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Reitsema M, Wallinga J, van Benthem BHB, Op de Coul ELM, Van Sighem A, Schim van der Loeff M, Xiridou M. Effects of improved partner notification on the transmission of HIV and N. gonorrhoea among men who have sex with men: a modelling study. Sex Transm Infect 2025; 101:236-241. [PMID: 39832950 DOI: 10.1136/sextrans-2023-055772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 11/29/2024] [Indexed: 01/22/2025] Open
Abstract
Objectives Men who have sex with men (MSM) are disproportionally affected by HIV in the Netherlands. Partner notification (PN) is an important element in controlling the transmission of sexually transmitted infections (STIs) and HIV. We investigated the effects of improving PN on the transmission of HIV and Neisseria gonorrhoeae (NG) among MSM in the Netherlands. Methods We developed an agent-based model that describes the transmission of HIV and NG among MSM. In the baseline scenario, 14.3% and 29.8% of casual and steady partners of the index case get notified and tested for HIV/STI after 3 weeks (percentage notified and tested (PNT)). We examined the following scenarios: (1) increase PNT to 41% for both partner types; (2) decrease the time between the index and the partners tested to 1 week and (3) combine scenarios 1 and 2. Effects are expressed as cumulative change from the baseline simulation over 15 years. Results Increasing PNT could lead to a decrease in gonorrhoea cases of 45% (IQR 39.9% to 49.9%), with an increase in the number of HIV/STI tests of 4.4% (IQR 1.6% to 7.3%), but no change in HIV infections (-5.4%; IQR -21% to 7.9%). Decreasing the time between tests could lead to a change in new NG infections of -14.2% (IQR -17.2% to -10%), no change in HIV infections (8.2%; IQR -1.3% to 20%) or in the number of HIV/STI tests performed (-0.4%; IQR -1.5 to 0.6%). Scenario 3 led to a change in NG infections of -56.8% (IQR -63.8% to -47.4%), no change in HIV infections (11.5%; IQR -11.1% to 33.9%) or in the number of HIV/STI tests (-0.5%; IQR: -4.9% to 4.3%). Conclusions Increasing the percentage of sexual partners notified and tested for HIV/STI may have only a small effect on HIV but could reduce the number of new NG infections substantially. However, it could lead to an increase in the number of HIV/STI tests performed.
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Affiliation(s)
- Maarten Reitsema
- Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Jacco Wallinga
- Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Birgit H B van Benthem
- Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Eline L M Op de Coul
- Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Noord-Holland, Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam UMC, Amsteredam, Netherlands
| | - Maria Xiridou
- Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Tanner MR, O’Shea JG, Byrd KM, Johnston M, Dumitru GG, Le JN, Lale A, Byrd KK, Cholli P, Kamitani E, Zhu W, Hoover KW, Kourtis AP. Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV - CDC Recommendations, United States, 2025. MMWR Recomm Rep 2025; 74:1-56. [PMID: 40331832 PMCID: PMC12064164 DOI: 10.15585/mmwr.rr7401a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025] Open
Abstract
Nonoccupational postexposure prophylaxis (nPEP) for HIV is recommended when a nonoccupational (e.g., sexual, needle, or other) exposure to nonintact skin or mucous membranes that presents a substantial risk for HIV transmission has occurred, and the source has HIV without sustained viral suppression or their viral suppression information is not known. A rapid HIV test (also referred to as point-of-care) or laboratory-based antigen/antibody combination HIV test is recommended before nPEP initiation. Health care professionals should ensure the first dose of nPEP is provided as soon as possible, and ideally within 24 hours, but no later than 72 hours after exposure. The initial nPEP dose should not be delayed due to pending results of any laboratory-based testing, and the recommended length of nPEP course is 28 days. The recommendations in these guidelines update the 2016 nPEP guidelines (CDC. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV - United States, 2016. Atlanta, GA: US Department of Health and Human Services, CDC; 2017). These 2025 nPEP guidelines update recommendations and considerations for use of HIV nPEP in the United States to include newer antiretroviral (ARV) agents, updated nPEP indication considerations, and emerging nPEP implementation strategies. The guidelines also include considerations for testing and nPEP regimens for persons exposed who have received long-acting injectable ARVs in the past. Lastly, testing recommendations for persons who experienced sexual assault were updated to align with the most recent CDC sexually transmitted infection treatment guidelines. These guidelines are divided into two sections: Recommendations and CDC Guidance. The preferred regimens for most adults and adolescents are now bictegravir/emtricitabine/tenofovir alafenamide or dolutegravir plus (tenofovir alafenamide or tenofovir disoproxil fumarate) plus (emtricitabine or lamivudine). However, the regimen can be tailored to the clinical circumstances. Medical follow-up for persons prescribed nPEP also should be tailored to the clinical situation; recommended follow-up includes a visit at 24 hours (remote or in person) with a medical provider, and clinical follow-up 4-6 weeks and 12 weeks after exposure for laboratory testing. Persons initiating nPEP should be informed that pre-exposure prophylaxis for HIV (PrEP) can reduce their risk for acquiring HIV if they will have repeat or continuing exposure to HIV after the end of the nPEP course. Health care professionals should offer PrEP options to persons with ongoing indications for PrEP and create an nPEP-to-PrEP transition plan for persons who accept PrEP.
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Zeballos D, Guimarães NS, Pereira M, Magno L, Dourado I. Performance of Adherence Measures for Oral, Tenofovir-Based HIV Pre-Exposure Prophylaxis: A Systematic Review. AIDS Behav 2025:10.1007/s10461-025-04741-8. [PMID: 40327271 DOI: 10.1007/s10461-025-04741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2025] [Indexed: 05/07/2025]
Abstract
Accurate adherence measures to HIV pre-exposure prophylaxis (PrEP) are essential for identifying individuals with low adherence and providing tailored support. This systematic review summarizes evidence on the performance of PrEP indirect adherence measures and explores their potential use in clinical practice. Following a registered protocol (PROSPERO: CRD42020144733) we searched PubMed, Embase, LILACS and Web of Science until December 2024. We included studies that assessed PrEP adherence among individuals using daily oral PrEP with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC). The reference standard involved quantifying PrEP in dried blood spots or plasma, and index tests included self-reported adherence, pill counts, pharmacy records, electronic monitoring, or composite measures. We used QUADAS-2 to assess the risk of bias and applicability concerns. Twenty-three studies, which included 6649 individuals, fulfilled the inclusion criteria. Most were observational studies (n = 17, 73.9%), and the most common measure was self-report (n = 18, 78.3%). The performance of indirect measures was reported through accuracy statistics in 12 studies (52.2%), concordance in two (8.7%), correlation in eight (34.8%), and proportions in one (4.3%). The risk of bias and applicability concerns were generally low or unclear due to unclear reporting. This review underscores the wide heterogeneity of indirect measures used to assess PrEP adherence, with self-reports being the most frequently utilized. Despite some correlation with direct measures, these methods showed mixed evidence of accuracy, with studies reporting moderate discriminatory capacity for identifying high protective levels of TFV-DP. This finding limits the broader applicability of the measures and underscores the need for further research.
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Affiliation(s)
- Diana Zeballos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador, Bahia, Brazil.
| | - Nathalia Sernizon Guimarães
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador, Bahia, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador, Bahia, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador, Bahia, Brazil
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Wang H, Delnoij M, Zimmermann HM, Jonas KJ. The Disparities of PrEP Adherence Among Men Who Have Sex With Men Between the Global South and the Global North: An Updated Determinantal Global Meta-Analysis. J Acquir Immune Defic Syndr 2025; 99:1-8. [PMID: 39878582 PMCID: PMC11970584 DOI: 10.1097/qai.0000000000003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 12/18/2024] [Indexed: 01/31/2025]
Abstract
BACKGROUND Suboptimal adherence to pre-exposure prophylaxis (PrEP) limits its global impact, with current evidence mostly from the Global North and lacking Global South perspectives. This meta-analysis synthesizes the rates and determinants of suboptimal adherence to oral PrEP among men who have sex with men (MSM) in both regions. METHODS We searched for literature describing PrEP adherence and its determinants among MSM globally up until October 2024 to conduct a meta-analysis on the rate and determinants of suboptimal adherence in both regions. The definition of (sub-)optimal adherence was study based. RESULTS We included 82 studies in the meta-analysis, with 24, 53, and 5 stemmed from the Global South, North, and global multicenter studies, respectively. Oral PrEP suboptimal adherence is prevalent among MSM PrEP users globally (rate = 0.33, 95% confidence interval [CI]: 0.28 to 0.38) with a significantly higher rate ( P = 0.021) in the Global South (rate = 0.41, 95% CI: 0.33 to 0.50) than in the Global North (rate = 0.29, 95% CI: 0.23 to 0.35). In the Global South, older age (OR = 0.57, 95% CI: 0.37 to 0.87), alcohol use (OR = 1.28, 95% CI: 1.02 to 1.60), and presenting depressive symptoms (OR = 1.47, 95% CI: 1.01 to 2.16) were associated with suboptimal adherence. In the Global North, MSM self-identified as Black (OR = 2.27, 95% CI: 1.31 to 3.95) or Other (OR = 1.36, 95% CI: 1.02 to 1.81), having a university degree (OR = 0.50, 95% CI: 0.34 to 0.73), and presenting depressive symptoms (OR = 2.26, 95% CI: 1.35 to 3.78) were associated with suboptimal adherence. On-demand PrEP users globally demonstrated a higher likelihood of suboptimal adherence (OR = 1.59, 95% CI: 1.18 to 2.14). CONCLUSIONS Suboptimal adherence to oral PrEP is prevalent among MSM globally, particularly higher in the Global South. Regional differences in determinants highlight the need for tailored interventions. Tailored interventions are required to address mental health with tailored efforts to younger MSM in the Global South, while interventions in the Global North should be tailored to specific subgroups.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands; and
- Viroscience Department, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Marit Delnoij
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands; and
| | - Hanne M.L. Zimmermann
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands; and
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands; and
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Lunkuse JF, Lwanga C, Wamono F, Muturi-Kioi V, Price M, Mayanja Y. Willingness to Use Long-Acting Injectable Pre-Exposure Prophylaxis among Adolescent Girls and Young Women in Kampala, Uganda. AIDS Behav 2025; 29:1458-1469. [PMID: 39883369 PMCID: PMC12031944 DOI: 10.1007/s10461-025-04616-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2025] [Indexed: 01/31/2025]
Abstract
Pre-exposure prophylaxis (PrEP) has proven to be a powerful tool in preventing HIV infection. There is limited information about the factors associated with willingness to use different PrEP modalities among adolescent girls and young women (AGYW) in Africa. We assessed willingness to use long-acting injectable PrEP (LAI-PrEP) among 14-24-year-old AGYW at high risk of HIV in Uganda, and associated factors determined using multivariable complementary log-log regression. Of the 285 participants, 69.8% of participants showed willingness to use LAI-PrEP despite only 3.9% having knowledge about it before enrolment. Report of recent transactional sex was high (92.6%). Participants that were divorced/separated (aOR = 1.74, 95% CI 1.03-2.92) and those with multiple sexual partners (aOR = 2.11, 95% CI 1.46-3.06) compared to those with one partner were more likely to be willing to use LAI-PrEP while those that were screened as heavy episodic drinkers (consuming 6 or more drinks on an occasion as per the AUDIT tool) were less likely to be willing to use LAI-PrEP (aOR = 0.61, 95% CI 0.42-0.87). LAI PrEP has shown efficacy in clinical trials; the product is approved for use by the Government of Uganda (MoH) and should be expedited for use by AGYW engaged in paid sex and those with multiple sexual partnerships. As it becomes available, we recommend PrEP education and counseling to increase awareness of LAI PrEP as an alternative HIV prevention method.
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Affiliation(s)
- Jane Frances Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda.
- , P.0 BOX 49, Plot 51-59 Nakiwogo Road, Entebbe, 256, Uganda.
| | - Charles Lwanga
- Department of Population Studies, Makerere University, Kampala, Uganda
| | - Felix Wamono
- Department of Statistics and Actuarial Science School of Statistics and Planning, Makerere University, Kampala, Uganda
| | | | - Matt Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- IAVI, New York, USA
| | - Yunia Mayanja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
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Roberts ST, Hatcher SM, Browne EN, Reilley B, Bensen M, Freeman A, Henne B, Hoover A, Desjardins MM, Leston J. PrEP knowledge, attitudes, and perceived barriers to access among American Indian/Alaska Native people in the US: Results from an online survey. PLoS One 2025; 20:e0321422. [PMID: 40305488 PMCID: PMC12043127 DOI: 10.1371/journal.pone.0321422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/06/2025] [Indexed: 05/02/2025] Open
Abstract
INTRODUCTION Compared to non-Indigenous communities, American Indian/Alaska Native (AI/AN) people are inequitably impacted by HIV, yet few data are available on barriers to pre-exposure prophylaxis (PrEP) use in this population. This study sought to examine PrEP knowledge, attitudes, and perceived barriers to use among AI/AN people in the United States. METHODS A cross-sectional, online survey was administered from January-May 2023 to respondents ≥ 16 years of age who identified as AI/AN. The survey assessed sociodemographic characteristics, PrEP knowledge, attitudes towards PrEP, and experiences with and barriers to PrEP use. Sociodemographic correlates of PrEP knowledge and attitudes were identified using bivariable and multivariable regression models. RESULTS The survey enrolled 403 participants and 354 (87.8%) completed all questions. Respondents had relatively low PrEP knowledge (mean score 4.0 of 9, standard deviation [SD] 3.0). Few (7%) had ever used PrEP. Mean scores on the stigma scales were 2.1 of 5 for stigmatizing PrEP attitudes (SD 0.7), 2.4 of 5 for anticipated stigma (SD 0.56), and 3.0 of 5 for perceived stigma (SD 0.38). Among non-users, 43.1% were not sure if they would be able to get a PrEP prescription if they desired, and 2.7% believed they would not be able to get one. The most common perceived barriers were not knowing where to get PrEP (54.7%) and concerns around discomfort, judgement, and privacy at the health facility (27.3%). In adjusted models, living on tribal/reservation lands was significantly associated with lower PrEP knowledge, higher stigmatizing attitudes, and higher anticipated stigma, and lower PrEP knowledge was associated with higher stigmatizing attitudes and anticipated stigma. Age, gender identity, sexual orientation, urban residence, and strength of connection to indigenous culture were also significantly correlated with one or more outcomes. CONCLUSIONS Our findings underscore the need for widespread sensitization about PrEP in Indigenous communities and for strategies to improve PrEP access and reduce stigma from providers and community members.
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Affiliation(s)
- Sarah T. Roberts
- Women’s Global Health Imperative, RTI International, Oakland, California, United States of America
| | - Sarah M. Hatcher
- Applied Public Health Research Center, RTI International, Durham, North Carolina, United States of America
| | - Erica N. Browne
- Women’s Global Health Imperative, RTI International, Oakland, California, United States of America
| | - Brigg Reilley
- Northwest Portland Area Indian Health Board, Portland, Oregon, United States of America
| | - Matthew Bensen
- Center for Survey Research Engineering, RTI International, Durham, North Carolina, United States of America
| | - Andrew Freeman
- Center for Communication and Media Impact, RTI International, Durham, North Carolina, United States of America
| | - Bob Henne
- Center for Survey Research Engineering, RTI International, Durham, North Carolina, United States of America
| | - Ashley Hoover
- Northwest Portland Area Indian Health Board, Portland, Oregon, United States of America
| | - Monica M. Desjardins
- Applied Public Health Research Center, RTI International, Durham, North Carolina, United States of America
| | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, Oregon, United States of America
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Wu ZH, Zhu YY, Huang XJ, Chen S, Chu ZX, Wang H, Chen YK, Jiang YJ, Shang H, Hu QH. The role of tenofovir-based HIV pre-exposure prophylaxis in preventing HBV infection among men who have sex with men: insights from China. Infect Dis Poverty 2025; 14:31. [PMID: 40287745 PMCID: PMC12034112 DOI: 10.1186/s40249-025-01305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Accepted: 04/11/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Oral emtricitabine-tenofovir disoproxil fumarate (F/TDF) for HIV pre-exposure prophylaxis (PrEP) demonstrates dual potential through antiviral activity against hepatitis B virus (HBV). While F/TDF lacks activity against hepatitis C virus (HCV), the use of F/TDF for HIV PrEP may elevate HCV risk through risk compensation. This study aims to investigate HBV/HCV incidence among men who have sex with men (MSM) using F/TDF-based HIV PrEP, addressing evidence gaps in low- and middle-income countries. METHODS We conducted a secondary analysis of the China Real-World Oral Intake of PrEP (CROPrEP) study, a multicenter prospective cohort of MSM (F/TDF users/non-users) from Beijing, Shenyang, Shenzhen, and Chongqing. Participants underwent HBV/HCV testing at baseline and at the 12-month follow-up. Only HBV-susceptible (hepatitis B surface antigen-negative, hepatitis B surface and core antibody-negative) MSM were included in the secondary analysis, to calculate HBV incidence. The primary outcomes were HBV/HCV incidence rates at the 12-month follow-up. Bayesian Poisson regression identified HBV/HCV infection risk factors. RESULTS The CROPrEP cohort prospectively recruited 1023 F/TDF users and 507 F/TDF non-users at baseline. This secondary analysis included 259 F/TDF users and 120 non-users identified as HBV-susceptible at baseline. At the 12-month of follow-up, no incident HBV infections occurred in the F/TDF users group, and only one incident HBV infection occurred in the F/TDF non-users group. The incidence of new HBV infections was 0.00/100 person-years (PY) [95% confidence interval (CI): 0.00-1.32] among HBV-susceptible F/TDF users and 0.77/100 PY (95% CI: 0.02-4.20) among HBV-susceptible F/TDF non-users. HBV incidence was reduced with F/TDF compared with no F/TDF [adjusted incidence rate ratio (aIRR): 0.00; 95% CI: 0.00-0.00]. HCV incidence among F/TDF users and non-users was 0.31/100 PY (95% CI: 0.06-0.90) and 0.00/100 PY (95% CI: 0.00-0.74) after 12 months, respectively. HCV incidence was lower in F/TDF non-users than in F/TDF users (aIRR: 0.00; 95% CI: 0.00-0.25). CONCLUSIONS This study suggests a potential benefit in reducing HBV incidence among MSM using F/TDF as HIV PrEP, highlighting the potential for integrated prevention strategies addressing both HIV and HBV risks in PrEP programmes. TRIAL REGISTRATION ChiCTR, ChiCTR-IIN-17013762. Registered 8 December 2017, https://www.chictr.org.cn/showproj.html?proj=22916 .
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Affiliation(s)
- Zhen-Hao Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China
| | - Yan-Yan Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China
| | - Xiao-Jie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shuo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China
| | - Zhen-Xing Chu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China
| | - Hui Wang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People's Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Yao-Kai Chen
- Chongqing Public Health Medical Center, Chongqing, China
| | - Yong-Jun Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China
| | - Hong Shang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China.
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China.
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China.
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China.
| | - Qing-Hai Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Prevention and Treatment, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, 110001, China.
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, 110001, China.
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, 110001, China.
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 79 Qingchun Street, Hangzhou, 310003, China.
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Zelaya DG, Janssen T, Windes B, Wheeler DP, Fields SD, Beauchamp G, Kahler CW, Wilton L, Mayer KH. The Association of Positive Intersectionality Latent Classes with Psychosocial Factors and PrEP Outcomes in Black Men Who Have Sex with Men (HPTN 073). J Racial Ethn Health Disparities 2025:10.1007/s40615-025-02418-5. [PMID: 40259184 DOI: 10.1007/s40615-025-02418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/31/2025] [Accepted: 04/04/2025] [Indexed: 04/23/2025]
Abstract
Experiences of discrimination and HIV risk in Black men who have sex with men (MSM) need to be examined from the perspective of strength and resilience and not just risk. Scholars have theorized that a strong connection with one's sociocultural identities may increase individuals' ability to cope with discrimination which has been related to positive health outcomes. Scholars have coined the term positive intersectionality to refer to how one's stigmatized identity(ies) can be used to draw strength and create a positive sense of self. The current study is a secondary data analysis of a study of 225 Black MSM. We utilized Latent Class Analysis to determine profiles of positive intersectionality measured by indicators of racial/ethnic identity, having an integrated sexual orientation and racial/ethnic identity, and levels of internalized homophobia. Fit indices suggested a five-latent class solution: low positive intersectionality (n = 3), ambivalent positive intersectionality (n = 19), moderate positive intersectionality (n = 66), salient/high positive intersectionality (n = 124), and conflict(ed) positive intersectionality (n = 13). Differences were found across classes on key outcomes, broadly individuals in classes with more positive intersectionality tended to report more positive psychosocial outcomes (i.e., more social support and less depression) than those in classes with lower positive intersectionality. Regarding PrEP outcomes, adherence (examined via a biomarker) was highest among those reporting ambivalent or conflict positive intersectionality compared to those with low positive intersectionality. Our findings underscore the need for the development of strengths-based and culturally tailored interventions may help to improve well-being for Black MSM.
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Affiliation(s)
- David G Zelaya
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S 121 South Main St, Providence, RI, 02912, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S 121 South Main St, Providence, RI, 02912, USA
| | - Brayden Windes
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S 121 South Main St, Providence, RI, 02912, USA
| | | | | | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research & Prevention (SCHARP) Vaccine and Infectious Disease Division (VIDD), Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S 121 South Main St, Providence, RI, 02912, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Department of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Kenneth H Mayer
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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9
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Storholm ED, Nacht CL, Opalo C, Flynn R, Murtaugh KL, Marroquin M, Baumgardner M, Dopp AR. Preliminary Outcomes from PrEP Well: A Community-led, Multicomponent HIV Prevention Strategy Implemented in a Transgender Community Health Center. J Community Health 2025:10.1007/s10900-025-01468-4. [PMID: 40257652 DOI: 10.1007/s10900-025-01468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2025] [Indexed: 04/22/2025]
Abstract
Transgender and nonbinary (TGNB) individuals are disproportionately impacted by HIV, particularly those who identify as racial/ethnic minorities and those who are socioeconomically disadvantaged. Pre-exposure prophylaxis (PrEP) is a highly effective medication to prevent HIV infection, but many TGNB individuals encounter barriers to PrEP uptake and adherence that limit fully realized preventive benefits. We developed PrEP Well, a multicomponent community-led program, to scale and sustain comprehensive PrEP services from a TGNB-led community organization that provides gender-affirming healthcare and social services. We used implementation science frameworks to evaluate initial program outcomes and contextual influences on program implementation. Preliminary data from August 2022 through January 2024 showed promising implementation and effectiveness outcomes. During that time, 113 primarily low-resourced TGNB clients were educated about PrEP and received an HIV test, of whom 60 (53%) attended a visit with a provider and received a PrEP prescription. At 30-day follow-up, urinalysis confirmed uptake of PrEP among 50 (83%) of the clients prescribed PrEP. At 90-day follow-up, 43 (72%) demonstrated continued use of PrEP and 40 (67%) showed protective levels of PrEP adherence. Qualitative interviews and surveys indicated that clients, staff, and leadership viewed the PrEP Well program as highly acceptable, feasible, and sustainable (including willingness to address persistent implementation barriers). Referral patterns and rates of PrEP uptake suggested increasing integration of PrEP Well into the TGNB community center over time. The PrEP Well program demonstrates the potential for TGNB communities to address HIV inequities by integrating community-led HIV prevention services with gender-affirming healthcare in TGNB-specific health centers.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA.
- RAND, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles, CA, USA.
- Health Promotion & Behavioral Science, San Diego State University School of Public Health, 5500 Campanile Drive, Hepner Hall 114E, 92182 - 4162, San Diego, CA, USA.
| | - Carrie L Nacht
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chloe Opalo
- Trans Wellness Center, Los Angeles, CA, USA
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, CA, USA
| | - Kimberly Ling Murtaugh
- Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles, CA, USA
- Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mariana Marroquin
- Trans Wellness Center, Los Angeles, CA, USA
- Los Angeles LGBT Center, Los Angeles, CA, USA
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10
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Jones J, Siegler AJ, Glick JL, Lucas IL, Sullivan PS, Sarkar S, Ragone L, Rawlings MK, Vannappagari V, Sanchez T. Brief Report: Potential Gains in PrEP Coverage and Effect on Racial Disparities After Introduction of On-Demand and Long-Acting Injectable PrEP: Preferences of Men Who Have Sex With Men in the United States, 2021-2022. J Acquir Immune Defic Syndr 2025; 98:429-433. [PMID: 40067782 DOI: 10.1097/qai.0000000000003602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/06/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION There are persistent race- and ethnicity-based disparities in HIV incidence among gay and bisexual men who have sex with men (GBMSM) in the United States, partially driven by inequities in distribution of pre-exposure prophylaxis (PrEP). We assessed how additional modalities of PrEP beyond daily oral might affect the uptake of PrEP and ongoing disparities in HIV incidence in the United States. METHODS In an online survey of GBMSM in the United States, we presented participants with descriptions of each PrEP modality. Among GBMSM not willing to use daily oral PrEP, we assessed willingness to use on-demand or long-acting injectable (LA) PrEP. Among GBMSM using daily oral PrEP, we assessed willingness to switch to on-demand or LA PrEP. RESULTS Among GBMSM who were not willing to use daily oral PrEP, most were also not willing to use either on-demand or LA PrEP. In adjusted analyses, Hispanic/Latino, non-Hispanic/Latino Black, and non-Hispanic/Latino GBMSM of other races were more willing to use LA PrEP than non-Hispanic/Latino White GBMSM; none of the adjusted prevalence ratios was statistically significant. Most GBMSM currently taking daily oral PrEP reported a preference for staying on that regimen. Among those interested in switching, most were interested in on-demand PrEP. CONCLUSIONS Most GBMSM not willing to use daily oral PrEP are also not willing to use other modalities of PrEP; most GBMSM who are currently using daily oral PrEP prefer to continue using that dosing strategy. Our results suggest that differential preferences in modalities of PrEP will not exacerbate existing disparities in PrEP distribution or HIV incidence.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University, Atlanta, GA
| | | | - Jennifer L Glick
- Department of Community Health Science and Policy, Louisiana State University Health Science Center, New Orleans, LA; and
| | - Iaah L Lucas
- Department of Epidemiology, Emory University, Atlanta, GA
| | | | | | | | | | | | - Travis Sanchez
- Department of Epidemiology, Emory University, Atlanta, GA
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11
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Chivardi C, Zamudio-Sosa A, Wilson-Barthes M, Alarid-Escudero F, Gandhi M, Mayer KH, Operario D, Galárraga O. Cost-Effectiveness of Using Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence Among Male Sex Workers. PHARMACOECONOMICS - OPEN 2025:10.1007/s41669-025-00569-z. [PMID: 40205318 DOI: 10.1007/s41669-025-00569-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2025] [Indexed: 04/11/2025]
Abstract
INTRODUCTION Conditional economic incentives can improve medication-taking behaviors among populations at risk of contracting human immunodeficiency virus (HIV). However, there are no data on the cost-effectiveness of incentive programs for improving pre-exposure prophylaxis (PrEP) adherence among male sex workers (MSWs) who have one of the highest HIV acquisition rates. Our objective was to assess the cost-effectiveness of incentive programs to improve adherence to pre-exposure prophylaxis (PrEP) among male sex workers METHODS: We conducted an economic evaluation of the PrEP Seguro randomized pilot trial in Mexico (ClinicalTrials.gov: NCT03674983). Among n = 110 MSWs, those randomized to the intervention received tiered incentives based on PrEP drug levels in scalp hair measured at three clinic visits over 6 months. The intervention led to a 28.7% increase in scalp hair PrEP concentration, consistent with increased adherence (p = 0.05). Here we use a micro-costing approach from the health system perspective to calculate costs. Quality-adjusted life years (QALYs) were estimated from the number of HIV infections averted through sufficient PrEP adherence (tenofovir concentration > 0.011 ng/mg corresponding to greater than or equal to three weekly doses). Incremental cost-effectiveness ratios (ICERs) estimated the cost/QALY gained owing to the intervention. RESULTS The mean cost per patient was US $165.53 and $179.55 among standard care and incentive patients, respectively. Over 6 months of follow-up, 62% of standard care patients and 78% of incentive recipients were PrEP adherent. After the program, the lifetime average QALYs gained per infection avoided were 9.17 (minimum, maximum: 7.5, 10.8) and 9.84 (minimum, maximum: 8.05, 11.6) among standard care and incentive patients, respectively. The 6-month ICER was US $20.92/QALY gained by the intervention, which was highly cost-effective at a willingness-to-pay of US $8655 (Mexico's 2020 per capita gross domestic product (GDP)). DISCUSSION Using behavioral economics approaches for enhancing adherence to HIV prevention may offer health and fiscal benefits through reduced HIV incidence. Fully powered implementation trials can determine future cost-effectiveness of scaling up incentives for PrEP adherence among high-risk populations.
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Affiliation(s)
| | | | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | | | - Monica Gandhi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, and Harvard University, Boston, MA, USA
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice & International Health Institute, Brown University School of Public Health, Providence, RI, USA.
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12
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Szczepański A, Klesiewicz K, Drożdż K, Ankiersztejn-Bartczak M, Olechowska-Jarząb A, Brzychczy-Włoch M. Assessment of the Impact of Gender, Age, Sexual Orientation and PrEP on HIV Infection: Analysis of Anonymous HIV Tests of People in Voluntary Counselling and Testing Points (VCTs) in Poland in 2015-2023. AIDS Behav 2025:10.1007/s10461-025-04701-2. [PMID: 40185968 DOI: 10.1007/s10461-025-04701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2025] [Indexed: 04/07/2025]
Abstract
Human immunodeficiency virus (HIV) is still an important global health burden and remains a common sexually transmitted infection (STI). Voluntary Counselling and Testing points (VCTs) in Poland allow free and anonymous access to HIV testing among the adult population. The aim of the study was to investigate whether there is an increased occurrence of HIV infection among individuals who identify as homosexual and to profile three distinct groups among VCTs clients: the most common patient coming for testing, the most frequent HIV-positive individual, and the most typical Pre-Exposure Prophylaxis (PrEP) user. Data obtained from 29 VCT points in Poland between 2015 and 2023 were retrospectively analyzed. The prevalence of HIV infection in this cohort was calculated and a model for HIV infection risk among various populations was built. 295,556 patient reports revealed that heterosexual men aged 25-34 years (13.43%) tested most frequently. In total, the average prevalence of HIV-positive patients amounted to 1.36%. Among the tested population, HIV infection was the most prevalent among homosexual men aged 25-34 (0.34%). Moreover, we showed that the risk of receiving a positive HIV result was almost five times higher among homosexual and bisexual patients than among heterosexual individuals. The findings highlight the urgent need for targeted HIV prevention efforts, particularly among homosexual and bisexual men. Ongoing monitoring and education are necessary even among PrEP users to prevent new infections.
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Affiliation(s)
- Adrian Szczepański
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Krakow, Poland
- Association of Health Prevention "One World", Miłkowskiego 5, 30-349, Krakow, Poland
| | - Karolina Klesiewicz
- Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Kamil Drożdż
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Krakow, Poland
| | | | - Aldona Olechowska-Jarząb
- Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Medyczna 9, 30-688, Krakow, Poland
| | - Monika Brzychczy-Włoch
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Krakow, Poland.
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13
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Howell J, Deane-King J, Maguire R. Factors Associated with PrEP Stigma Among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM): A Systematic Review. JOURNAL OF HOMOSEXUALITY 2025; 72:623-652. [PMID: 38511847 DOI: 10.1080/00918369.2024.2326891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. While pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, uptake of PrEP among gbMSM is low, which may in part be due to stigma associated with PrEP use. This systematic review aimed to explore experiences of PrEP stigma and to identify factors associated with this. Four databases were searched for papers including terms relating to (i) gbMSM, (ii) PrEP, and (iii) stigma, with narrative synthesis used to analyze results. After screening, 70 studies were included in the final analysis. Experiences of PrEP stigma were found to be characterized by a number of stereotypes and came from a range of sources. Five categories of factors were associated with stigma: (i) healthcare-related factors, (ii) cultural and contextual factors, (iii) sociodemographic factors, (iv) peer-discussion, and (v) psychosocial factors. These findings suggest that stigma can be a common experience for gbMSM. However, some are more at risk than others. Interventions aimed at reducing PrEP stigma may be useful in increasing uptake.
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Affiliation(s)
- Jamie Howell
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | | | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Ireland
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14
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Nijhawan AE, Kholy J, Marcus JL, Hogan TP, Higashi RT, Naeem J, Hansen L, Torres B, Harris BL, Zhang S, Krakower D. A Multicomponent Strategy to Improve HIV Pre-Exposure Prophylaxis in a Southern US Jail: Protocol for a Type 3 Hybrid Implementation-Effectiveness Trial. JMIR Res Protoc 2025; 14:e64813. [PMID: 40100263 PMCID: PMC11962320 DOI: 10.2196/64813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 10/08/2024] [Accepted: 12/12/2024] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective approach for preventing HIV infection, but it is underutilized by populations who may benefit the most, including people living in the Southern United States and those involved in the criminal legal (CL) system. Improving the access and use of PrEP for these groups could decrease HIV-related health disparities. Beyond individual outcomes, HIV prevention for CL-involved people can have a significant public health impact on HIV incidence due to a high turnover between jails and the community. OBJECTIVE We will develop, implement, and evaluate a multicomponent PrEP implementation strategy for the Dallas County Jail (DCJ) to increase the initiation of this HIV-preventive intervention for CL-involved individuals. METHODS This is a type 3 hybrid implementation-effectiveness study that takes a combined approach by assessing the implementation of a strategy to identify candidates for PrEP at the DCJ and linking them to PrEP providers upon community re-entry while also gathering information about clinical outcomes. The approach is guided by the EPIS (exploration, preparation, implementation, sustainment) framework. Initial formative work (exploration) involves qualitative interviews of diverse key stakeholders to identify factors that may influence linkage to PrEP after jail release. These findings will undergo rapid qualitative analysis (preparation) to inform the adaptation of a multicomponent jail PrEP implementation strategy protocol. This approach, which will include an electronic health record (EHR) prediction model and integration of a PrEP patient navigator into the jail health team, will allow medical providers and the navigator at the DCJ to engage individuals most likely to benefit in shared decision-making about PrEP and navigate them to community PrEP care (implementation) in a process that begins before release from jail and ends with successful care linkage. Regular quantitative and qualitative evaluations of this approach will allow for ongoing stakeholder input, refinement of the implementation strategy, and maintenance of the program (sustainment). RESULTS Findings from 26 qualitative interviews (9 formerly incarcerated individuals, 9 county jail staff, and 8 employees of community organizations) have been obtained, analyzed, and mapped to an implementation strategy formalized in a jail PrEP protocol. An HIV risk prediction model based on EHR data to identify individuals most likely to benefit from PrEP has been developed and internally validated and is ready to be deployed. We anticipate the availability of preliminary study findings in 2026. CONCLUSIONS This study will provide key insights into the feasibility and effectiveness of a PrEP implementation strategy among people at increased risk of HIV acquisition in an urban jail in Southern United States. This practical and scalable strategy can be used as a model for other urban jails to address HIV-related inequities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/64813.
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Affiliation(s)
- Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jana Kholy
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Julia L Marcus
- Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Robin T Higashi
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jacqueline Naeem
- Parkland Center for Clinical Innovation, Dallas, TX, United States
| | - Laura Hansen
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Brynn Torres
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Barry-Lewis Harris
- Parkland Correctional Health, Dallas County Jail, Dallas, TX, United States
| | - Song Zhang
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Douglas Krakower
- Harvard Pilgrim Health Care Institute, Boston, MA, United States
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States
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15
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Lin YT, Liu WD, Cheng CN, Chang WC, Chuang CC, Sun HY, Lin KY, Huang YS, Wu PY, Chen LY, Chang HY, Luo YZ, Chen YT, Liu WC, Su YC, Li GC, Hung CC, Kuo CH. Measurements of tenofovir-diphosphate and emtricitabine-triphosphate concentrations in dried blood spots of people receiving pre-exposure prophylaxis for HIV with co-formulated tenofovir disoproxil fumarate and emtricitabine. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2025:S1684-1182(25)00045-3. [PMID: 40087092 DOI: 10.1016/j.jmii.2025.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 02/22/2025] [Accepted: 03/01/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND/PURPOSE(S) Data regarding the concentrations of tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in the Asian population receiving pre-exposure prophylaxis (PrEP) for HIV with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) (TDF/FTC) are limited, and the associations between the frequency of TDF/FTC administration and drug concentration among people receiving on-demand PrEP remain unclear. METHODS Fifty-seven participants receiving daily TDF/FTC and 113 participants receiving on-demand TDF/FTC were enrolled in this study. The concentrations of TFV-DP and FTC-TP were measured in dried blood spots using liquid chromatography‒mass spectrometry. RESULTS Thirty-six (62.2 %) daily PrEP users and 38 (33.6 %) on-demand PrEP users achieved TFV-DP concentrations ≥700 fmol/punch. Higher proportions of undetectable FTC-TP were observed in participants whose TFV-DP concentrations were ≤350 fmol/punch, regardless of the frequency of TDF/FTC administration. In participants who used on-demand PrEP, the TFV-DP and FTC-TP concentrations were moderately correlated with the TDF/FTC tablets taken when sampling was performed within 12-24 h after the last dose of TDF/FTC (R = 0.63, p = 0.006 and R = 0.75, p = 0.0005). In addition, on-demand PrEP users who had received 8 tablets within the last 28 days had a median TFV-DP concentration similar to that of those participants who had received 16 tablets (544.6 vs. 556.9 fmol/punch, p > 0.99). CONCLUSIONS These results underscore the importance of well-controlled sampling times for obtaining reliable TFV-DP and FTC-TP concentrations to estimate the adherence and effectiveness of on-demand PrEP.
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Affiliation(s)
- Ya-Ting Lin
- School of Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan; The Metabolomics Core Laboratory, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Chih-Ning Cheng
- School of Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan; The Metabolomics Core Laboratory, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chi Chang
- The Tenth Core Lab, Department of Medical Research, National Taiwan University, Taipei, Taiwan
| | - Chia-Chi Chuang
- The Tenth Core Lab, Department of Medical Research, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ying Wu
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Ya Chen
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsi-Yen Chang
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Zhen Luo
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ting Chen
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Ching Su
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Guei-Chi Li
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
| | - Ching-Hua Kuo
- School of Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan; The Metabolomics Core Laboratory, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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16
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Devanathan AS, Poliseno AJ, White NR, Schauer AP, Sykes C, Weideman AMK, Kilpatrick KW, Hudgens MG, Gay CL, Rosen EP, Dumond JB, Kashuba ADM, Cottrell ML. A Cross-Biomeasure Study to Optimize Antiretroviral Adherence Estimation. J Acquir Immune Defic Syndr 2025; 98:291-299. [PMID: 39813294 DOI: 10.1097/qai.0000000000003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/21/2024] [Indexed: 01/18/2025]
Abstract
BACKGROUND Incomplete adherence to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) reduces effectiveness. Adherence biomeasures (ie, drug concentrations in biological specimen) are more accurate than self-report. TDF/FTC's intracellular active metabolites (tenofovir-diphosphate; TFVdp and FTC-triphosphate; FTCtp) can be quantified in different types of blood samples to estimate adherence. To optimize adherence estimation, we investigated approaches to measure TFVdp and FTCtp in 4 blood matrices. METHODS Twelve HIV-negative, healthy volunteers were enrolled in a single-center, open-label, 3-phase, directly observed therapy study. LC-MS/MS methods quantified TFVdp/FTCtp in dried blood spots, volumetrically accurate microsampling, upper layer packed cells, and peripheral blood mononuclear cells (PBMCs). Noncompartmental analysis estimated half-lives and accumulation ratios. Correlations characterized relationships between clinical variables and exposure. Regression models were fit to determine concentrations associated with <4 and ≥4 doses/week; correct classification percentages were determined. RESULTS Terminal half-life estimates of 3-4 vs 15-22 days distinguished between moderate-term (FTCtp in all samples; TFVdp in PBMCs) versus long-term (TFVdp in red blood cell-containing matrices) measures. Model-derived thresholds accurately categorized <4 and ≥4 doses/week when including both metabolites for 14- and 28-day dosing periods (81%-91% and 82%-85%, respectively). Within each classification and regression trees analyses containing both moderate- and long-term measures, dried blood spots exhibited highest accuracy to predict stable (74%-94%) and changing (42%-47%) adherence patterns. CONCLUSIONS We demonstrate higher accuracy of moderate-term biomeasures to classify adherence over a 14-day period compared with long-term biomeasures to classify adherence over a 28-day period. Combined moderate- and long-term biomeasures predicted stable and changing adherence patterns, with dried blood spots exhibiting highest accuracy.
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Affiliation(s)
| | - Amanda J Poliseno
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Nicole R White
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Amanda P Schauer
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Craig Sykes
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Ann Marie K Weideman
- Biostatistics Core, Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Michael G Hudgens
- Biostatistics Core, Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cynthia L Gay
- University of North Carolina School of Medicine, Chapel Hill, NC; and
| | - Elias P Rosen
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Julie B Dumond
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Angela D M Kashuba
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
- University of North Carolina School of Medicine, Chapel Hill, NC; and
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17
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Galárraga O, Wilson-Barthes M, Chivardi C, Gras-Allain N, Alarid-Escudero F, Gandhi M, Mayer KH, Operario D. Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2025; 26:299-311. [PMID: 39002005 PMCID: PMC11725604 DOI: 10.1007/s10198-024-01705-y] [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: 11/17/2023] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence (p = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers (p < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.
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Affiliation(s)
- Omar Galárraga
- Department of Health Services Policy and Practice, Brown University School of Public Health, 121 South Main St. Box G-S121-2, Providence, RI, 02903, USA.
- International Health Institute, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
| | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA
| | - Carlos Chivardi
- National Institute of Public Health (INSP), University No. 655 Colonia Santa María Ahuacatitlán, Cuernavaca, Mexico
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Nathalie Gras-Allain
- Center for HIV/AIDS Prevention and Care, Clínica Especializada Condesa, Gral. Benjamín Hill 24, Hipódromo Condesa Cuauhtémoc, México City, 06170, Mexico
| | - Fernando Alarid-Escudero
- Center for Economics Teaching and Research (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, Aguascalientes, CP, 20313, Mexico
- Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305, USA
| | - Monica Gandhi
- University of California, 1001 Potrero Ave, #423D, San Francisco, CA, 94110, USA
| | - Kenneth H Mayer
- The Fenway Institute, 7 Haviland St, Boston, MA, 02115, USA
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Don Operario
- Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA
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Ewart LD, Larson ME, Ghanooni D, Verhagen R, Manuel J, McCollister K, Fardone E, DeVries B, Dilworth S, Blackstock M, Doblecki-Lewis S, Nahum-Shani I, Grov C, Carrico AW. Getting to yes: Pilot sequential multiple assignment randomized trial of motivational enhancement interventions targeting preexposure prophylaxis use in sexual minority men who use stimulants. Health Psychol 2025; 44:310-320. [PMID: 39992777 PMCID: PMC11980644 DOI: 10.1037/hea0001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
OBJECTIVE This pilot sequential multiple assignment randomized trial estimated the feasibility, acceptability, and scalability of telehealth motivational enhancement interventions for optimizing HIV prevention efforts in sexual minority men (SMM) who use stimulants. METHOD Seventy SMM who use stimulants with nonreactive HIV results that were not taking preexposure prophylaxis (PrEP) were randomized to: (a) a two-session motivational interviewing (MI) intervention focusing on PrEP use and concomitant risk behaviors; or (b) a contingency management (CM) intervention with financial incentives for PrEP clinical evaluation ($50) and filling a PrEP prescription ($50). After 3 months, participants who reported they had not filled a prescription for PrEP were randomized a second time to: (a) switch to a second-stage intervention (i.e., MI + CM); or (b) continue with assessments only. RESULTS There was a robust engagement in the interventions, which participants described as flexible and nonjudgmental. Participants reported using CM incentives to meet basic needs and indicated that MI sessions improved their understanding of PrEP. The estimated cost of intervention delivery per participant was $404 for MI, $236 for CM, and $475 for MI + CM. Across both randomizations, participants who received CM only were most likely to provide verified evidence of PrEP use over 6 months, and there were potential benefits for reducing concomitant risk behaviors in nonresponders receiving MI + CM. Prior PrEP use and increases in PrEP intentions were significantly associated with verified PrEP use. CONCLUSION Although more definitive trials are needed to examine effectiveness, telehealth motivational enhancement interventions are promising, scalable approaches for optimizing HIV prevention among SMM who use stimulants. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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Affiliation(s)
- Leah Davis Ewart
- Robert Stempel College of Public Health and Social Work, Florida International University
| | - Michaela E. Larson
- Robert Stempel College of Public Health and Social Work, Florida International University
| | - Delaram Ghanooni
- Robert Stempel College of Public Health and Social Work, Florida International University
| | - Rachel Verhagen
- Department of Psychology, College of Arts and Sciences, University of Miami
| | - Jennifer Manuel
- Department of Psychiatry, University of California, San Francisco
| | | | | | | | | | - Makayla Blackstock
- Robert Stempel College of Public Health and Social Work, Florida International University
| | | | | | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York
| | - Adam W. Carrico
- Robert Stempel College of Public Health and Social Work, Florida International University
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Dos Santos FC, Brin M, Tanner MR, Galindo CA, Schnall R. The mChoice App, an mHealth Tool for the Monitoring of Preexposure Prophylaxis Adherence and Sexual Behaviors in Young Men Who Have Sex With Men: Usability Evaluation. JMIR Hum Factors 2025; 12:e59780. [PMID: 40019786 PMCID: PMC11887583 DOI: 10.2196/59780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 01/19/2025] [Accepted: 01/19/2025] [Indexed: 03/01/2025] Open
Abstract
Background Mobile health (mHealth) apps provide easy and quick access for end users to monitor their health-related activities. Features such as medication reminders help end users adhere to their medication schedules and automatically record these actions, thereby helping manage their overall health. Due to insufficient mHealth tools tailored for HIV preventive care in young men who have sex with men (MSM), our study evaluated the usability of the mChoice app, a tool designed to enhance preexposure prophylaxis (PrEP) adherence and promote sexual health (eg, encouraging the use of condoms and being aware of the partner's HIV status and PrEP use). Objective This study aimed to apply systematic usability evaluations to test the mChoice app and to refine the visualizations to better capture and display patient-reported health information. Methods Usability testing involved heuristic evaluations conducted with 5 experts in informatics and user testing with 20 young MSM who were taking or were eligible to take PrEP. Results End users demonstrated satisfaction with the appearance of the mChoice app, reporting that the app has an intuitive interface to track PrEP adherence. However, participants highlighted areas needing improvement, including chart titles and the inclusion of "undo" and "edit" buttons to improve user control when recording PrEP use. Conclusions Usability evaluations involving heuristic experts and end users provided valuable insights into the mChoice app's design. Areas for improvement were identified, such as enhancing chart readability and providing additional user controls. These findings will guide iterative refinements, ensuring that future versions of the app better address the needs of its target audience and effectively support HIV prevention.
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Affiliation(s)
| | - Maeve Brin
- School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, United States, 1 212-305-5756
| | - Mary R Tanner
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carla A Galindo
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, United States, 1 212-305-5756
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Apreku A, Guure C, Dery S, Yakubu A, Abu-Ba'are GR, Addo SA, Torpey K. Awareness, willingness, and uptake of pre-exposure prophylaxis (PrEP) among men who have sex with men in Ghana. BMC Infect Dis 2025; 25:213. [PMID: 39948458 PMCID: PMC11827451 DOI: 10.1186/s12879-025-10614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 02/07/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND HIV prevalence among men who have sex with men (MSM) in Ghana is 18.1% as compared to 1.6% in the general population. Pre-exposure Prophylaxis (PrEP) is recommended by the World Health Organization (WHO) for people who are HIV-negative and at high risk of acquiring HIV. Since PrEP introduction in Ghana in 2020, little is known nationally about the level of awareness, uptake, and willingness to take PrEP among MSM. This study aims to generate estimates on PrEP awareness, uptake and willingness to use among MSM in Ghana. METHODS We conducted a bio-behavioral survey among MSM aged 18 years and above in all the 10 traditional regions in Ghana from August 2022 to July 2023 using respondent-driven sampling (RDS). RDS-Analyst was used to compute weights based on the participants' network. Data analysis was restricted to MSM who were HIV-negative and sexually active to estimate the prevalence of awareness, willingness, and uptake of PrEP. A multivariable logistic regression model was used to assess the factors influencing these outcomes. RESULTS Out of the 3,420 total MSM surveyed, 2,627 were HIV negative and were included in the analysis, Out of which 44.5% (95% CI: 42.0-47.0) were aware of PrEP, 90.4% (95% CI: 88.0-92.3) were willing to take PrEP and 17.8% (95% CI: 16.0 - 19.8) had ever taken PrEP. In the regression analyses, PrEP awareness was 5-fold higher among those who completed tertiary education (aOR: 5.56, 95% CI: 2.87-10.78, p < 0.001) and 4-fold among those who interacted with peer educators (aOR: 3.78, 95% CI: 2.52-5.67, p < 0.001). In terms of uptake, the odds were almost 9 times among those who had experienced forced sex (aOR: 8.88, 95% CI: 1.42-55.47, p = 0.02). MSM aged 25-34 were less willing to take PrEP (aOR:0.21, 95% CI 0.07-0.65, p = 0.006) and PrEP use was also less likely among those who consumed high alcohol (aOR:0.42, 95% CI 0.19-0.92, p = 0.03) and never tested for HIV (aOR: 0.44, 95% CI" 0.25-0.88, p = 0.017). CONCLUSION In Ghana, awareness and willingness to take PrEP to prevent HIV is high, but uptake is low. These results highlight the need for interventions to improve the overall uptake of PrEP among MSM in Ghana, especially among those aged 25-34, high alcohol consumers and those who have never screened for HV. Effective implementation of these findings into the national policies can enhance access and encourage PrEP use, ultimately reducing HIV incidence in Ghana among MSM.
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Affiliation(s)
- Amos Apreku
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
| | - Samuel Dery
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Alhassan Yakubu
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
- Total Family Organisation, Accra, Ghana
| | | | | | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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21
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Crepalde-Ribeiro K, Braga MDG, Silveira MR, Moura AS, Vaz-de-Melo POS, Ferraz MMD, Pearson SA, Costa JDO. Non-adherence, discontinuation, and seroconversion among people on daily HIV pre-exposure prophylaxis (PrEP) in Brazil: a nationwide cohort study. AIDS Care 2025; 37:289-299. [PMID: 39729430 DOI: 10.1080/09540121.2024.2443824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 12/12/2024] [Indexed: 12/29/2024]
Abstract
The goal of this study was to evaluate characteristics associated with Pre-exposure Prophylaxis for HIV infection (PrEP) non-adherence or discontinuation in Brazil and assess the association between these outcomes and HIV seroconversion. We used linked national dispensing and pathology data to identify people aged 14+ years initiating PrEP in 2018. We estimated non-adherence using the proportion of days covered (PDC), defining non-adherence as PDC < 60%. We defined discontinuation as a gap in therapy of at least 120 days. We used logistic regression models to assess characteristics associated with non-adherence or discontinuation within 365 days and to assess HIV seroconversion and its association with non-adherence or discontinuation. In 2018, 5100 people initiated PrEP; 34.4% (95%CI 33.1%; 35.7%) were non-adherent and 34.3% (95%CI 33.0%; 35.6%) discontinued. People aged 34 years or less, women, people with lower education levels, or living in the Northern region of Brazil were more likely to be non-adherent or discontinue therapy. Thirty people (0.6% 95%CI 0.4%; 0.8%) seroconverted. HIV seroconversion was associated with PrEP non-adherence or discontinuation (OR = 6.2 for both). Non-adherence and discontinuation were common in people initiating PrEP and strongly associated with HIV seroconversion. Our work identifies populations at higher risk of non-adherence or discontinuation which could be targeted in interventions to reduce new HIV cases in Brazil.
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Affiliation(s)
- Kennedy Crepalde-Ribeiro
- Postgraduation Program in Medicines and Pharmaceutical Policy, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria das Graças Braga
- Department of Social Pharmacy, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Micheline Rosa Silveira
- Department of Social Pharmacy, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alexandre Sampaio Moura
- Postgraduation Program in Medicine and Biomedicine, Faculdade Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro O S Vaz-de-Melo
- Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Matheus Marchesotti Dutra Ferraz
- Computer Science degree, Department of Computer Science, Institute of Exact Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sallie-Anne Pearson
- Faculty of Medicine and Health, School of Population Health - UNSW Sydney, Kensington, NSW, Australia
| | - Juliana de Oliveira Costa
- Faculty of Medicine and Health, School of Population Health - UNSW Sydney, Kensington, NSW, Australia
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22
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Gichane MW, Velloza J, Hosek S, Beauchamp G, Anderson P, Delany-Moretlwe S, Celum C. Hoping to Adhere? Examining the Relationship Between Hope and Pre-exposure Prophylaxis Willingness, Adherence, and Persistence Among Young Women in South Africa and Zimbabwe (HPTN 082). AIDS Behav 2025; 29:527-534. [PMID: 39446266 PMCID: PMC11814051 DOI: 10.1007/s10461-024-04536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2024] [Indexed: 10/25/2024]
Abstract
Hope is a powerful psychological construct which is linked to positive health. Greater hope is associated with improved antiretroviral therapy adherence; however, less is known about the impact of hope on oral pre-exposure prophylaxis (PrEP) outcomes. HIV Prevention Trials Network 082, was an open-label PrEP study among young women (ages 16-25) in South Africa and Zimbabwe. Hope was measured at baseline and follow-up using a subset of the Hope for the Future Scale (score range 6-24) and PrEP willingness was measured using a subscale of the HIV Prevention Readiness Measure (score range 6-30). Intracellular tenofovir-diphosphate (TFV-DP) concentrations were obtained from dried blood spot samples at weeks 13, 26, and 52; high PrEP adherence was defined as TFV-DP concentrations ≥ 700 fmol/punch. Persistence was defined as TFV-DP > 16 fmol/punch at weeks 26 and 52. Linear regression and generalized estimating equations were used to assess the relationship between hope and PrEP willingness, adherence, and persistence. The median age of participants (n = 432) was 21 years (interquartile range [IQR]: 19-22). The mean hope score at baseline was 21.0 (SD = 3.4). Although hope was positively associated with PrEP willingness (β = 0.22, 95% CI 0.15, 0.37), it was not associated with high PrEP adherence (aRR = 1.00, 95% CI 0.96, 1.05), or persistence at follow-up (aRR = 1.02, 95% CI 0.99, 1.05). While cultivating hope may be an important strategy in building willingness to take oral PrEP, it may not be enough to sustain PrEP adherence or persistence.
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Affiliation(s)
- Margaret W Gichane
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA, USA.
| | - Jennifer Velloza
- Division of Global Health and Infectious Disease Epidemiology, University of California San Francisco, San Francisco, USA
| | - Sybil Hosek
- Department of Medicine, University of Illinois Chicago, Chicago, USA
| | | | - Peter Anderson
- University of Colorado Denver - Anschutz Medical Campus, Denver, USA
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, USA
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23
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Hightow-Weidman LB, Rainer C, Schader L, Rosso MT, Benkeser D, Cottrell M, Tompkins L, Claude K, Stocks JB, Yigit I, Budhwani H, Muessig KE. Prepared, Protected, EmPowered (P3): Primary Results of a Randomized Controlled Trial Using a Social Networking, Gamification, and Coaching App to Promote Pre-exposure Prophylaxis (PrEP) Adherence for Sexual and Gender Minority (SGM) Youth Living in the United States. AIDS Behav 2025; 29:652-663. [PMID: 39531118 DOI: 10.1007/s10461-024-04547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2024] [Indexed: 11/16/2024]
Abstract
The population-level reductions in HIV incidence attributed to pre-exposure prophylaxis (PrEP) have not been fully realized among sexual, gender, and racial/ethnic minority youth. P3 (Prepared, Protected, emPowered) is a comprehensive mobile application (app) intervention developed to support PrEP adherence through gamification, medication tracking, and social engagement. A randomized controlled trial was conducted with 246 young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWMSM) currently on or planning to begin PrEP. Participants were randomized in a 1:1:1 ratio to: standard of care (SOC), P3 app (P3), or P3 app plus in-app adherence coaching (P3+). Adherence was measured at 3- and 6- months post enrollment by emtricitabine-triphosphate (FTC-TP) and tenofovir-diphosphate (TFV-DP) levels in dried blood spots consistent with PrEP use > 4 days/week. The primary outcome was the difference in the proportion adherent comparing P3/P3+ to SOC. P3/P3+ was associated with a higher proportion adherent compared to SOC for both outcome measures. At 3 months, the estimated increase in the proportion adherent was 0.13 (95% CI: 0.00, 0.27, p: 0.05) and 0.12 (95% CI: -0.03, 0.26, p: 0.11) for TFV-DP and FTC-TP, respectively. Estimated adherence was higher, but not statistically different, in P3+ compared to P3, for both TFV-DP and FTC-TP. Receipt of P3 (P3 or P3+) is associated with an increase in PrEP adherence among YMSM and YTWSM at 3 months. Additional analyses to discern the role of app usage and sociodemographic and behavioral factors on intervention effects are warranted.
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Affiliation(s)
- Lisa B Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA.
| | - Crissi Rainer
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Lindsey Schader
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew T Rosso
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mackenzie Cottrell
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren Tompkins
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristina Claude
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Jacob B Stocks
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Ibrahim Yigit
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Henna Budhwani
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
| | - Kathryn E Muessig
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, USA
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24
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Williams MP, Manjourides J, Smith LH, Rainer CB, Hightow-Weidman LB, Haley DF. Studying the Digital Intervention Engagement-Mediated Relationship Between Intrapersonal Measures and Pre-Exposure Prophylaxis Adherence in Sexual and Gender Minority Youth: Secondary Analysis of a Randomized Controlled Trial. J Med Internet Res 2025; 27:e57619. [PMID: 39804696 PMCID: PMC11773288 DOI: 10.2196/57619] [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: 02/28/2024] [Revised: 10/18/2024] [Accepted: 11/13/2024] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND Improving adherence to pre-exposure prophylaxis (PrEP) via digital health interventions (DHIs) for young sexual and gender minority men who have sex with men (YSGMMSM) is promising for reducing the HIV burden. Measuring and achieving effective engagement (sufficient to solicit PrEP adherence) in YSGMMSM is challenging. OBJECTIVE This study is a secondary analysis of the primary efficacy randomized controlled trial (RCT) of Prepared, Protected, Empowered (P3), a digital PrEP adherence intervention that used causal mediation to quantify whether and to what extent intrapersonal behavioral, mental health, and sociodemographic measures were related to effective engagement for PrEP adherence in YSGMMSM. METHODS In May 2019, 264 YSGMMSM were recruited for the primary RCT via social media, community sites, and clinics from 9 study sites across the United States. For this secondary analysis, 140 participants were eligible (retained at follow-up, received DHI condition in primary RCT, and completed trial data). Participants earned US currency for daily use of P3 and lost US currency for nonuse. Dollars accrued at the 3-month follow-up were used to measure engagement. PrEP nonadherence was defined as blood serum concentrations of tenofovir-diphosphate and emtricitabine-triphosphate that correlated with ≤4 doses weekly at the 3-month follow-up. Logistic regression was used to estimate the total effect of baseline intrapersonal measures on PrEP nonadherence, represented as odds ratios (ORs) with a null value of 1. The total OR for each intrapersonal measure was decomposed into direct and indirect effects. RESULTS For every US $1 earned above the mean (US $96, SD US $35.1), participants had 2% (OR 0.98, 95% CI 0.97-0.99) lower odds of PrEP nonadherence. Frequently using phone apps to track health information was associated with a 71% (OR 0.29, 95% CI 0.06-0.96) lower odds of PrEP nonadherence. This was overwhelmingly a direct effect, not mediated by engagement, with a percentage mediated (PM) of 1%. Non-Hispanic White participants had 83% lower odds of PrEP nonadherence (OR 0.17, 95% CI 0.05-0.48) and had a direct effect (PM=4%). Participants with depressive symptoms and anxiety symptoms had 3.4 (OR 3.42, 95% CI 0.95-12) and 3.5 (OR 3.51, 95% CI 1.06-11.55) times higher odds of PrEP nonadherence, respectively. Anxious symptoms largely operated through P3 engagement (PM=51%). CONCLUSIONS P3 engagement (dollars accrued) was strongly related to lower odds of PrEP nonadherence. Intrapersonal measures operating through P3 engagement (indirect effect, eg, anxious symptoms) suggest possible pathways to improve PrEP adherence DHI efficacy in YSGMMSM via effective engagement. Conversely, the direct effects observed in this study may reflect existing structural disparity (eg, race and ethnicity) or behavioral dispositions toward technology (eg, tracking health via phone apps). Evaluating effective engagement in DHIs with causal mediation approaches provides a clarifying and mechanistic view of how DHIs impact health behavior. TRIAL REGISTRATION ClinicalTrials.gov; NCT03320512; https://clinicaltrials.gov/study/NCT03320512.
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Affiliation(s)
- Michael P Williams
- Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Justin Manjourides
- Bouve College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Louisa H Smith
- Roux Institute, Northeastern University, Portland, ME, United States
| | - Crissi B Rainer
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | | | - Danielle F Haley
- Department of Community Health Sciences, Boston University, Boston, MA, United States
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25
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Paschen-Wolff MM, Tross S, Mindy Nelson C, Hatch MA, Meche D, Ertl MM, Wright L, Laschober TC. Factors associated with PrEP awareness and use among men who have sex with men who use drugs in the Southern United States. AIDS Care 2025; 37:21-32. [PMID: 39651544 DOI: 10.1080/09540121.2024.2438923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 11/25/2024] [Indexed: 12/11/2024]
Abstract
ABSTRACTPre-exposure prophylaxis (PrEP) dramatically reduces HIV transmission risk. PrEP is underutilized among men who have sex with men who use substances (SU-MSM) in the Southern U.S., for whom there is limited research and high PrEP need. Using cross-sectional data from the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) 0082 study, we explored factors associated with PrEP awareness and use among 225 SU-MSM in the Southern U.S. Participants were recruited from community-based sexually transmitted infection clinics, syringe services programs and outpatient substance use treatment programs in eight cities across five Southern states with high HIV incidence. Multinomial logistic regressions examined PrEP awareness and use relative to sociodemographic factors, sexual behaviors and substance use. Results demonstrated overall high awareness, yet limited uptake of PrEP. Younger age, higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP awareness. Higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP use. Results highlight the need for innovative PrEP outreach to Southern SU-MSM that accounts for age, education and substances used.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Susan Tross
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University, New York, NY, USA
| | - C Mindy Nelson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary A Hatch
- Department of Psychiatry and Behavioral Sciences, University of Washington Addictions, Drug & Alcohol Institute, Seattle, WA, USA
| | - David Meche
- School of Social Work, Louisiana State University, Baton Rouge, LA, USA
| | - Melissa M Ertl
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Lynette Wright
- Department of Psychiatry and Behavioral Sciences, University of Washington Addictions, Drug & Alcohol Institute, Seattle, WA, USA
| | - Tanja C Laschober
- Department of Psychiatry and Behavioral Sciences, University of Washington Addictions, Drug & Alcohol Institute, Seattle, WA, USA
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Orser L, MacPherson P, O'Byrne P, Saeed M. Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications. AIDS Care 2025; 37:141-150. [PMID: 39644220 DOI: 10.1080/09540121.2024.2437564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 11/25/2024] [Indexed: 12/09/2024]
Abstract
HIV PrEP is over 99% effective in preventing HIV when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated whether gbMSM with objective risk factors for HIV who were automatically offered PrEP would have higher uptake and retention in PrEP care. For this, gbMSM with clinical evidence of HIV risk received a reflexive offer for PrEP from a nurse. The number of offers, referral acceptance, presentation to the first appointment, initiation and retention at 6 months were examined. Of 1181 gbMSM with objective HIV risk factors who were offered PrEP, only 50% accepted, 28% initiated and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between recent STI diagnosis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at-risk individuals were retained on PrEP because of an active offer. PrEP delivered by nurses was as effective as that delivered by infectious disease physicians. While active offer PrEP successfully brought at-risk individuals into care, more work is required to understand the perceptions of risk, the benefits and challenges of PrEP use, and how stigma and structural barriers affect retention among diverse groups affected by HIV.
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Affiliation(s)
- Lauren Orser
- University of Ottawa, School of Nursing, Ottawa, Canada
| | - Paul MacPherson
- Ottawa Hospital, Infectious Diseases Clinic & Research Institute, Ottawa, Canada
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Lee J, Higashi RT, Hogan TP, Marcus JL, Repasky EC, Torres MB, Krakower D, Nijhawan AE. Linking Criminal Justice-Involved Individuals to HIV Preexposure Prophylaxis: A Qualitative Analysis of Multiple Stakeholder Perspectives. J Int Assoc Provid AIDS Care 2025; 24:23259582251341940. [PMID: 40350581 PMCID: PMC12066857 DOI: 10.1177/23259582251341940] [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] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 04/09/2025] [Accepted: 04/27/2025] [Indexed: 05/14/2025] Open
Abstract
ObjectiveAlthough incarcerated individuals are at disproportionately higher HIV risk compared to the general US population, few jails offer linkage to preexposure prophylaxis (PrEP). We explored stakeholder perspectives about barriers and facilitators to PrEP for justice-involved individuals.MethodsSemi-structured interviews were conducted with three stakeholder groups in Dallas County, Texas: justice-involved individuals (n = 8), County Jail staff (n = 9), and employees of local community organizations that provide PrEP services (n = 9). Transcripts were analyzed using a combined deductive and inductive approach.ResultsBarriers to PrEP linkage included: limited provider knowledge of and capacity for PrEP care, stigma around incarceration and PrEP, and mistrust in healthcare and criminal justice systems among justice-involved individuals. Perceived facilitators included addressing competing priorities, partnering with community organizations, and providers' cultural competency training.ConclusionFuture research should focus on adapting successful implementation strategies to the needs of justice-involved populations to improve HIV prevention and health outcomes in high-burden regions like the Southern USA.
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Affiliation(s)
- Jessica Lee
- UT Southwestern Medical Center, Department of Medicine, Dallas, TX, USA
| | - Robin T. Higashi
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
| | - Timothy P. Hogan
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
- Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, MA, USA
| | - Emily C. Repasky
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
| | - M. Brynn Torres
- UT Southwestern Medical Center, Department of Medicine, Dallas, TX, USA
| | - Douglas Krakower
- Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ank E. Nijhawan
- UT Southwestern Medical Center, Department of Medicine, Dallas, TX, USA
- UT Southwestern Medical Center, O’Donnell School of Public Health, Dallas, TX, USA
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Zeballos D, Magno L, Soares F, Pinto Junior JA, Amorim L, Greco D, Grangeiro A, Dourado I, on behalf of The PrEP15-19 study group. Performance of indirect adherence measures for daily oral pre-exposure prophylaxis for HIV among adolescent men who have sex with men and transgender women in Brazil. PLoS One 2024; 19:e0310861. [PMID: 39739641 PMCID: PMC11687640 DOI: 10.1371/journal.pone.0310861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 09/04/2024] [Indexed: 01/02/2025] Open
Abstract
BACKGROUND Consistent monitoring of PrEP adherence with accurate measurement tools at point-of-care could greatly contribute to reaching adolescents with poor adherence. We aimed to assess the performance of indirect adherence measures to oral PrEP among adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). METHODS PrEP15-19 is a prospective, multicenter, PrEP demonstration cohort study that includes AMSM and ATGW aged 15-19 in three Brazilian cities. A diagnostic accuracy study was conducted using tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots as the reference standard, along with three index tests: medication possession ratio (MPR), pill count, and self-report. We calculated the area under the curve (AUC) for protective TFV-DP levels (≥800 fmol/punch) and sensitivity (SE) and specificity (SP) for established cutoff points. RESULTS We included 302 samples from 188 participants. Most of participants were AMSM (78.7%), aged 18-19 years (80.3%), and non-whites (72.9%). The AUC was 0.59 for MPR, 0.69 for pill count, and 0.75 for self-report. When combining MPR and self-report, the AUC increased to 0.77. Sensitivity was high for the cutoff points identified by the Youden index, 80% for MPR, 92% for self-report, and 97% for pill count. However, specificities were low 40%, 46%, and 38%, respectively. CONCLUSIONS Indirect measures were able to discriminate adolescents with good adherence. However, their performance in identifying those with low adherence might be limited, suggesting that it is necessary to initiate adherence interventions when there is no evidence of perfect adherence. Combining measures can provide wider information on adherence.
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Affiliation(s)
- Diana Zeballos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Leila Amorim
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Shuper PA, Joharchi N, Varatharajan T, Bogoch II, Loutfy M, El-Helou P, Giolma K, Woodward K, Rehm J. Medical chart-reported alcohol consumption, substance use, and mental health issues in association with HIV pre-exposure prophylaxis (PrEP) nonadherence among gay, bisexual, and other men-who-have-sex-with-men. BMC Public Health 2024; 24:3487. [PMID: 39696067 DOI: 10.1186/s12889-024-20934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/02/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Although some evidence suggests that alcohol, substance use, and mental health issues diminish adherence to HIV Pre-Exposure Prophylaxis (PrEP) among gay, bisexual, and other men-who-have-sex-with-men (gbMSM), findings are somewhat inconsistent and have primarily derived from studies involving non-random samples. Medical chart extraction can provide unique insight by in part surmounting sampling-related limitations, as data for entire PrEP clinic populations can be examined. Our investigation entailed comprehensive chart extraction to assess the extent to which chart-reported alcohol, substance use, and mental health issues were associated with chart-reported PrEP nonadherence. METHODS Data from medical charts of gbMSM at two PrEP clinics in Toronto, Canada were extracted for a retrospective 12-month period (02/2018-01/2019). Charts were reviewed for all patients who were 1) ≥ 18 years old; 2) gbMSM; 3) prescribed PrEP ≥ 3 months, and 4) not in a PrEP-related drug trial. Information regarding PrEP, alcohol, substance use, mental health, and sexual behavior was extracted. PrEP adherence was classified in terms of (1) any reported nonadherence, and (2) 'suboptimal adherence,' reflecting nonadherence patterns indicative of insufficient pharmacological protection from HIV. Multivariate logistic regression was employed to identify factors associated with adherence outcomes. RESULTS Data were extracted from 4,292 clinic visits among 501 eligible patients (age: M = 39.1; duration on PrEP: M = 17.4 months; daily PrEP regimen = 93.8%). Hazardous/harmful drinking, club drug use, and mental health issues were reported among 8.8%, 22.2%, and 26.1% of patients, respectively. Any nonadherence and suboptimal adherence were reported among 37.5% and 12.4% of patients, respectively. Factors significantly associated with any nonadherence included age < 25 (AOR = 3.08, 95%CI = 1.54-6.15, p < .001), club drug use (AOR = 2.71, 95%CI = 1.65-4.47, p < .001), and condomless sex (AOR = 1.83, 95%CI = 1.19-2.83, p = .006). For suboptimal adherence, significant factors included age < 25 (AOR = 4.83, 95%CI = 2.28-10.22, p < .001), non-daily PrEP regimens (AOR = 2.94, 95%CI = 1.19-7.22, p = .019), missing PrEP appointments (AOR = 1.97, 95%CI = 1.09-3.55, p = .025), and club drug use (AOR = 1.97, 95%CI = 1.01-3.68, p = .033). Neither alcohol nor mental health issues were associated with nonadherence outcomes. CONCLUSIONS Chart-indicated suboptimal adherence was present among a small subgroup of PrEP-prescribed gbMSM. Adherence-related interventions should target gbMSM who use club drugs, are younger, experience challenges attending PrEP care, and are prescribed non-daily regimens. Offering long-acting injectable PrEP when available and feasible may also improve PrEP's HIV-preventive impact among this population.
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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 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada.
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, 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 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Thepikaa Varatharajan
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
| | - Isaac I Bogoch
- 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
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
- 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 S.t, Toronto, ON, M5S 1B2, Canada
- 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
| | - Kevin Giolma
- Maple Leaf Medical Clinic, 14 College St, Toronto, ON, M5G 1K2, 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 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada
- Department of Psychiatry, University of Toronto, 250 College St, Toronto, ON, M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, Germany
- Klinische Psychologie & Psychotherapie, Technische Universität Dresden' Chemnitzer Str, 46D-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, 119991, Russian Federation
- Graduate Department of Community Health, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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Jaiswal J, Grin B, Gagnon K, John T, Walters S, Griffin M, Kay E. Staff and Providers' Perceptions of Patients' PrEP Candidacy, Acceptability, and Adherence in Methadone Clinic Settings. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241288981. [PMID: 39690479 DOI: 10.1177/29767342241288981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
BACKGROUND People who use drugs and patients in substance use treatment may be placed at high risk for HIV due to mixing sex and drugs, potential engagement in sex work, and injection drug use. However, pre-exposure prophylaxis (PrEP) adoption among these populations remains low. Methadone clinics, a main point of contact with the healthcare system for this population, are a missed opportunity to offer biomedical HIV prevention. Understanding provider and staff perceptions of patients' PrEP-related candidacy, acceptability, and adherence is a critical first step to informing PrEP implementation in substance use treatment settings. METHODS Thirty semistructured interviews were conducted at 2 methadone clinics in Northern New Jersey between January and April 2019. Participants included methadone counselors, medical providers, front desk staff, intake coordinators, and other clinic staff members. RESULTS Three major themes were identified: (1) provider and staff's perceptions of who would benefit most from PrEP, (2) perceptions of patients' acceptability of PrEP, and (3) perceptions of patients' ability to take a pill every day. Broadly, staff perceived younger patients to be better PrEP candidates than older patients, expressed cautious optimism that PrEP would be acceptable to their patient populations, and were mixed in terms of their perceptions of patients' ability to adhere to PrEP. Notably, staff largely did not mention patients who inject drugs as potential PrEP candidates, suggesting a missed opportunity. CONCLUSION To promote PrEP implementation in methadone clinics, staff and providers should receive training around screening for PrEP eligibility in order to maximize the benefits of PrEP for various subpopulations, especially those who inject. Importantly, discussions around sexual behavior and injection drug use must be approached in an open, non-stigmatizing manner. These findings can be used to inform future interventions to integrate PrEP services into substance use treatment settings.
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Affiliation(s)
- Jessica Jaiswal
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, Birmingham, AL, USA
| | - Benjamin Grin
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - Kelly Gagnon
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tejossy John
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzan Walters
- Department of Population Health, New York University, New York, NY, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers University, Piscataway, NJ, USA
| | - Emma Kay
- School of Nursing-Nursing Acute, Chronic & Continuing Care, University of Alabama at Birmingham, Birmingham, AL, USA
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Onwubiko UN, Murray SM, Rao A, Chamberlain AT, Sanchez TH, Benkeser D, Holland DP, Jenness SM, Baral SD. Individual & joint associations of sexual stigma and mental distress with PrEP uptake, adherence and persistence among US gay and bisexual men. Soc Sci Med 2024; 363:117493. [PMID: 39541830 PMCID: PMC11611602 DOI: 10.1016/j.socscimed.2024.117493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 11/06/2024] [Accepted: 11/07/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Sexual stigma, mental health disorders, and socioeconomic disparities present important yet incompletely understood barriers to PrEP adoption among gay men and other men who have sex with men (MSM). This study examines how these factors interact and affect PrEP uptake, adherence, and persistence among MSM. METHODS Data from the 2018 and 2019 American Men's Internet Survey cycles, involving 6907 adult MSM eligible for PrEP, were analyzed. We assessed sexual stigma heterogeneity among this group using latent class analysis and investigated individual relationships between i) stigma class membership, ii) mental distress, and PrEP engagement (past-year use, adherence, and persistence) using Poisson regression with a robust error variance, considering potential variations based on poverty status. The combined associations of sexual stigma and mental distress with PrEP engagement was evaluated using inverse probability weighting. RESULTS Four distinct sexual stigma classes were identified, each exhibiting varied associations with PrEP engagement. Associations with mental distress lost statistical significance after adjusting for confounders. However, having both mental distress and sexual stigma was associated with lower past-year PrEP use, with the strongest association observed for those with anticipated healthcare stigma class membership and mental distress (aPR 0.53 [95% CI: 0.37, 0.76]). Sexual stigma accompanied by mental distress was also associated with significantly increased poor PrEP adherence, particularly among those with family and general social stigma class membership (aPR 2.31 [95% CI: 1.08, 4.97]). CONCLUSIONS Psychosocial factors exert synergistic impacts on PrEP engagement among MSM. Tailored interventions addressing these subtleties may effectively optimize PrEP uptake and improve consistency of use among MSM.
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Affiliation(s)
- Udodirim N Onwubiko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Amrita Rao
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Allison T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - David P Holland
- Fulton County Board of Health, Atlanta, GA, United States; Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, United States
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
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Ho T, Ricklefs C. Healthcare for Sexual and Gender Minority Adolescents. Prim Care 2024; 51:675-688. [PMID: 39448102 DOI: 10.1016/j.pop.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024]
Abstract
Primary care providers have a unique opportunity to provide high-quality care to lesbian, gay, bisexual, transgender, queer, intersex, asexual and other identities not encompassed (LGBTQIA+) adolescents. Providers should be familiar with the various identities and definitions in the LGBTQIA + community, as well as social determinants of health and health disparities amongst LGBTQIA + adolescents. Providers should also understand how to foster a welcoming clinical environment, address gender affirming care to adolescents, and demonstrate clinical comfort with pre-exposure human immunodeficiency virus prophylaxis.
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Affiliation(s)
- Tiffany Ho
- Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Colbey Ricklefs
- Division of Adolescent and Young Adult Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA 94158, USA.
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Landovitz RJ, Tao L, Yang J, de Boer M, Carter C, Das M, Baeten JM, Liu A, Hoover KW, Celum C, Grinsztejn B, Morris S, Wheeler DP, Mayer KH, Golub SA, Bekker LG, Diabaté S, Hoornenborg E, Myers J, Leech AA, McCormack S, Chan PA, Sweat M, Matthews LT, Grant R. Type 1 Human Immunodeficiency Virus (HIV-1) Incidence, Adherence, and Drug Resistance in Individuals Taking Daily Emtricitabine/Tenofovir Disoproxil Fumarate for HIV-1 Pre-exposure Prophylaxis: Pooled Analysis From 72 Global Studies. Clin Infect Dis 2024; 79:1197-1207. [PMID: 38484128 PMCID: PMC7616831 DOI: 10.1093/cid/ciae143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (F/TDF) has high efficacy against HIV-1 acquisition. Seventy-two prospective studies of daily oral F/TDF PrEP were conducted to evaluate HIV-1 incidence, drug resistance, adherence, and bone and renal safety in diverse settings. METHODS HIV-1 incidence was calculated from incident HIV-1 diagnoses after PrEP initiation and within 60 days of discontinuation. Tenofovir concentrations in dried blood spots (DBS), drug resistance, and bone/renal safety indicators were evaluated in a subset of studies. RESULTS Among 17 274 participants, there were 101 cases with new HIV-1 diagnosis (.77 per 100 person-years; 95% confidence interval [CI]: .63-.94). In 78 cases with resistance data, 18 (23%) had M184I or V, 1 (1.3%) had K65R, and 3 (3.8%) had both mutations. In 54 cases with tenofovir concentration data from DBS, 45 (83.3%), 2 (3.7%), 6 (11.1%), and 1 (1.9%) had average adherence of <2, 2-3, 4-6, and ≥7 doses/wk, respectively, and the corresponding incidence was 3.9 (95% CI: 2.9-5.3), .24 (.060-.95), .27 (.12-.60), and .054 (.008-.38) per 100 person-years. Adherence was low in younger participants, Hispanic/Latinx and Black participants, cisgender women, and transgender women. Bone and renal adverse event incidence rates were 0.69 and 11.8 per 100 person-years, respectively, consistent with previous reports. CONCLUSIONS Leveraging the largest pooled analysis of global PrEP studies to date, we demonstrate that F/TDF is safe and highly effective, even with less than daily dosing, in diverse clinical settings, geographies, populations, and routes of HIV-1 exposure.
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Affiliation(s)
- Raphael J Landovitz
- UCLA Center for Clinical AIDS Research and Education, Los Angeles, California, USA
| | - Li Tao
- Gilead Sciences, Inc, Foster City, California, USA
| | - Juan Yang
- Gilead Sciences, Inc, Foster City, California, USA
| | | | | | - Moupali Das
- Gilead Sciences, Inc, Foster City, California, USA
| | | | - Albert Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, USA
| | - Karen W Hoover
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Connie Celum
- University of Washington, Seattle, Washington, USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | | | - Kenneth H Mayer
- Fenway Health and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | | | | | - Janet Myers
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, USA
| | - Ashley A Leech
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sheena McCormack
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | | | - Michael Sweat
- Medical University of South Carolina, Charleston, North Carolina, USA
| | - Lynn T Matthews
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert Grant
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Coyle RP, Morrow M, Mann SC, Mainella V, Ellis SL, Schwab S, Coppinger C, Barker N, Ellison L, Zheng JH, Al Zuabi S, Alpert PE, Carnes TC, Buffkin DE, Chai PR, Bushman LR, Kiser JJ, MaWhinney S, Brooks KM, Anderson PL, Castillo-Mancilla JR. Tenofovir-Diphosphate and Emtricitabine-Triphosphate Adherence Benchmarks in Dried Blood Spots for Persons With HIV Receiving Tenofovir Alafenamide and Emtricitabine-Based Antiretroviral Therapy (QUANTI-TAF). Clin Infect Dis 2024; 79:1233-1241. [PMID: 38636950 PMCID: PMC11581703 DOI: 10.1093/cid/ciae212] [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: 01/21/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND QUANTI-TAF aimed to establish tenofovir-diphosphate (TFV-DP)/emtricitabine-triphosphate (FTC-TP) adherence benchmarks in dried blood spots (DBS) for persons with human immunodeficiency virus (PWH) receiving tenofovir alafenamide/emtricitabine (TAF/FTC)-based antiretroviral therapy (ART). METHODS For 16 weeks, PWH received TAF/FTC-based ART co-encapsulated with an ingestible sensor to directly measure cumulative (enrollment to final visit) and 10-day adherence. At monthly visits, intraerythrocytic concentrations of TFV-DP and FTC-TP in DBS were quantified and summarized at steady-state (week 12 or 16) as median (interquartile range). Linear mixed-effects models evaluated factors associated with TFV-DP/FTC-TP. RESULTS Eighty-four participants (11% female, 4% transgender) predominantly receiving bictegravir/TAF/FTC (73%) were enrolled. Ninety-two percent completed week 12 or 16 (94% unboosted ART). TFV-DP for <85% (7/72), 85%-<95% (9/72), and ≥95% (56/72) cumulative adherence was 2696 (2039-4108), 3117 (2332-3339), and 3344 (2605-4293) fmol/punches. Adjusting for cumulative adherence, TFV-DP was higher with boosted ART, lower body mass index, and in non-Black participants. FTC-TP for <85% (14/77), 85%-<95% (6/77), and ≥95% (57/77) 10-day adherence was 3.52 (2.64-4.48), 4.58 (4.39-5.06), and 4.96 (4.21-6.26) pmol/punches. All participants with ≥85% cumulative and 10-day adherence had TFV-DP ≥1800 fmol/punches and FTC-TP ≥2.5 pmol/punches, respectively. Low-level viremia (HIV-1 RNA 20-199 copies/mL) occurred at 18% of visits in 39% of participants with similar TFV-DP (3177 [2494-4149] fmol/punches) compared with suppressed visits (3279 [2580-4407] fmol/punches). CONCLUSIONS TFV-DP ≥1800 fmol/punches and FTC-TP ≥2.5 pmol/punches represent DBS benchmarks for ≥85% adherence to unboosted TAF/FTC-based ART. Among PWH with high adherence, low-level viremia was common. CLINICAL TRIALS REGISTRATION NCT04065347.
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Affiliation(s)
- Ryan P Coyle
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Morrow
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarah C Mann
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Vincent Mainella
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Samuel L Ellis
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefanie Schwab
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Corwin Coppinger
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nicholas Barker
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lucas Ellison
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jia-Hua Zheng
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Subhi Al Zuabi
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | - Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- The Fenway Institute, Boston, Massachusetts, USA
| | - Lane R Bushman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer J Kiser
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Medical Affairs, Merck & Co, Inc, Rahway, New Jersey, USA
| | - Samantha MaWhinney
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristina M Brooks
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jose R Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Clinical Development, ViiV Healthcare, Durham, North Carolina, USA
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Brisson J, Castro-Arteaga M, Apedaile D, Perez-Brumer A. Enhancing daily oral PrEP adherence with digital communications: Protocol for a systematic review and meta-analysis. PLoS One 2024; 19:e0313322. [PMID: 39531430 PMCID: PMC11556712 DOI: 10.1371/journal.pone.0313322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/21/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) stands as an effective tool in preventing HIV transmission among individuals at risk of HIV infection. However, the effectiveness of daily oral PrEP is contingent on the adherence of its users, which can pose a challenge for many individuals. Various studies have explored different interventions aimed at bolstering PrEP adherence. One recurring type of intervention revolves around digital communication (e.g., SMS, mobile applications) to send reminders for PrEP usage. The objective of our systematic review and meta-analysis is to address the following research question: What is the effectiveness of digital communication interventions in enhancing daily oral PrEP adherence among individuals at a heightened risk of HIV infection? This paper presents our study protocol. METHOD AND ANALYSIS We will conduct searches across four health-related databases: Embase, PubMed, Web of Science, and PsycINFO. We will also explore other sources, including clinical trials registries and grey literature. Our search will be restricted to original randomized controlled trials published in English, French, and Spanish conducted since 2012, when PrEP was approved, to today. To ensure rigor, three reviewers will perform the systematic review and meta-analysis. This systematic review will adhere to the guidelines outlined in the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our primary outcome of interest is proper daily oral PrEP adherence, which we will measure using association metrics (e.g., odds ratios). DISCUSSION This review will offer insights into the effectiveness of utilizing digital communication methods to assist individuals at risk of HIV in improving their PrEP adherence. PROTOCOL REGISTRATION NUMBER International Prospective Register for Systematic Reviews (PROSPERO) number CRD42023471269.
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Affiliation(s)
- Julien Brisson
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mariangela Castro-Arteaga
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dorothy Apedaile
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Gamarel K, Mayo-Wilson LJ, Jadwin-Cakmak L, Reyes L, Monro D, Ubong IA, Sullivan S, Abad J, Poindexter J, Harris H, Riser C, Stephenson J, Ortiz G, Peitzmeier SM, Neilands TB, Poteat T. Strengthening Community Responses to Economic vulnerability (SeCuRE): a protocol of an HIV status-neutral pilot randomized clinical trial with transgender women of color in Detroit, Michigan. Pilot Feasibility Stud 2024; 10:135. [PMID: 39511631 PMCID: PMC11545932 DOI: 10.1186/s40814-024-01558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 10/16/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND In the United States (US), transgender women of color experience cyclical, interlocking systems of structural and institutional oppression rooted in racism and transphobia, which fuel economic vulnerability. Together, cycles of intersecting racism, transphobia, and economic vulnerability create conditions that give rise to extreme HIV inequities among transgender women of color. Microeconomic interventions - designed to improve financial standing by increasing income generation and access to financial resources through entrepreneurship, cash transfers, and training - have the potential to address structural factors underlying HIV inequities. Over the past few years, several trans-led organizations, including the Trans Sistas of Color Project, have integrated microeconomic strategies, specifically emergency assistance, into their programming. The aim of the current study is to conduct a pilot randomized controlled trial (RCT) to evaluate the feasibility and acceptability of a definitive subsequent RCT and explore initial evidence of an enhanced microeconomic intervention to increase income generation and improve HIV prevention and care continua outcomes. METHODS This is a two-arm waitlist randomized controlled trial in which transgender women of color will be randomly allocated to either usual care that includes the Trans Sistas of Color Project's existing microeconomic interventions, which includes the following: (1) US $250 in emergency assistance and (2) peer support to obtain legal gender affirmation (i.e., legal name and gender markers on identification documents) or the enhanced microeconomic intervention that includes usual care and will be enhanced to include the following: (1) 12 weekly educational group sessions on economic empowerment (i.e., job acquisition, income generation through micro-business, and financial literacy) and HIV prevention and care, (2) employment-focused mentoring, and (3) an unconditional grant (US $1200) for use towards acquiring self-led or formal employment. Participants in each condition will complete a baseline survey prior to randomization, a follow-up survey immediately following intervention completion, and 3-month survey after intervention completion. Participants will also complete qualitative exit interviews within 1 month of intervention completion for both conditions. DISCUSSION This study will be one of the first US-based pilot randomized clinical trials that builds upon existing community-led solutions to economic vulnerability to address HIV inequities. Findings will provide the necessary groundwork to examine intervention effectiveness in a future large-scale trial. TRIALS REGISTRATION NCT06212544. PROTOCOL VERSION September 25, 2024, version 2.
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Affiliation(s)
- Kristi Gamarel
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA.
| | | | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | | | - Dior' Monro
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Ini-Abasi Ubong
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Stephen Sullivan
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Julisa Abad
- Trans Sistas of Color Project, Detroit, MI, USA
- Fair Michigan Foundation, Detroit, MI, USA
| | | | | | | | - J Stephenson
- Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA
| | - Gabi Ortiz
- Boston College School of Social Work, Boston, MA, USA
| | - Sarah M Peitzmeier
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tonia Poteat
- Duke University School of Nursing, Durham, NC, USA
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Oo MM, Shukalek C, Kishibe T, Hull M, Tan DHS. HIV risk assessment tools for identifying individuals who could benefit from pre-exposure prophylaxis: a systematic review protocol. BMJ Open 2024; 14:e090565. [PMID: 39515851 PMCID: PMC11552022 DOI: 10.1136/bmjopen-2024-090565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 10/14/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a highly effective, safe and acceptable intervention for preventing HIV infection. However, identifying individuals who could best benefit from PrEP remains a significant challenge. Existing HIV risk assessment tools vary in performance depending on context. This systematic review aims to synthesise evidence on their diagnostic performances to predict incident HIV infection. METHODS AND ANALYSIS This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols. We will search MEDLINE (Ovid), Embase (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (January 1998-May 2024) for observational and relevant interventional studies assessing the diagnostic performance of HIV risk tools to predict incident HIV for PrEP eligibility. There will be no restrictions on study language or location. Two reviewers will conduct the search, data extraction and risk of bias assessment using the Johanna Briggs Institute Critical Appraisal Checklist for Diagnostic Studies. Standardised templates will be used in Covidence for data extraction. We will conduct a meta-analysis if appropriate, otherwise, a narrative review. We will use the PRISMA guidelines to guide reporting. ETHICS AND DISSEMINATION OF RESEARCH Ethical approval is not required as data is publicly available. This review will inform updates to Canadian HIV PrEP guidelines and guide healthcare professionals in using HIV risk assessment tools for identifying PrEP candidates. Findings will be presented at guideline panel meetings and submitted for publication in a peer-reviewed journal and conferences. PROSPERO REGISTRATION NUMBER CRD42024543975.
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Affiliation(s)
- Myo Minn Oo
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | | | - Teruko Kishibe
- Library Services, St Michael's Hospital, Toronto, Ontario, Canada
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, Washington, Canada
| | - Darrell H S Tan
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chen YN, Zhou J, Kirkham HS, Witt EA, Jenness SM, Wall KM, Kamaleswaran R, Naimi AI, Siegler AJ. Understanding Typology of Preexposure Prophylaxis (PrEP) Persistence Trajectories Among Male PrEP Users in the United States. Open Forum Infect Dis 2024; 11:ofae584. [PMID: 39564150 PMCID: PMC11574613 DOI: 10.1093/ofid/ofae584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 10/09/2024] [Indexed: 11/21/2024] Open
Abstract
Introduction Understanding longitudinal patterns of preexposure prophylaxis (PrEP) use among men who have sex with men could offer insights for developing efficient and timely interventions to promote PrEP persistence. Setting We extracted 2 years of pharmacy fill records for 4000 males who initiated PrEP in 2017 at a national chain pharmacy in the United States. Methods Group-based trajectory models were used to develop PrEP trajectory clusters, with periods of use defined based on optimal PrEP seroprotection probabilities (ie, PrEP use frequency ≥4 doses/week). Multinomial logistic regressions were used to evaluate the associations between sociodemographic covariates and identified trajectory group membership. Results We identified 4 distinct groups of PrEP persistence trajectories: (1) persistent use of PrEP throughout the period (persistent user), (2) brief use followed by sustained cessation of PrEP use (brief user), (3) PrEP use up to the mid-term followed by sustained cessation of PrEP use (mid-term user), and (4) PrEP use, followed by cessation and subsequent reinitiation (PrEP reinitiator). Persistent users and brief users accounted for 40.1% and 22.9% of the population, respectively, whereas mid-term users and reinitiators accounted for 18.9% and 18.2%, respectively. Older age at PrEP initiation, commercial insurance as the primary payer of PrEP, and use of specialty pharmacy were found to be associated with persistent PrEP use over the other patterns of nonpersistence. Conclusions Subgroups of PrEP users could benefit from PrEP persistence interventions that target specific timings of likely PrEP cessation or considerations of reinitiation.
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Affiliation(s)
- Yi-No Chen
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Junlan Zhou
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, Illinois, USA
| | - Heather S Kirkham
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, Illinois, USA
| | - Edward A Witt
- Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, Illinois, USA
| | - Samuel M Jenness
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Kristin M Wall
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Rishi Kamaleswaran
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA
| | - Ashley I Naimi
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Aaron J Siegler
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
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Nacht CL, Reynolds HE, Jessup O, Amato M, Storholm ED. The Association between Social Support and Pre-Exposure Prophylaxis use among Sexual Minority Men in the United States: A Scoping Literature Review. AIDS Behav 2024; 28:3559-3573. [PMID: 39039399 PMCID: PMC11471694 DOI: 10.1007/s10461-024-04446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
Sexual minority men (SMM) are disproportionately affected by HIV. Although pre-exposure prophylaxis (PrEP) is an effective way of reducing HIV incidence, PrEP use has remained relatively low. Social support may be one effective factor in increasing PrEP use among SMM, but the association between social support and PrEP use/adherence is not well understood. The objective of this paper was to summarize the current literature on the association of social support and PrEP use among SMM in the United States. A systematic search was conducted using six different databases MEDLINE / PubMed, PsycINFO, Cochrane CENTRAL, Google Scholar, Embase, and Web of Science using terms established from keywords and medical subject headings (MeSH) terms before being adapted to each database. Data were extracted for key study factors (e.g., study population, geographic location, study design) and main findings. This search produced eleven articles: ten manuscripts and one conference abstract. Of these, two were randomized control trials, two were interventions, three were qualitative, and four were cross-sectional. The studies were widespread across the country, but most were in major metropolitan areas. From the articles included in this review, findings were inconsistent in the association between social support; some studies showed null findings, others that only certain sources of social support were significant, and others that there was a significant association between social support and PrEP use. This review highlights the complexity of the relationship between social support and PrEP use among SMM, indicating the need for further research to identify specific types and sources of support that effectively enhance PrEP uptake and adherence. Targeted interventions based on these insights could significantly reduce HIV incidence in the population.
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Affiliation(s)
- Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, San Diego, CA, USA.
| | - Hannah E Reynolds
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Owen Jessup
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Marianna Amato
- College of Education, San Diego State University, San Diego, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
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Murray GE, Palfai TP, Kratzer MPL, Maisto SA, Simons JS. Sexual alcohol expectancies moderate the relation between alcohol use and sexual behavior among men who have sex with men. Alcohol 2024; 120:35-40. [PMID: 38101524 PMCID: PMC11250926 DOI: 10.1016/j.alcohol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND HIV transmission remains a significant health concern for men who have sex with men (MSM) in the United States. Heavy episodic drinking (HED) is related to increased rates of condomless anal intercourse (CAI) among MSM, though evidence suggests that this association may vary by individual difference factors. The present secondary analysis tested whether sexual alcohol expectancies (SAEs) moderate the associations between frequency of HED and anal intercourse (AI) with and without a condom among moderate-to-heavy drinking HIV- MSM. METHODS Two hundred and forty-eight moderate-to-heavy drinking MSM completed self-report questionnaires including the Sexual Behavior Questionnaire, the Modified Daily Drinking Questionnaire, and the Sexual Alcohol Expectancies Questionnaire. RESULTS Negative binomial regressions indicated that SAEs moderated the association between frequency of HED and AI with a condom, but not between the frequency of HED and condomless AI (CAI). CONCLUSIONS These results suggest that stronger SAEs play a role in alcohol-related sexual behavior among MSM, but do not provide evidence that SAEs are associated with increased risk for HIV transmission through CAI.
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Affiliation(s)
- Grace E Murray
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, United States.
| | - Tibor P Palfai
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, United States
| | - Maya P L Kratzer
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, United States
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, United States
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Markley JD. Pre-Exposure Prophylaxis for HIV: Bioethical, Clinical, and Epidemiological Considerations. LINACRE QUARTERLY 2024; 91:386-402. [PMID: 39493495 PMCID: PMC11528579 DOI: 10.1177/00243639241239068] [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: 11/05/2024]
Abstract
Public health authorities are broadly promoting a strategy known as pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) transmission in the context of high-risk sexual activity and injection drug use. However, there are several limitations to this strategy that are underrecognized. This article reviews the primary literature supporting the use of PrEP and explores the unintended consequences associated with its use. Current public health messaging indicates that PrEP reduces the risk of HIV transmission during sex by 99 percent; however, this figure is based on modeling rather than study findings, and real-world efficacy may be significantly lower. PrEP has been associated with increased rates of sexually transmitted infections, risk compensation, HIV drug resistance, low adherence, and drug side effects. To make fully informed decisions, medical professionals and patients should be aware of these pitfalls. Additionally, this article explores the bioethical implications of prescribing PrEP from a Catholic perspective. Although not always morally illicit, PrEP is most often prescribed in the context of sexual activity outside of marriage between a biological male and female, placing the prescriber in cooperation with activity deemed to be immoral by the Catholic Church. While all medical professionals seeking the common good should aim to reduce the transmission of HIV, not all means are morally licit. Conscience protection for medical professionals opposed to this strategy has become increasingly relevant. Thoughtful discernment is necessary when considering PrEP. Summary: The use of CDC material (figure 1) in this article does not imply endorsement by CDC. The material is in the public domain and available on the CDC website free of charge.
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Oglesby A, Germain G, Metzner AA, Laliberté F, MacKnight SD, Hilts A, Swygard H, Duh MS. Pre-Exposure Prophylaxis for the Prevention of HIV-1: An Assessment of Oral Pre-Exposure Prophylaxis Usage Patterns, First Evidence of HIV-1, and HIV-1 Risk Factors in the United States. AIDS Patient Care STDS 2024; 38:495-506. [PMID: 39506929 DOI: 10.1089/apc.2024.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024] Open
Abstract
In clinical trials, once-daily oral tenofovir-based pre-exposure prophylaxis (PrEP) significantly reduced HIV-1 acquisition risk; however, this was highly dependent on medication adherence and persistence. We report clinical characteristics, PrEP usage patterns, first evidence of HIV-1, and associated risk factors among adults with commercial insurance using oral PrEP in the United States using health plan claims from the IQVIA PharMetrics® Plus database between January 1, 2015, and March 31, 2020, from individuals who newly initiated emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) or FTC/tenofovir alafenamide (TAF) for daily PrEP. Overall, 25,419 individuals were included (FTC/TDF, n = 24,232; FTC/TAF, n = 1187), with generally similar characteristics reported during the 6-month baseline period across cohorts. Mean follow-up length was 504 and 77 days for FTC/TDF and FTC/TAF, respectively, corresponding with the 2019 approval of FTC/TAF for PrEP. Similarly, mean PrEP use duration was 354 and 68 days for FTC/TDF and FTC/TAF, respectively. PrEP breaks (>90-day gap) were observed in 11.1% of individuals using FTC/TDF, with a mean break duration of 249 days; 20.0% of individuals using FTC/TDF and 7.3% using FTC/TAF had ≥1 sexually transmitted infection diagnosis during follow-up. From 6 to 12 months of follow-up, mean FTC/TDF proportion of days covered (PDC; 0.74 vs. 0.67) and persistence (70.2% vs. 57.4%) decreased; real-world PDC and persistence were lower than reported in globally conducted clinical trials. First evidence of HIV-1 was infrequent among individuals using FTC/TDF (0.6%), though 60.3% had PrEP on hand when HIV-1 definition was met; high-risk sexual behavior, syphilis, and gonorrhea were the most important risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | - Mei S Duh
- Analysis Group, Inc., Boston, Massachusetts, USA
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Shah P, Spinelli M, Irungu E, Kabuti R, Ngurukiri P, Babu H, Kungu M, Champions TMFS, Nyabuto C, Mahero A, Devries K, Kyegombe N, Medley GF, Gafos M, Seeley J, Weiss HA, Kaul R, Gandhi M, Beattie TS, Kimani J. Factors Associated with Usage of Oral-PrEP among Female Sex Workers in Nairobi, Kenya, Assessed by Self-Report and a Point-of-Care Urine Tenofovir Immunoassay. AIDS Behav 2024; 28:3836-3849. [PMID: 39136824 PMCID: PMC11471708 DOI: 10.1007/s10461-024-04455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 10/15/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV acquisition. We aimed to estimate usage of oral-PrEP, and factors associated with adherence among female sex workers (FSWs) in Nairobi, Kenya, using a novel point-of-care urine tenofovir lateral flow assay (LFA). The Maisha Fiti study randomly selected FSWs from Sex Worker Outreach Program clinics in Nairobi. Data were collected from 1003 FSWs from June-October 2019, including surveys on self-reported oral-PrEP adherence. Adherence was also measured using the LFA for HIV-negative FSWs currently taking oral-PrEP. Informed by a social-ecological theoretical framework, we used hierarchical multivariable logistic regression models to estimate associations between individual, interpersonal/community, and structural/institutional-level factors and either self-reported or LFA-assessed adherence. Overall, 746 HIV-negative FSWs aged 18-40 participated in the study, of whom 180 (24.1%) self-reported currently taking oral-PrEP. Of these, 56 (31.1%) were adherent to oral-PrEP as measured by LFA. In the multivariable analyses, associations with currently taking oral-PrEP included having completed secondary education, high alcohol/substance use, feeling empowered to use PrEP, current intimate partner, no recent intimate partner violence, having support from sex worker organisations, experiencing sex work-related stigma, and seeking healthcare services despite stigma. Associations with oral-PrEP LFA-measured adherence measured included having only primary education, experience of childhood emotional violence, belonging to a higher wealth tertile, and being nulliparous. Oral-PrEP adherence, measured by self-report or objectively, is low among FSWs in Nairobi. Programs to improve oral-PrEP usage among FSWs should work to mitigate social and structural barriers and involve collaboration between FSWs, healthcare providers and policymakers.
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Affiliation(s)
- Pooja Shah
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Matthew Spinelli
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erastus Irungu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Mary Kungu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - The Maisha Fiti Study Champions
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Chrispo Nyabuto
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Anne Mahero
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nambusi Kyegombe
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Graham F Medley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
| | - Helen A Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rupert Kaul
- Departments of Immunology and Medicine, University of Toronto, Toronto, Canada
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tara S Beattie
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
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Torres Silva MS, Torres TS, Coutinho C, Ismério Moreira R, da Costa Leite I, Cunha M, da Costa Leite PHA, Cáceres CF, Vega-Ramírez H, Konda KA, Guanira J, Valdez Madruga J, Wagner Cardoso S, Benedetti M, Pimenta MC, Hoagland B, Grinsztejn B, Gonçalves Veloso V. Bacterial sexually transmitted infections among men who have sex with men and transgender women using oral pre-exposure prophylaxis in Latin America (ImPrEP): a secondary analysis of a prospective, open-label, multicentre study. Lancet HIV 2024; 11:e670-e679. [PMID: 39243787 PMCID: PMC11442320 DOI: 10.1016/s2352-3018(24)00211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The global burden of sexually transmitted infections (STIs) poses a challenge in the context of HIV pre-exposure prophylaxis (PrEP) programmes. We aimed to explore factors associated with prevalent, incident, and recurrent STIs in men who have sex with men (MSM) and transgender women on PrEP in Brazil, Mexico, and Peru. METHODS ImPrEP was a prospective, single-arm, open-label, multicentre study that enrolled MSM and transgender women in the context of the public health systems of Brazil (14 sites), Mexico (four sites), and Peru (ten sites) between February, 2018, and June, 2021. Eligibility criteria followed regional PrEP guidelines at the study start, including participants aged 18 years and older, not living with HIV, and reporting at least one of the following in the previous 6 months: condomless anal sex (CAS), anal sex with partner(s) living with HIV, any bacterial STI, or transactional sex. Eligible participants were screened and enrolled on the same day to receive daily oral PrEP (tenofovir disoproxil fumarate 300 mg and emtricitabine 200 mg). We assessed three outcomes: prevalent bacterial STIs, incident bacterial STIs, and recurrent bacterial STIs. Testing occurred at baseline and quarterly for syphilis, anorectal chlamydia, and anorectal gonorrhoea. Behavioural data were collected at baseline and quarterly. The study was registered with the Brazilian Registry of Clinical Trials, U1111-1217-6021. FINDINGS Among all 9509 participants included in the ImPrEP study (3928 [41·3%] in Brazil, 3288 [34·6%] in Mexico, and 2293 [24·1%] in Peru), 8525 (89·7%) had available STI results at baseline and were included in the prevalent STI analysis, and 7558 (79·5%) had available STI results during follow-up and were included in the incident and recurrent STI analyses. 2184 (25·6%) of 8525 participants had any bacterial STI at baseline. STI incidence during follow-up was 31·7 cases per 100 person-years (95% CI 30·7-32·7), with the highest rate for anorectal chlamydia (11·6 cases per 100 person-years, 95% CI 11·0-12·2), followed by syphilis (10·5 cases per 100 person-years, 9·9-11·1) and anorectal gonorrhoea (9·7 cases per 100 person-years, 9·2-10·3). Although only 2391 (31·6%) of 7558 participants had at least one STI during follow-up, 915 (12·1%) participants had recurrent diagnoses, representing 2328 (61·2%) of 3804 incident STI diagnoses. Characteristics associated with prevalent, incident, and recurrent STIs included younger age, multiple sex partners, receptive CAS, substance use, and previous STI diagnoses at baseline (incident or recurrent only). INTERPRETATION Our findings underscore the nuanced dynamics of STI transmission among MSM and transgender women across Latin America, highlighting an urgent need for tailored interventions to mitigate STI burden effectively, especially among the most susceptible individuals. FUNDING Unitaid, WHO, and ministries of health (Brazil, Mexico, and Peru). TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Mayara Secco Torres Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Ronaldo Ismério Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Iuri da Costa Leite
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, Brazil
| | - Marcelo Cunha
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz (ENSP-Fiocruz), Rio de Janeiro, Brazil
| | | | - Carlos F Cáceres
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias en Salud, Sexualidad, y SIDA, Lima, Peru
| | - Hamid Vega-Ramírez
- Instituto Nacional de Psiquiatria Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Kelika A Konda
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias en Salud, Sexualidad, y SIDA, Lima, Peru; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Juan Guanira
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinarias en Salud, Sexualidad, y SIDA, Lima, Peru
| | | | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Maria Cristina Pimenta
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil.
| | - Valdilea Gonçalves Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, Brazil
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Wu L, Niu X, Brunelli MK, Mugwanya KK. Adherence and HIV Protection Thresholds for Emtricitabine and Tenofovir Disoproxil Fumarate Preexposure Prophylaxis among Cisgender Women: A Systematic Review. Curr HIV/AIDS Rep 2024; 21:264-281. [PMID: 39120667 DOI: 10.1007/s11904-024-00705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW Adherence-concentration-efficacy benchmarks have not been fully characterized for cisgender women using emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) oral daily pre-exposure prophylaxis (PrEP) for HIV prevention. RECENT FINDINGS We conducted a systematic review to investigate current evidence on the adherence-concentration-efficacy relationship of tenofovir-diphosphate (TFV-DP) derived from FTC/TDF PrEP in dried blood spots (DBS) and peripheral mononuclear cells (PBMC) in cisgender women without HIV, including during pregnancy. We searched for completed and ongoing studies published before May 2024 in PubMed, Embase, Cochrane Library, CINAHL, and clinicaltrial.gov. Overall, 11 studies assessing adherence benchmarks focusing on (n = 5) or involving (n = 6) cisgender women were included. Women-specific median steady-state TFV-DP concentration for daily dosing ranged from 17 to 51 fmol/106 in PBMC and 1389 to 1685 fmol/punch in DBS in non-pregnant women; 50 to 71 fmol/106 in PBMC and 583 to 965 fmol/punch in DBS in pregnant women; and 618 to 1406 fmol/punch in DBS in postpartum women. DBS TFV-DP levels were 14-43% lower in pregnancy versus postpartum or non-pregnant periods, but PBMC TFV-DP levels appear to be comparable. Clinical and modeling studies demonstrate effective HIV protection for women taking at least four doses/week of oral TDF-based PrEP, and emerging evidence suggests that systemic drug levels are more likely to be predictive of efficacy than local tissue levels at the site of exposure. The preponderance of emerging evidence points to comparable efficacy and similar adherence requirement for women as men among those with detectable drug levels, although there was an indication that the highest achievable efficacy may be reached at a lower adherence level in men than women. In this review, we found evidence that women-specific TFV-DP adherence benchmarks in DBS and PBMC are within range of US-based historical thresholds derived from healthy men and women. Emerging evidence suggests that imperfect but adequate adherence to oral FTC/TDF PrEP with at least four doses/week provides sufficient HIV protection in cisgender women as it does in MSM, but more data are still needed to refine intrinsic achievable efficacy estimates for cisgender women.
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Affiliation(s)
- Linxuan Wu
- Department of Global Health, University of Washington, 908 Jefferson Street, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Xin Niu
- Department of Global Health, University of Washington, 908 Jefferson Street, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | | | - Kenneth K Mugwanya
- Department of Global Health, University of Washington, 908 Jefferson Street, Seattle, WA, 98104, USA.
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
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Yigit I, Budhwani H, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Associations Between PrEP Stigma, PrEP Confidence, and PrEP Adherence: Conditional Indirect Effects of Anticipated HIV Stigma. J Acquir Immune Defic Syndr 2024; 97:99-106. [PMID: 39250643 PMCID: PMC11573708 DOI: 10.1097/qai.0000000000003474] [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: 02/23/2024] [Accepted: 06/03/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Research has linked stigma surrounding preexposure prophylaxis (PrEP) to poor HIV prevention outcomes, including PrEP adherence. However, there remains a limited understanding of the mechanisms through which PrEP stigma affects PrEP adherence, specifically among sexual and gender minority (SGM) youth. In this study, we aimed to investigate the indirect effect of PrEP stigma on PrEP adherence through PrEP confidence and the moderating role of anticipated HIV stigma. METHODS Participants included 235 SGM youth, assigned male sex at birth, aged 16-24, and self-reported HIV-negative, with an active PrEP prescription from the Prepared, Protected, emPowered randomized controlled trial. Participants were recruited from 9 clinics in the United States between 2019 and 2021. Using baseline data, we tested cross-sectional indirect and conditional indirect effects using the Statistical Package for the Social Sciences Process with confidence intervals and 2000 resamples. RESULTS We found significant indirect effects, suggesting that PrEP stigma was negatively associated with PrEP confidence, which in turn resulted in both monthly and weekly optimal PrEP adherence (Indirect effects: B = -0.11, Standard Error [SE] = 0.05, CI: [-0.244 to -0.032]; B = -0.09, SE = 0.04, CI: [-0.191 to -0.014], respectively). Anticipated HIV stigma moderated these indirect effects (B = -0.11, SE = 0.08, CI: [-0.315 to -0.001]; B = -0.09, SE = 0.06, CI: [-0.245 to -0.001], respectively), suggesting that the conditional indirect effects were significant at high but not low levels of anticipated HIV stigma. CONCLUSION Results suggest that SGM youth who are on PrEP anticipating HIV stigma experience a compounding effect of PrEP stigma on PrEP confidence, consequently leading to suboptimal adherence. Interventions addressing the intersectionality of PrEP and HIV stigmas and enhancing confidence could improve PrEP adherence, particularly among SGM youth.
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Affiliation(s)
- Ibrahim Yigit
- College of Nursing, Florida State University, Tallahassee, FL
| | - Henna Budhwani
- College of Nursing, Florida State University, Tallahassee, FL
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL
| | - Crissi B. Rainer
- College of Nursing, Florida State University, Tallahassee, FL
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL
| | - Kristina Claude
- College of Nursing, Florida State University, Tallahassee, FL
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL
| | - Kathryn E. Muessig
- College of Nursing, Florida State University, Tallahassee, FL
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL
| | - Lisa B. Hightow-Weidman
- College of Nursing, Florida State University, Tallahassee, FL
- Institute on Digital Health and Innovation, Florida State University (FSU), Tallahassee, FL
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Poteat T, Bothma R, Maposa I, Hendrickson C, Meyer-Rath G, Hill N, Pettifor A, Imrie J. Transgender-Specific Differentiated HIV Service Delivery Models in the South African Public Primary Health Care System (Jabula Uzibone): Protocol for an Implementation Study. JMIR Res Protoc 2024; 13:e64373. [PMID: 39269745 PMCID: PMC11437231 DOI: 10.2196/64373] [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: 07/16/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Almost 60% of transgender people in South Africa are living with HIV. Ending the HIV epidemic will require that transgender people successfully access HIV prevention and treatment. However, transgender people often avoid health services due to facility-based stigma and lack of availability of gender-affirming care. Transgender-specific differentiated service delivery (TG-DSD) may improve engagement and facilitate progress toward HIV elimination. Wits RHI, a renowned South African research institute, established 4 TG-DSD demonstration sites in 2019, with funding from the US Agency for International Development. These sites offer unique opportunities to evaluate the implementation of TG-DSD and test their effectiveness. OBJECTIVE The Jabula Uzibone study seeks to assess the implementation, effectiveness, and cost of TG-DSD for viral suppression and prevention-effective adherence. METHODS The Jabula Uzibone study collects baseline and 12-month observation checklists at 8 sites and 6 (12.5%) key informant interviews per site at 4 TG-DSD and 4 standard sites (n=48). We seek to enroll ≥600 transgender clients, 50% at TG-DSD and 50% at standard sites: 67% clients with HIV and 33% clients without HIV per site type. Participants complete interviewer-administered surveys quarterly, and blood is drawn at baseline and 12 months for HIV RNA levels among participants with HIV and tenofovir levels among participants on pre-exposure prophylaxis. A subset of 30 participants per site type will complete in-depth interviews at baseline and 12 months: 15 participants will be living with HIV and 15 participants will be HIV negative. Qualitative analyses will explore aspects of implementation; regression models will compare viral suppression and prevention-effective adherence by site type. Structural equation modeling will test for mediation by stigma and gender affirmation. Microcosting approaches will estimate the cost per service user served and per service user successfully treated at TG-DSD sites relative to standard sites, as well as the budget needed for a broader implementation of TG-DSD. RESULTS Funded by the US National Institutes of Mental Health in April 2022, the study was approved by the Human Research Ethics Committee at University of Witwatersrand in June 2022 and the Duke University Health System Institutional Review Board in June 2023. Enrollment began in January 2024. As of July 31, 2024, a total of 593 transgender participants have been enrolled: 348 are living with HIV and 245 are HIV negative. We anticipate baseline enrollment will be complete by August 31, 2024, and the final study visit will take place no later than August 2025. CONCLUSIONS Jabula Uzibone will provide data to inform HIV policies and practices in South Africa and generate the first evidence for implementation of TG-DSD in sub-Saharan Africa. Study findings may inform the use of TG-DSD strategies to increase care engagement and advance global progress toward HIV elimination goals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/64373.
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Affiliation(s)
- Tonia Poteat
- Duke University School of Nursing, Durham, NC, United States
| | - Rutendo Bothma
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University, Boston, MA, United States
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Naomi Hill
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - John Imrie
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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48
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Hill-Rorie J, Biello KB, Quint M, Johnson B, Elopre L, Johnson K, Lillis R, Burgan K, Krakower D, Whiteside Y, Mayer KH. Weighing the Options: Which PrEP (Pre-exposure Prophylaxis) Modality Attributes Influence Choice for Young Gay and Bisexual Men in the United States? AIDS Behav 2024; 28:2970-2978. [PMID: 39126557 DOI: 10.1007/s10461-024-04384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/12/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, but uptake and adherence among young men who have sex with men (YMSM) remains suboptimal. New PrEP formulations may enhance PrEP use, but little is known about their acceptability. We enrolled 39 cis- and transgender YMSM (age 18-34) from Boston, MA; Jackson, MS; Birmingham, AL; and New Orleans, LA, who participated in video-based focus groups (n = 30) or in-depth interviews (n = 9) to examine how new PrEP products (e.g., injections, monthly pills, implants) are perceived and might be improved for YMSM. Focus groups were transcribed, coded, and analyzed using grounded theory and content analysis. Nearly half (46%) of participants were Black; 11% identified as Hispanic. Seventy-nine percent were PrEP experienced. Product preference was driven by the desire for flexible, safe, effective, and affordable PrEP options. A majority of participants preferred subcutaneous injections every 6 months or monthly pills dispersed in 3 or 4 doses. Subcutaneous injections and batched monthly pills were favored by those with demanding schedules and those who desired fewer provider visits; monthly pills were more appealing for those who feared needles. Despite broad preferences for longer-acting products for convenience, participants raised concerns regarding side effects and waning protection after missed doses. Participants felt that more education about safety and efficacy profiles of new products could influence their attitudes. These findings suggest that it is important to prioritize YMSM's dynamic lifestyles during product development, and that product safety and efficacy information should be accessible in youth-friendly language.
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Affiliation(s)
| | - Katie B Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
| | - Meg Quint
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kendra Johnson
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Rebecca Lillis
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Kaylee Burgan
- University of Alabama, Birmingham, Birmingham, AL, USA
| | - Douglas Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Medical Center/Harvard Medical School, Boston, MA, USA
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Weeden T, Garofalo R, Johnson AK, Schnall R, Cervantes M, Scherr T, Kuhns LM. Assessing Preferences for Long-Acting Injectable Pre-Exposure Prophylaxis Among Young Adult Sexual Minority Men and Transgender Women. Acad Pediatr 2024; 24:1110-1115. [PMID: 38631476 PMCID: PMC11343673 DOI: 10.1016/j.acap.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. However, oral PrEP uptake is low, particularly among sexual and gender minority youth who are vulnerable to HIV infection. Alternative methods of PrEP delivery, such as long-acting injectable (LAI) PrEP may overcome barriers and be preferred. However, attitudes and preferences of younger sexual and gender minorities towards LAI PrEP have not been well studied. The purpose of this study is to describe preferences for initiating LAI PrEP among sexual and gender minority youth. METHODS We analyzed data collected as part of an HIV prevention randomized trial from January 2022 to February 2023, using multiple regression to identify factors associated with a preference for LAI PrEP. RESULTS The study sample (N = 265) was 50% youth of color, mean age 25 years (SD=3.4, range=18-31), and primarily identified as gay (71%) and male (91%). Forty two percent had heard of LAI PrEP and 31% preferred LAI PrEP over other prevention methods. In multiple regression analysis, LAI PrEP preference was associated with identifying as White, previous PrEP experience, and perceived LAI PrEP efficacy. CONCLUSIONS We conclude that gaps in awareness exist for LAI PrEP, however it may be preferred over other prevention methods especially in White youth, those with PrEP experience and higher perceptions of its efficacy. More education and outreach are needed to prevent extension of existing race and ethnicity disparities in use of oral daily PrEP to LAI PrEP.
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Affiliation(s)
- Terrance Weeden
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Robert Garofalo
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Amy K Johnson
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Rebecca Schnall
- School of Nursing (R Schnall), Columbia University, New York City, NY
| | - Marbella Cervantes
- Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill
| | - Thomas Scherr
- Department of Chemistry (T Scherr), Vanderbilt University, Nashville, Tenn
| | - Lisa M Kuhns
- Northwestern University (T Weeden, R Garofalo, AK Johnson, and LM Kuhns), Department of Pediatrics, Feinberg School of Medicine, Chicago, Ill; Ann & Robert H. Lurie Children's Hospital of Chicago (T Weeden, R Garofalo, AK Johnson, M Cervantes, and LM Kuhns), Potocsnak Family Division of Adolescent and Young Adult Medicine, Chicago, Ill.
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Braz Junior RP, Cesar GA, Amianti C, Bandeira LM, Da Silva ASP, Motta-Castro ARC. Behind Prep Decisions: Understanding User Patterns and Discontinuation Factors in Real-World. AIDS Behav 2024; 28:2979-2989. [PMID: 38825651 DOI: 10.1007/s10461-024-04383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/04/2024]
Abstract
This study aimed to characterize the epidemiological aspects of PrEP use and barriers to accessing this prophylaxis. This cross-sectional study was conducted between January 2021 and April 2022, encompassing 140 PrEP users treated at the Testing and Counseling Center (CTA) in Campo Grande, Mato Grosso do Sul. Data on sociodemographic characteristics and factors associated with PrEP discontinuation were obtained using a standardized questionnaire. Most PrEP users were cisgender men (92.00%), predominantly white (51.00%), over 30 years of age (56.50%), homosexual-oriented (76.50%), and had a minimum of 12 years of education (77.50%). Approximately 60.00% admitted to inconsistent condom use in recent sexual encounters, primarily involving anal intercourse. Approximately 88.00% perceived themselves as at risk of contracting STIs in the upcoming year. Regarding new presentation forms, 54.00% indicated a willingness to use "on-demand PrEP," and 92.00% expressed interest in using "injectable PrEP." After 6 months of follow-up, 43.60% (95.00% CI: 35.50-52.00) discontinued PrEP use, primarily due to changes in sexual behavior (38.30%) and difficulties accessing healthcare services (21.28%). This study underscores the need to involve diverse key populations and highlights the significance of PrEP as an ongoing monitoring strategy for HIV/STI prevention in addition to the importance of incorporating new formulations such as daily oral PrEP into the Brazilian National Health System (SUS).
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Affiliation(s)
- R P Braz Junior
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
- Secretaria Municipal de Saúde Municipal de Campo Grande (SESAU), Campo Grande, MS, Brasil
| | - G A Cesar
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
- Secretaria Municipal de Saúde Municipal de Campo Grande (SESAU), Campo Grande, MS, Brasil
| | - C Amianti
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil.
| | - L M Bandeira
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil.
| | - A S P Da Silva
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
- Secretaria Municipal de Saúde Municipal de Campo Grande (SESAU), Campo Grande, MS, Brasil
| | - A R C Motta-Castro
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz/Ministério da Saúde/Brasil, Campo Grande, MS, Brasil
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