j.jcv.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/10/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Assays that detect HIV antigen (Ag) and antibody (Ab) can be used to screen for HIV infection. OBJECTIVES To compare the performance of the BioPlex 2200 HIV Ag-Ab assay and two other Ag/Ab combination assays for detection of acute HIV infection. STUDY DESIGN Samples were obtained from 24 individuals (18 from the US, 6 from South Africa); these individuals were classified as having acute infection based on the following criteria: positive qualitative RNA assay; two negative rapid tests; negative discriminatory test. The samples were tested with the BioPlex assay, the ARCHITECT HIV Ag/Ab Combo test, the Bio-Rad GS HIV Combo Ag-Ab EIA test, and a viral load assay. RESULTS Twelve (50.0%) of 24 samples had RNA detected only ( > 40 to 13,476 copies/mL). Ten (43.5%) samples had reactive results with all three Ag/Ab assays, one sample was reactive with the ARCHITECT and Bio-Rad assays, and one sample was reactive with the Bio-Rad and BioPlex assays. The 11 samples that were reactive with the BioPlex assay had viral loads from 83,010 to >750,000 copies/mL; 9/11 samples were classified as Ag positive/Ab negative by the BioPlex assay. CONCLUSIONS Detection of acute HIV infection was similar for the BioPlex assay and two other Ag/Ab assays. All three tests were less sensitive than a qualitative RNA assay and only detected HIV Ag when the viral load was high. The BioPlex assay detected acute infection in about half of the cases, and identified most of those infections as Ag positive/Ab negative.
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Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment. J Acquir Immune Defic Syndr 2017; 76:493-500. [PMID: 28930769 DOI: 10.1097/qai.0000000000001549] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission, but to date, experimental evidence for the causal risk-taking impact of alcohol among HIV-positive populations is lacking. The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men (MSM), and to assess whether alcohol's impact differs between MSM who are HIV-positive versus HIV-negative. METHODS In a randomized controlled alcohol administration experiment, HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and randomly assigned to beverage consumption condition: alcohol (target blood alcohol concentration = 0.080%), placebo alcohol (target blood alcohol concentration = 0.000%), or water (control). Participants then underwent a video-based sexual arousal manipulation (sexually aroused/nonaroused) and indicated their intentions to engage in condom-protected and condomless sexual acts in a standardized paradigm. The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex. RESULTS A total of 282 MSM (141 HIV-positive; 141 HIV-negative) completed experimental procedures. MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water (F(1,274) = 9.43, P = 0.002). The impact of alcohol did not differ between HIV-positive and HIV-negative MSM (F(1,274) = 1.86, P = 0.174). CONCLUSIONS The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample, and results demonstrated that consuming alcohol had an independent, causal impact on intentions to engage in sexual behaviors that can result in HIV transmission. Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts.
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Woodward EN, Banks RJ, Marks AK, Pantalone DW. Identifying Resilience Resources for HIV Prevention Among Sexual Minority Men: A Systematic Review. AIDS Behav 2017; 21:2860-2873. [PMID: 27981398 DOI: 10.1007/s10461-016-1608-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Most HIV prevention for sexual minority men and men who have sex with men targets risk behaviors (e.g., condom use) and helps <50% of participants. Bolstering resilience might increase HIV prevention's effectiveness. This systematic review identified resilience resources (protective factors) in high-risk, HIV-negative, sexual minority men. We reviewed PsycINFO, PsycARTICLES, MEDLINE, references, and Listservs for studies including sexual minority men with 1+ HIV risk factor (syndemics): childhood sexual abuse, partner abuse, substance abuse, or mental health symptoms. From 1356 articles screened, 20 articles met inclusion criteria. Across the articles, we identified and codified 31 resilience resources: socioeconomic (e.g., employment), behavioral coping strategies (e.g., mental health treatment), cognitions/emotions (e.g., acceptance), and relationships. Resilience resources were generally associated with lower HIV risk; there were 18 low-risk associations, 4 high-risk associations, 8 non-significant associations). We generated a set of empirically based resilience variables and a hypothesis to be evaluated further to improve HIV prevention.
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Implementation and Operational Research: A Cost-Effective, Clinically Actionable Strategy for Targeting HIV Preexposure Prophylaxis to High-Risk Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2017; 72:e61-7. [PMID: 26977749 DOI: 10.1097/qai.0000000000000987] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) is effective at preventing HIV infection among men who have sex with men (MSM), but there is uncertainty about how to identify high-risk MSM who should receive PrEP. METHODS We used a mathematical model to assess the cost-effectiveness of using the HIV Incidence Risk Index for MSM (HIRI-MSM) questionnaire to target PrEP to high-risk MSM. We simulated strategies of no PrEP, PrEP available to all MSM, and eligibility thresholds set to HIRI-MSM scores between 5 and 45, in increments of 5 (where a higher score predicts greater HIV risk). Based on the iPrEx, IPERGAY, and PROUD trials, we evaluated PrEP efficacies from 44% to 86% and annual costs from $5900 to 8700. We designate strategies with incremental cost-effectiveness ratio (ICER) ≤$100,000/quality-adjusted life-year (QALY) as "cost-effective." RESULTS Over 20 years, making PrEP available to all MSM is projected to prevent 33.5% of new HIV infections, with an ICER of $1,474,000/QALY. Increasing the HIRI-MSM score threshold reduces the prevented infections, but improves cost-effectiveness. A threshold score of 25 is projected to be optimal (most QALYs gained while still being cost-effective) over a wide range of realistic PrEP efficacies and costs. At low cost and high efficacy (IPERGAY), thresholds of 15 or 20 are optimal across a range of other input assumptions; at high cost and low efficacy (iPrEx), 25 or 30 are generally optimal. CONCLUSIONS The HIRI-MSM provides a clinically actionable means of guiding PrEP use. Using a score of 25 to determine PrEP eligibility could facilitate cost-effective use of PrEP among high-risk MSM who will benefit from it most.
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Abstract
There is a strong push to conduct large-scale randomized controlled study designs in HIV prevention studies. In these randomized controlled studies, the primary research objective is typically to determine the treatment effect based on some biological outcome (eg, HIV infection). But many unused self-reported outcomes are also being collected. We illustrate the extent of this problem using the EXPLORE data as an example.
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Assessing the Performance of 3 Human Immunodeficiency Virus Incidence Risk Scores in a Cohort of Black and White Men Who Have Sex With Men in the South. Sex Transm Dis 2017; 44:297-302. [PMID: 28407646 DOI: 10.1097/olq.0000000000000596] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Risk scores have been developed to identify men at high risk of human immunodeficiency virus (HIV) seroconversion. These scores can be used to more efficiently allocate public health prevention resources, such as pre-exposure prophylaxis. However, the published scores were developed with data sets that comprise predominantly white men who have sex with men (MSM) collected several years prior and recruited from a limited geographic area. Thus, it is unclear how well these scores perform in men of different races or ethnicities or men in different geographic regions. METHODS We assessed the predictive ability of 3 published scores to predict HIV seroconversion in a cohort of black and white MSM in Atlanta, GA. Questionnaire data from the baseline study visit were used to derive individual scores for each participant. We assessed the discriminatory ability of each risk score to predict HIV seroconversion over 2 years of follow-up. RESULTS The predictive ability of each score was low among all MSM and lower among black men compared to white men. Each score had lower sensitivity to predict seroconversion among black MSM compared to white MSM and low area under the curve values for the receiver operating characteristic curve indicating poor discriminatory ability. CONCLUSIONS Reliance on the currently available risk scores will result in misclassification of high proportions of MSM, especially black MSM, in terms of HIV risk, leading to missed opportunities for HIV prevention services.
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Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC, Mabey D, Marrazzo JM, Sonder GJB, Schwebke JR, Hoornenborg E, Peeling RW, Philip SS, Low N, Fairley CK. Sexually transmitted infections: challenges ahead. THE LANCET. INFECTIOUS DISEASES 2017; 17:e235-e279. [PMID: 28701272 DOI: 10.1016/s1473-3099(17)30310-9] [Citation(s) in RCA: 430] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/30/2017] [Indexed: 12/30/2022]
Abstract
WHO estimated that nearly 1 million people become infected every day with any of four curable sexually transmitted infections (STIs): chlamydia, gonorrhoea, syphilis, and trichomoniasis. Despite their high global incidence, STIs remain a neglected area of research. In this Commission, we have prioritised five areas that represent particular challenges in STI treatment and control. Chlamydia remains the most commonly diagnosed bacterial STI in high-income countries despite widespread testing recommendations, sensitive and specific non-invasive testing techniques, and cheap effective therapy. We discuss the challenges for chlamydia control and evidence to support a shift from the current focus on infection-based screening to improved management of diagnosed cases and of chlamydial morbidity, such as pelvic inflammatory disease. The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is globally recognised. We review current and potential future control and treatment strategies, with a focus on novel antimicrobials. Bacterial vaginosis is the most common vaginal disorder in women, but current treatments are associated with frequent recurrence. Recurrence after treatment might relate to evidence that suggests sexual transmission is integral to the pathogenesis of bacterial vaginosis, which has substantial implications for the development of effective management approaches. STIs disproportionately affect low-income and middle-income countries. We review strategies for case management, focusing on point-of-care tests that hold considerable potential for improving STI control. Lastly, STIs in men who have sex with men have increased since the late 1990s. We discuss the contribution of new biomedical HIV prevention strategies and risk compensation. Overall, this Commission aims to enhance the understanding of some of the key challenges facing the field of STIs, and outlines new approaches to improve the clinical management of STIs and public health.
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Affiliation(s)
- Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Catriona S Bradshaw
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henry J C de Vries
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands; Amsterdam Institute for Infection and Immunity, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanna C Francis
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - David Mabey
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeanne M Marrazzo
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Gerard J B Sonder
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands; Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jane R Schwebke
- Department of Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
| | - Elske Hoornenborg
- STI Outpatient Clinic, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Rosanna W Peeling
- Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan S Philip
- Disease Prevention and Control Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
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Taylor SW, Goshe BM, Marquez SM, Safren SA, O'Cleirigh C. Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse. PSYCHOL HEALTH MED 2017; 23:454-464. [PMID: 28697624 DOI: 10.1080/13548506.2017.1348609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.
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Affiliation(s)
- S Wade Taylor
- a Department of Social Work, Leadership, and Youth Advocacy , Wheelock College , Boston , MA , USA.,b Fenway Health , The Fenway Institute , Boston , MA , USA
| | - Brett M Goshe
- c Department of Psychology , University of Connecticut , Storrs , CT , USA
| | | | - Steven A Safren
- b Fenway Health , The Fenway Institute , Boston , MA , USA.,d Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Conall O'Cleirigh
- b Fenway Health , The Fenway Institute , Boston , MA , USA.,e Behavioral Medicine Program , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
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Rao A, Tobin K, Davey-Rothwell M, Latkin CA. Social Desirability Bias and Prevalence of Sexual HIV Risk Behaviors Among People Who Use Drugs in Baltimore, Maryland: Implications for Identifying Individuals Prone to Underreporting Sexual Risk Behaviors. AIDS Behav 2017; 21:2207-2214. [PMID: 28509997 DOI: 10.1007/s10461-017-1792-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The role of social desirability bias (SDB) in self-reported HIV risk behaviors continues to be problematic. This study examined whether SDB was associated with self-reported, via audio computer assisted self-interviewing, sexual risk behaviors among people who use drugs. The present study was conducted among 559 participants who reported having a recent sexual partner at their 6-month visit of a longitudinal study. Robust Poisson regression was used to model the association between SDB and five risk behaviors. Analyses were stratified by gender and partner type. Higher scores of SDB were associated with decreased reporting of selling sex and having more than one sexual partner. Higher SDB scores were associated with increased reporting of always using condoms during oral, vaginal, and anal sex. Gender-specific differences were observed. The inclusion of a measure of SDB in data collection, along with other strategies, can be used to both identify and reduce self-report biases.
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Affiliation(s)
- Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Karin Tobin
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Davey-Rothwell
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl A Latkin
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Critical Review: When the Party is Over: A Systematic Review of Behavioral Interventions for Substance-Using Men Who Have Sex with Men. J Acquir Immune Defic Syndr 2017; 73:299-306. [PMID: 27258233 DOI: 10.1097/qai.0000000000001102] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because problematic patterns of alcohol and other substance use are prevalent drivers of the HIV/AIDS epidemic, comprehensive interventions are needed for substance-using men who have sex with men (SUMSM). We conducted a systematic review of 12 randomized controlled trials (RCTs) of behavioral interventions for reducing condomless anal intercourse (CAI) in SUMSM. Three RCTs observed that cognitive behavioral or motivational interviewing interventions achieved a 24% to 40% decrease in CAI. Interventions also tended to demonstrate greater efficacy for reducing CAI and substance use among those who had lower severity of substance use disorder symptoms. Although behavioral interventions for SUMSM are one potentially important component of biobehavioral HIV/AIDS prevention, further research is needed to examine whether integrative approaches that cultivate resilience and target co-occurring syndemic conditions demonstrate greater efficacy. Multilevel intervention approaches are also needed to optimize the effectiveness of pre-exposure prophylaxis and HIV treatment as prevention with SUMSM.
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Correlates of Enhanced Sexual Pleasure from Condom Use: A Study of Young Black Men Who Have Sex with Men in the United States. AIDS Behav 2017; 21:1491-1496. [PMID: 27683086 DOI: 10.1007/s10461-016-1564-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study of young Black MSM (YBMSM) explored the correlates and outcomes of enhanced sexual pleasure from condom-protected sex. Six-hundred YBMSM were enrolled from an sexually transmitted infection clinic in the southern United States. Men completed a computer-assisted self-interview. A 3-item scale assessed perceptions related to condoms enhancing sexual pleasure. Nine of 14 correlates met the screening level of significance and were tested in a regression model. Three obtained multivariable significance: (1) Men discussing condom use with sex partners had greater odds (AOR = 1.67, 95 % CI 1.20-2.34) of experiencing enhanced pleasure; (2) Insertive-partners had lower odds (AOR = 0.63, 95 % CI 0.44-0.91) of experiencing enhanced pleasure; and (3) men scoring higher in internalized homophobia had lower odds (AOR = 0.66, 95 % CI 0.47-0.93) of experiencing enhanced pleasure. Also, men experiencing enhanced pleasure were less likely to report any condomless anal sex. The experience of enhanced sexual pleasure during condom-protected sex may be an important "target" of behavioral intervention efforts.
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Serious concerns regarding a meta-analysis of preexposure prophylaxis use and STI acquisition. AIDS 2017; 31:739-740. [PMID: 28225452 DOI: 10.1097/qad.0000000000001386] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bio-behavioral Interventions to Prevent HIV Transmission. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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