1
|
Wyatt GE, Norwood-Scott E, Cooley-Strickland M, Zhang M, Smith-Clapham A, Jordan W, Liu H, Hamilton AB. Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+). Womens Health Issues 2024; 34:241-249. [PMID: 38267337 DOI: 10.1016/j.whi.2023.11.001] [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: 09/27/2022] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND African American women are disproportionately at risk for HIV infection. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV. METHODS Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (n = 47) and post-implementation (n = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) symptoms, substance use, sexual risk behaviors, health care-related discrimination, and social support. In a process evaluation, a subset of women completed qualitative interviews at baseline (n = 35) and post-implementation (n = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention. RESULTS Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (p < .01) and in a typical week (p < .05); reduced PTS symptoms (p < .05); increased HIV knowledge (p < .0001) and awareness of PrEP (p < .001); and greater consideration of using PrEP (p < .001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained. CONCLUSIONS The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women.
Collapse
Affiliation(s)
- Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California.
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Michele Cooley-Strickland
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Muyu Zhang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Amber Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Wilbert Jordan
- Charles R. Drew University/OASIS Clinic, Los Angeles, California
| | - Honghu Liu
- Section of Public and Population Health, School of Dentistry, University of California Los Angeles, Los Angeles, California; Departments of Biostatistics and Medicine, University of California Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California; Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| |
Collapse
|
2
|
Wyatt GE, Chin D, Loeb TB, Norwood-Scott E, McEwan JA, Zhang M, Smith-Clapham AM, Cooley-Strickland M, Trinidad C, Flint JR, Wells Y, Divinity R, Liu H. Women-Centered Program for Women of Color (WC4WC): A Community-Based Participatory, Culturally Congruent Sexual Health Intervention in Los Angeles County, California. Am J Public Health 2023; 113:S110-S114. [PMID: 37339413 PMCID: PMC10282859 DOI: 10.2105/ajph.2023.307296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 06/22/2023]
Abstract
The Women-Centered Program for Women of Color, a culturally congruent sexual health intervention, was implemented in 2018 in Los Angeles County, California, according to the principles of community-based participatory research: enhancing community capacity, establishing sustainable programs, and translating research findings to community settings. Participants exhibited significantly increased knowledge of and interest in preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) over time, but no significant change in condom use was evident. Booster sessions are needed to maintain interest in PrEP and PEP given concerns about reproductive and sexual health. (Am J Public Health. 2023;113(S2):S110-S114. https://doi.org/10.2105/AJPH.2023.307296).
Collapse
Affiliation(s)
- Gail E Wyatt
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Dorothy Chin
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Tamra B Loeb
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Enricka Norwood-Scott
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Jenna A McEwan
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Muyu Zhang
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Amber M Smith-Clapham
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Michele Cooley-Strickland
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Cheryl Trinidad
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Janette R Flint
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Yvette Wells
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Rosalynd Divinity
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| | - Honghu Liu
- Gail E. Wyatt, Dorothy Chin, Tamra B. Loeb, Enricka Norwood-Scott, Jenna A. McEwan, Muyu Zhang, Amber M. Smith-Clapham, and Michele Cooley-Strickland are with the Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Gail E. Wyatt is also a guest editor of this special issue. Cheryl Trinidad is with To Help Everyone Health and Wellness Centers, Los Angeles. Janette R. Flint is with Black Women for Wellness, Los Angeles. Yvette Wells and Rosalynd Divinity are with Watts Healthcare Corporation, Los Angeles. Honghu Liu is with the Section of Public and Population Health, University of California, Los Angeles
| |
Collapse
|
4
|
Lewis JB, Cunningham SD, Shabanova V, Hassan SS, Magriples U, Rodriguez MG, Ickovics JR. Group prenatal care and improved birth outcomes: Results from a type 1 hybrid effectiveness-implementation study. Prev Med 2021; 153:106853. [PMID: 34678329 DOI: 10.1016/j.ypmed.2021.106853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
To compare birth outcomes for patients receiving Expect With Me (EWM) group prenatal care or individual care only, we conducted a type 1 hybrid effectiveness-implementation trial (Detroit and Nashville, 2014-2016). Participants entered care <24 weeks gestation, had singleton pregnancy, and no prior preterm birth (N = 2402). Mean participant age was 27.1 (SD = 5.77); 49.5% were Black; 15.3% were Latina; 59.7% publicly insured. Average treatment effect of EWM compared to individual care only was estimated using augmented inverse probability weighting (AIPW). This doubly-robust analytic method produces estimates of causal association between treatment and outcome in the absence of randomization. AIPW was effective at creating equivalent groups for potential confounders. Compared to those receiving individual care only, EWM patients did significantly better on three of four primary outcomes: lower risk of infants born preterm (<37 weeks gestation; 6.4% vs. 15.1%, risk ratio (RR) 0.42, 95% Confidence Interval (CI) 0.29, 0.54), low birthweight (<2500 g; 4.3% vs. 11.6%, RR 0.37, 95% CI 0.24, 0.49), and admission to NICU (9.4% vs. 14.6%, RR 0.64, 95% CI 0.49, 0.78). There was no difference in small for gestational age (<10% percentile of weight for gestational age). EWM patients attended a mean of 5.9 group visits (SD = 2.7); 70% attended ≥5 group visits. Post-hoc analyses indicated EWM patients utilizing the integrated information technology platform had lower risk for low birthweight infants (RR 0.47, 95% CI 0.24, 0.86) than non-users. Future research is needed to understand mechanisms by which group prenatal care improves outcomes, best practices for implementation, and health systems savings. Trial registration: ClinicalTrials.govNCT02169024.
Collapse
Affiliation(s)
- Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
| | - Shayna D Cunningham
- Department of Public Health Sciences, UConn Health, Farmington, CT, United States of America
| | - Veronika Shabanova
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Sonia S Hassan
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, United States of America
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States of America
| | - Marisa G Rodriguez
- Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, MI, United States of America
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| |
Collapse
|
5
|
Loeb TB, Ebor MT, Smith-Clapham AM, Chin D, Novacek DM, Hampton-Anderson JN, Norwood-Scott E, Hamilton AB, Brown AF, Wyatt GE. How Mental Health Professionals Can Address Disparities in the Context of the COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 27:60-69. [PMID: 34025223 DOI: 10.1037/trm0000292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology's role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels.
Collapse
Affiliation(s)
- Tamra Burns Loeb
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Megan T Ebor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Amber M Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Dorothy Chin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Derek M Novacek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095.,Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Joya N Hampton-Anderson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, 30322
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095.,Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research (GIM and HSR), University of California Los Angeles, CA, USA, 90095.,Division of GIM and HSR, Olive View-UCLA Medical Center, Sylmar, CA, USA, 91342
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| |
Collapse
|