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Atkins K, Bruce J, Kay ES, Musgrove K, Kellar P, MacCarthy S. Transactional sex among adults accessing sexual health services in Alabama, 2008-2022: Prevalence, associated risk factors, and associations with HIV, HCV, and STI diagnosis. Ann Epidemiol 2024; 92:35-39. [PMID: 38360156 DOI: 10.1016/j.annepidem.2024.02.004] [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: 10/11/2023] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The U.S. Deep South bears a disproportionate burden of HIV and other STIs. Transactional sex may influence these epidemics, but few studies have estimated its prevalence or correlates in the Deep South. METHODS We estimated the history of transactional sex among adults accessing an Alabama AIDS Service Organization from 2008-2022, using chi-square tests to examine its sociodemographic and behavioral correlates. We used modified Poisson regression with cluster-robust standard errors to estimate adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI) for the associations between transactional sex and new HIV, hepatitis C (HCV), and STI diagnoses. RESULTS Transactional sex was reported at 944/20,013 visits (4.7 %) and associated with older age, being a cisgender woman or gender minority, identifying as white, diverse drug use, and sharing of drug equipment. Compared to others, clients reporting transactional sex had increased prevalence of syphilis (apR 3.60, 95 % CI 1.16-11.19) and HCV (aPR 1.53, 95 % CI 1.24-1.88). CONCLUSION Using 14 years of community-based data, this study is the first to estimate the relationship between transactional sex and HIV, HCV, and STIs in Alabama and highlights the need address STI burden and diverse drug use among people who transact sex in the Deep South.
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Affiliation(s)
- Kaitlyn Atkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Josh Bruce
- Birmingham AIDS Outreach, Birmingham, AL, USA
| | - Emma Sophia Kay
- Birmingham AIDS Outreach, Birmingham, AL, USA; Department of Acute, Chronic, and Continuing Care University of Alabama at Birmingham School of Nursing Birmingham, AL, USA
| | | | | | - Sarah MacCarthy
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
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Mckay V, Zamantakis A, Pachicano AM, Merle J, Purrier M, Swan M, Li D, Mustanski B, Smith JD, Hirschhorn L, Benbow N. Establishing Evidence Criteria for Implementation Strategies: A Delphi Study for HIV Services. RESEARCH SQUARE 2024:rs.3.rs-3979631. [PMID: 38464091 PMCID: PMC10925451 DOI: 10.21203/rs.3.rs-3979631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND There are no criteria specifically for evaluating the quality of implementation research and recommend implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Rubric, a set of criteria to evaluate the evidence supporting implementation strategies, in the context of HIV. METHODS We developed the Best Practices Rubric from 2022-2023 in three phases. (1) We purposively selected and recruited by email participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. We developed a draft rubric and criteria based on a literature review and key informant interviews. (2) The rubric was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate, and the rubric and criteria were revised. (3) We then applied the rubric to a set of research studies assessing 18 implementation strategies designed to promote the adoption and uptake of pre-exposure prophylaxis, an HIV prevention medication, to assess reliable application of the rubric and criteria. RESULTS Our initial literature review yielded existing rubrics and criteria for evaluating intervention-level evidence. For a strategy-level rubric, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best practice, promising practice, more evidence needed, and harmful practices. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies. CONCLUSIONS We developed a rubric to evaluate the evidence supporting implementation strategies for HIV services. Although the rubric is specific to HIV, this tool is adaptable for evaluating strategies in other health areas.
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Mustanski B, Queiroz A, Merle JL, Zamantakis A, Zapata JP, Li DH, Benbow N, Pyra M, Smith JD. A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States. Annu Rev Psychol 2024; 75:55-85. [PMID: 37722749 PMCID: PMC10872355 DOI: 10.1146/annurev-psych-032620-035725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Pyra
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Jin G, Shi H, Du J, Guo H, Yuan G, Yang H, Zhu Z, Zhang J, Zhang K, Zhang X, Lu X, Xu W, Wang S, Hao J, Sun Y, Su P, Zhang Z. Pre-Exposure Prophylaxis Care Continuum for HIV Risk Populations: An Umbrella Review of Systematic Reviews and Meta-Analyses. AIDS Patient Care STDS 2023; 37:583-615. [PMID: 38011347 DOI: 10.1089/apc.2023.0158] [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: 11/29/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy for HIV prevention. This umbrella review is aimed at providing a comprehensive summary of the current status of each stage of the PrEP care cascade. A systematic literature search was conducted in PubMed, Embase, and Cochrane. Additionally, a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist were used to evaluate their methodological and reporting quality, respectively. A total of 30 systematic reviews met the inclusion criteria. According to the results of methodological quality assessment, 3 reviews were rated as low, while 27 as critically low. Furthermore, the results of the reporting quality evaluation revealed a mean score of 23.03 for the included reviews. Across all the reviews, awareness of PrEP was generally moderate in all populations, and the acceptability was even higher compared with awareness. Unfortunately, the PrEP uptake among different groups was even less optimal, although the adherence was almost above moderate, and several barriers that hindered the utilization of PrEP were identified, and the most common are as follows: cost, stigma, lack of knowledge, mistrust, low risk perception, and more. Although PrEP has proven to be an effective prevention method to date, the promotion of PrEP failed to achieve the anticipated outcome. To reinforce the generalization of and use of PrEP, and effectively control HIV transmission, it is urgent to identify the underlying causes of low uptake rates so that efficient interventions can be implemented.
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Affiliation(s)
- Guifang Jin
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyan Shi
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Du
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyun Guo
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Guojing Yuan
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Huayu Yang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihui Zhu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jianghui Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Kexin Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xueqing Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiaoyan Lu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenzhuo Xu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Sainan Wang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
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Riley T, Anaya G, Gallegos PA, Castaneda R, Khosropour CM. Pre-exposure Prophylaxis Use and Discontinuation in a Federally Qualified Health Center in a Mexico-US Border City. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01807-y. [PMID: 37787944 DOI: 10.1007/s40615-023-01807-y] [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: 05/11/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Latino men who have sex with men (MSM) experience disproportionately high rates of HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) use is critical to reduce this inequity, but PrEP awareness, access, and use are low among Latino MSM. This study aims to describe patterns of PrEP persistence and discontinuation among predominately Latino MSM accessing PrEP in a federally qualified health center (FQHC) in El Paso, Texas. METHODS This retrospective cohort comprised individuals who were eligible for PrEP at a FQHC in El Paso, Texas, between January 30, 2019, and August 15, 2021. We defined hierarchical categories of PrEP use and discontinuation, which was defined as more than 120 days between PrEP visits. We used Kaplan-Meier survival plots to estimate median time to first PrEP discontinuation. RESULTS There were 292 patients evaluated for PrEP; 91% were Latino. The majority of PrEP patients (70%, 205/292) experienced any PrEP discontinuation, and the median time to first PrEP discontinuation was 202 days (95% CI: 179-266). The proportion of patients who remained on PrEP at 3 months after initiation was 82% (95% CI: 76%, 87%) and at 6 months after initiation was 55% (95% CI: 46%, 62%). CONCLUSION While 3-month PrEP retention was high in this predominately Latino MSM patient population, PrEP discontinuation was common. Interventions that enhance longer-term persistence and support for restarting PrEP are needed to reduce the persistent ethnoracial disparities in HIV incidence.
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Affiliation(s)
- Taylor Riley
- School of Public Health, Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | | | | | | | - Christine M Khosropour
- School of Public Health, Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
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Khosropour CM, Riley T, Healy E, Backus KV, Gomillia CE, Mena L, Lockwood KR, Gordon FM, Means AR, Ward LM. Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study. BMC Public Health 2023; 23:1130. [PMID: 37312077 PMCID: PMC10262591 DOI: 10.1186/s12889-023-16072-1] [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] [Received: 10/07/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence. METHODS This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior. RESULTS There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals' desire to stay healthy and the support of PrEP clinic staff were facilitators. CONCLUSIONS The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.
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Affiliation(s)
- Christine M Khosropour
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | - Taylor Riley
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Elise Healy
- Department of Medicine, Health Sciences Building, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Kandis V Backus
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Khadijra R Lockwood
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Felicia M Gordon
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Arianna R Means
- Department of Global Health, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Lori M Ward
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
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Hollcroft MR, Gipson J, Barnes A, Mena L, Dombrowski JC, Ward LM, Khosropour CM. PrEP Acceptance among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi. J Int Assoc Provid AIDS Care 2023; 22:23259582231167959. [PMID: 37032460 PMCID: PMC10088405 DOI: 10.1177/23259582231167959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.
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Affiliation(s)
| | - June Gipson
- Open Arms Healthcare Center, Jackson, MS, USA
| | | | - Leandro Mena
- Open Arms Healthcare Center, Jackson, MS, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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Mulatu MS, Carter JW, Flores SA, Benton S, Galindo CA, Johnson WD, Wilkes AL, Prather C. Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019. Public Health Rep 2023; 138:31-42. [PMID: 35023401 PMCID: PMC9730169 DOI: 10.1177/00333549211058173] [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: 11/16/2022] Open
Abstract
OBJECTIVE Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. METHODS We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. RESULTS PrIDE jurisdictions implemented multiple health equity-focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP (z = -33.57; P < .001). CONCLUSIONS PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity-focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.
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Affiliation(s)
- Mesfin S. Mulatu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jarvis W. Carter
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen A. Flores
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaliondel Benton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carla A. Galindo
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne D. Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aisha L. Wilkes
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mitchell JT, Burns CM, Atkinson B, Cottrell M, Frye JK, McKellar MS, Kashuba ADM, McClernon FJ, Okeke NL. Feasibility, Acceptability, and Preliminary Efficacy of a Gamified Mobile Health Contingency Management Intervention for PrEP Adherence Among Black MSM. AIDS Behav 2022; 26:3311-3324. [PMID: 35416595 PMCID: PMC9474612 DOI: 10.1007/s10461-022-03675-9] [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] [Accepted: 03/26/2022] [Indexed: 11/01/2022]
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV. However, low adherence is common and undermines these protective effects. This is particularly relevant for groups with disproportionately higher rates of HIV, including Black men who have sex with men (MSM). The current study tested the feasibility, acceptability, and preliminary efficacy of a gamified mobile health contingency management intervention for PrEP adherence-called mSMART (Mobile App-Based Personalized Solutions for Medication Adherence of Rx Pill Tool). Fifteen Black MSM already prescribed PrEP in the community completed baseline and follow-up assessments separated by 8 weeks of using mSMART. Regarding feasibility, there was no study attrition, no mSMART functional difficulties that significantly interfered with use, and a mean rate of 82% daily mSMART use. Acceptability ratings were in the moderately to extremely satisfied range for factors such as willingness to recommend mSMART to others and user-friendliness, and in the low range for ratings on difficulty learning how to use mSMART. Scores on a system usability measure were in the acceptable range for 73% of the sample. Qualitative analysis of follow-up interviews identified individual components of mSMART that could be modified in future iterations to make it more engaging. PrEP composite adherence scores from biomarkers indicated an improvement from baseline to follow-up with a medium effect size, as well as a decrease in the number of perceived barriers to medication adherence. Findings indicate a future efficacy trial is needed to examine the effects of this gamified mobile health contingency management intervention on PrEP adherence.
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Affiliation(s)
- John T Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC, 27705, USA.
- Duke Center for Addiction Science and Technology, Durham, NC, USA.
| | - Charles M Burns
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Breyah Atkinson
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Mackenzie Cottrell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin K Frye
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Mehri S McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Angela D M Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC, 27705, USA
- Duke Center for Addiction Science and Technology, Durham, NC, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
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10
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Gaps in HIV PrEP Care Following State Partner Services for Massachusetts Primary and Secondary Syphilis Cases, 2017-2018. Sex Transm Dis 2022; 49:657-661. [PMID: 35797587 DOI: 10.1097/olq.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition. We used a PrEP continuum of care to measure impact of field epidemiologist-facilitated referrals for PrEP-naïve infectious syphilis cases across multiple clinical and pharmacy sites of care. METHODS Retrospective analysis of 2017-2018 primary and secondary syphilis cases, medical charts, and pharmacy data to identify PrEP education, referral offer, referral acceptance, first visit, prescription pickup (PrEP initiation) and 2-3 months (PrEP persistence). HIV seroconversion was determined using database match at syphilis diagnosis date and at 12 months. Chi-square or Fisher's exact tests were used to compare demographic characteristics associated with steps with lower progression rates. RESULTS Of 1077 syphilis cases, partner services engaged 662/787 (84%) HIV-negative cases; 490 were PrEP-naïve, 266 received education, 166 were offered referral, 67 accepted referral, 30 attended an initial appointment, and 22 were prescribed PrEP. Of 16 with pharmacy data, 14 obtained medication, and 8 persisted on PrEP at 2-3 months. Continuum progression was lowest from (1) PrEP-naïve to receiving PrEP education, (2) offered referral to referral acceptance, and (3) referral acceptance to initial PrEP appointment. Males with male partners were more likely to receive PrEP education or accept a referral. Higher social vulnerability was associated with increased PrEP referral acceptance. CONCLUSIONS Few individuals accepted PrEP referrals and persisted on PrEP. Field and clinic data capture were inconsistent, possibly underestimating referral volume and impact of field engagement. Efforts aimed at increasing referral acceptance and clinic attendance may improve PrEP uptake especially among women and heterosexual men with syphilis.
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Zhang J, Li C, Xu J, Hu Z, Rutstein SE, Tucker JD, Ong JJ, Jiang Y, Geng W, Wright ST, Cohen MS, Shang H, Tang W. Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis. Lancet HIV 2022; 9:e254-e268. [PMID: 35364026 PMCID: PMC9124596 DOI: 10.1016/s2352-3018(22)00030-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Poor adherence to oral HIV pre-exposure prophylaxis (PrEP) diminishes its clinical and public health benefits. This study synthesises evidence regarding discontinuation, adherence, and reinitiation of PrEP among geographically diverse PrEP users. METHODS We did a systematic review and meta-analysis evaluating studies published in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to Dec 18, 2020. We included longitudinal studies that presented data for PrEP discontinuation, defined as investigator-reported loss to follow-up or participant self-reported PrEP stoppage. Data were extracted from published reports and assessed for risk of bias. We used a random-effects meta-analysis to pool estimates of discontinuation and I2 and τ2 to evaluate heterogeneity. This study is registered with PROSPERO, CRD42020155675. FINDINGS We identified 4129 records, of which 59 articles were included (n=43 917 participants). 41·0% (95% CI 18·8-63·5) of participants discontinued PrEP within 6 months, with the highest rates in observational studies. The discontinuation rate in sub-Saharan Africa (47·5%, 95% CI: 29·4-66·4%) was higher than in other regions (p<0·001). Discontinuation rates were lower in studies with adherence interventions than in those without (24·7% vs 36·7%, p=0·015). Gay or bisexual men who have sex with men and transgender women offered daily or non-daily dosing options had lower discontinuation rates than those offered daily dosing alone (21·6% vs 31·5%; p<0·001). The pooled suboptimal adherence within 6 months was 37·7% (95% CI 8·4-66·9). Among people who discontinued PrEP, 47·3% (95% CI 31·5-63·2) reinitiated PrEP within 1 year of PrEP initiation. The included studies had poor quality in terms of study design, with a moderate risk of bias. INTERPRETATION Strategies to encourage reinitiating PrEP for new or persistent risk should be a focus of future PrEP implementation strategies. FUNDING National Institutes of Health and Nature Science Foundation of China.
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Affiliation(s)
- Jing Zhang
- The NHC Key Laboratory of AIDS Immunology and National Clinical Research Center for Laboratory Medicine of the First Affiliated Hospital of China Medical University
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences
- Key Laboratory of AIDS Immunology of Liaoning Province
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Chunyan Li
- Department of Health Behavior of University of North Carolina
| | - Junjie Xu
- The NHC Key Laboratory of AIDS Immunology and National Clinical Research Center for Laboratory Medicine of the First Affiliated Hospital of China Medical University
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences
- Key Laboratory of AIDS Immunology of Liaoning Province
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Zhili Hu
- The NHC Key Laboratory of AIDS Immunology and National Clinical Research Center for Laboratory Medicine of the First Affiliated Hospital of China Medical University
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences
- Key Laboratory of AIDS Immunology of Liaoning Province
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | | | - Joseph D. Tucker
- Department of Medicine of University of North Carolina
- University of North Carolina Project-China
- Faculty of Infectious and Tropical Diseases of London School of Hygiene and Tropical Medicine
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases of London School of Hygiene and Tropical Medicine
- Monash University
| | - Yongjun Jiang
- The NHC Key Laboratory of AIDS Immunology and National Clinical Research Center for Laboratory Medicine of the First Affiliated Hospital of China Medical University
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences
- Key Laboratory of AIDS Immunology of Liaoning Province
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Wenqing Geng
- The NHC Key Laboratory of AIDS Immunology and National Clinical Research Center for Laboratory Medicine of the First Affiliated Hospital of China Medical University
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences
- Key Laboratory of AIDS Immunology of Liaoning Province
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | | | | | - Hong Shang
- The NHC Key Laboratory of AIDS Immunology and National Clinical Research Center for Laboratory Medicine of the First Affiliated Hospital of China Medical University
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences
- Key Laboratory of AIDS Immunology of Liaoning Province
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases
| | - Weiming Tang
- Department of Medicine of University of North Carolina
- University of North Carolina Project-China
- Dermatology Hospital of Southern Medical University
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12
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Burns CM, Borges M, Frye J, Keicher K, Elliott S, Schwartz S, Shipp K, Okeke NL, McKellar MS. Understanding Retention in Pre-Exposure Prophylaxis Care in the South: Insights from an Academic HIV Prevention Clinic. AIDS Res Hum Retroviruses 2022; 38:306-312. [PMID: 35172632 PMCID: PMC9048170 DOI: 10.1089/aid.2021.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) is poorly utilized in the southern United States. We examined PrEP retention in care and sexually transmitted infections (STIs) through a retrospective review of the Duke University PrEP Clinic from January 1, 2015 to October 15, 2019. We evaluated short-term (3 months), long-term (additional 8–12 months), and longitudinal retention in care in our clinic. Adjusted odds ratios (aOR) were generated to explore demographics associated with retention. Kaplan–Meier curves were generated to view retention longitudinally. STIs were examined at baseline (1 year before initial PrEP visit) and while retained in care. Of a total of 255 patients; 88% were men, 37% were black, and 73% were men who have sex with men (MSM). Short- and long-term retention in care were met by 130/237 (55%) and 80/217 (37%) patients, respectively. MSM were more likely to be retained in the short term (aOR = 5.22, 95% confidence interval [CI] = 1.57–17.32). Self-referred patients were more likely to be retained in the long term (aOR = 2.18, 95% CI = 1.12–4.23). Uninsured patients were less likely to be retained in the long term (aOR = 0.32, 95% CI = 0.11–0.91). STI diagnoses include 42 infections at baseline and 69 infections during follow-up. STI diagnosed while in PrEP care was associated with longer retention in care over time. Patients discontinue PrEP care over time and STIs were frequently encountered. Additional studies are needed to determine the best way to retain patients in HIV preventative care.
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Affiliation(s)
- Charles M. Burns
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Monica Borges
- Duke Center for AIDS Research, Duke University, Durham, North Carolina, USA
| | - Justin Frye
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Kathryn Keicher
- Department of Case Management and Duke University Medical Center, Durham, North Carolina, USA
| | - Scotty Elliott
- Department of Case Management and Duke University Medical Center, Durham, North Carolina, USA
| | - Sheila Schwartz
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Kenneth Shipp
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Mehri S. McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
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Chasco EE, Shafer C, Dillon DMB, Owens S, Ohl ME, Hoth AB. Bringing Iowa TelePrEP to Scale: A Qualitative Evaluation. Am J Prev Med 2021; 61:S108-S117. [PMID: 34686280 DOI: 10.1016/j.amepre.2021.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Regional partnerships between public health organizations and telehealth programs have the potential to expand access to HIV pre-exposure prophylaxis in rural and small urban areas. However, little is known about the best practices for such partnerships. Iowa TelePrEP, a regional public health‒partnered telehealth model created by the Iowa Department of Public Health and the University of Iowa, expanded statewide between 2017 and 2019. This qualitative evaluation assessed the barriers and facilitators to statewide expansion and the lessons learned. METHODS Key informants from public health partners across Iowa participated in a focus group and interviews between May 2019 and November 2020. Public health partners included local health departments and disease intervention specialist/partner services programs. Qualitative data were transcribed and thematically coded. Program documents and routinely collected reporting data were reviewed to provide the context for qualitative findings. Data were analyzed in 2020. RESULTS TelePrEP expanded in 4 phases through partnerships with 12 public health partners. Public health partners referred 708 clients with pre-exposure prophylaxis indications to telenavigation; of these, 258 were navigated to TelePrEP, and 167 initiated pre-exposure prophylaxis. The facilitators of expansion included early public health partner engagement, model acceptability and inclusion of a navigator, and adaptability to local public health partner settings. The barriers included the need to adapt communication and processes to varying public health partners, difficulty in engaging underserved populations, the COVID-19 pandemic, and perceived gaps in understanding client outcomes. CONCLUSIONS Partnerships between regional telehealth programs and local health departments can expand to the state level and increase the capacity to implement pre-exposure prophylaxis in rural and small urban settings. Partnerships should consider how to balance program adaptability to local public health partners with standardization and scalability.
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Affiliation(s)
- Emily E Chasco
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
| | - Cody Shafer
- HIV Special Projects Division, NuCara Pharmacy, Pleasant Hill, Iowa
| | - Dena M B Dillon
- Department of Pharmaceutical Care, University of Iowa Hospitals & Clinics, University of Iowa Health Care, Iowa City, Iowa
| | - Seth Owens
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Michael E Ohl
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa; Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa
| | - Angela B Hoth
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Bonacci RA, Smith DK, Ojikutu BO. Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S. Am J Prev Med 2021; 61:S60-S72. [PMID: 34686293 PMCID: PMC8668046 DOI: 10.1016/j.amepre.2021.05.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/16/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural- and policy-level options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.
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Affiliation(s)
- Robert A Bonacci
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Dawn K Smith
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bisola O Ojikutu
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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15
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Pre-Exposure Prophylaxis (PrEP) Adherence Questionnaire: Psychometric Validation among Sexually Transmitted Infection Patients in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010980. [PMID: 34682730 PMCID: PMC8535751 DOI: 10.3390/ijerph182010980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Ensuring adherence guarantees the efficacy of pre-exposure prophylaxis (PrEP). METHODS We conducted a cross-sectional study among 816 sexually transmitted infection (STI) patients in Shanghai. The questionnaire included self-reported demographic characteristics, self-administered items on adherence to free oral PrEP, and PrEP uptake behavior measurement. We conducted item analysis, reliability analysis, validity analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Not all items were considered acceptable in the item analysis. The questionnaire had a McDonald's ω coefficient of 0.847. The scale-level content validity index (CVI) was 0.938 and the item-level CVI of each item ranged from 0.750 to 1. In exploratory factor analysis, we introduced a four-factor model accounting for 79.838% of the aggregate variance, which was validated in confirmatory factor analysis. Adding PrEP adherence questionnaire scores contributed to prediction of PrEP uptake behavior (p < 0.001) in regression analysis. The maximum area under the ROC curve was 0.778 (95% IC: 0.739-0.817). CONCLUSION The PrEP adherence questionnaire presented psychometric validation among STI patients.
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16
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Lillis R, Beckford J, Fegley J, Siren J, Hinton B, Gomez S, Taylor SN, Butler I, Halperin J, Clement ME. Evaluation of an HIV Pre-Exposure Prophylaxis Referral System: From Sexual Health Center to Federally Qualified Health Center Pre-Exposure Prophylaxis Clinic. AIDS Patient Care STDS 2021; 35:354-359. [PMID: 34448603 DOI: 10.1089/apc.2021.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Innovative delivery strategies are needed to facilitate access to HIV pre-exposure prophylaxis (PrEP). The objective of this study was to evaluate a navigator-facilitated PrEP referral process from a sexual health center (SHC) to a co-located PrEP clinic as an alternative delivery model. Electronic health record (EHR) data were used to calculate the number of clients seen at the SHC in 2019. Charts were manually reviewed to determine whether a PrEP clinic referral was made and document type of referral method: face-to-face appointment scheduling with the navigator (warm handoff), EHR messaging to navigator to schedule the appointment at a later time (EHR message), or provision of navigator's contact information to the client (card only). In 2019, 2481 unique potentially PrEP-eligible clients were seen at the SHC; 220 (9%) received a PrEP referral. Of referred clients, median age was 30 years (interquartile range, 24-34), 182 (83%) were male, 89 (40%) were non-Hispanic Black, and 24 (11%) were Latinx. In total, 94/220 (43%) referred clients attended an initial PrEP visit with a provider, and the proportion attending by referral method was 81%, 36%, and 27% for warm handoff, EHR message, and card only, respectively (p < 0.0001). Despite co-location of these two clinics, there were significant drop-offs along the PrEP care continuum for this referral system. Warm handoff was the most effective referral method, but further efforts are needed to understand barriers to referral. Implementation of same-day PrEP services at SHCs is one potential solution to engaging additional clients.
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Affiliation(s)
- Rebecca Lillis
- Louisiana State University Health Sciences Center, Department of Medicine, Section of Infectious Diseases, New Orleans, Louisiana, USA
- LSU-CrescentCare Sexual Health Center, New Orleans, Louisiana, USA
| | - Jeremy Beckford
- Louisiana State University Health Sciences Center, Department of Medicine, Section of Infectious Diseases, New Orleans, Louisiana, USA
| | - Joshua Fegley
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Julia Siren
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Bruce Hinton
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Samuel Gomez
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Stephanie N. Taylor
- Louisiana State University Health Sciences Center, Department of Medicine, Section of Infectious Diseases, New Orleans, Louisiana, USA
- LSU-CrescentCare Sexual Health Center, New Orleans, Louisiana, USA
| | - Isolde Butler
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Jason Halperin
- CrescentCare Federally Qualified Health Center, New Orleans, Louisiana, USA
| | - Meredith Edwards Clement
- Louisiana State University Health Sciences Center, Department of Medicine, Section of Infectious Diseases, New Orleans, Louisiana, USA
- LSU-CrescentCare Sexual Health Center, New Orleans, Louisiana, USA
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Clement ME, Nicchitta M, Sun Y, Ellis A, Chakraborty H, McGee K, Eagle C, Frye J, Taylor D, Okeke NL, Johnston B, Seña AC, McKellar M. Preexposure Prophylaxis Outcomes in an Urban Community in North Carolina: Discontinuation of Care and Sexually Transmitted Infections. Sex Transm Dis 2021; 48:183-188. [PMID: 33003182 PMCID: PMC7867579 DOI: 10.1097/olq.0000000000001288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have examined long-term outcomes among persons who initiate preexposure prophylaxis (PrEP) in the South, including PrEP discontinuation and sexually transmitted infection (STI) rates. METHODS Care discontinuation (>6 months without a PrEP appointment) and incident STIs were evaluated for patients at 2 PrEP clinics in Durham, NC. We tested for predictors of discontinuation as a binary variable using logistic regression. Model covariates included age, race/ethnicity, sex, known HIV-positive partner, commercial sex work, men who have sex with men (MSM) versus not MSM, type of insurance, and clinic site. A similar analysis was completed for STI incidence, controlling for days in the study. RESULTS Among 271 patients, mean age was 33.2 years, 46.9% were Black and 11.1% were Latino, 81.2% were MSM, and 32% were uninsured. Preexposure prophylaxis was discontinued in 47%, and another 11% had intermittent care. Sexually transmitted infection incidence was 45.4/100 person-years, and 5 patients were diagnosed with HIV at baseline or in follow-up. Men who have sex with men were less likely to discontinue PrEP relative to non-MSM (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.10-0.64). Baseline STI was associated with a higher likelihood of incident STI (OR, 8.19; 95% CI, 3.69-19.21), whereas care discontinuation was associated with a lower likelihood of STI (OR, 0.28; 95% CI, 0.11-0.65). CONCLUSIONS Preexposure prophylaxis programs in the Southern United States are reaching uninsured and predominantly Black and Latino MSM, but discontinuation rates are high despite elevated rates of incident STI and HIV. Further work is required to elucidate causes of PrEP discontinuation and encourage persistence in care.
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Affiliation(s)
| | | | - Ying Sun
- Duke Clinical Research Institute, Durham, NC
| | | | | | - Kara McGee
- Duke University School of Medicine, Durham, NC
| | - Cedar Eagle
- Durham Country Department of Public Health, Durham, NC
| | - Justin Frye
- Duke University School of Medicine, Durham, NC
| | | | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Barbara Johnston
- Lincoln Community Health Center, Durham, NC
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
| | - Arlene C. Seña
- Institute for Global Health and Infectious Diseases, University of North Carolina -Chapel Hill, NC
| | - Mehri McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC
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Teixeira da Silva D, Bouris A, Ramachandran A, Blocker O, Davis B, Harris J, Pyra M, Rusie LK, Brewer R, Pagkas-Bather J, Hotton A, Ridgway JP, McNulty M, Bhatia R, Schneider JA. Embedding a Linkage to Preexposure Prophylaxis Care Intervention in Social Network Strategy and Partner Notification Services: Results From a Pilot Randomized Controlled Trial. J Acquir Immune Defic Syndr 2021; 86:191-199. [PMID: 33109935 PMCID: PMC8103968 DOI: 10.1097/qai.0000000000002548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased preexposure prophylaxis (PrEP) uptake among black men who have sex with men and black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/ sexually transmitted infections testing may be an important strategy to accelerate PrEP uptake. SETTING Partner Services PrEP study is a pilot, randomized, control trial to improve linkage to PrEP care among BMSM/TW presenting for network services in Chicago, IL, from 2015 to 2017. METHODS BMSM/TW (N = 146) aged 18-40 years were recruited from network services (partners services and social network strategy services). Intervention participants developed an individualized linkage plan based on the information-motivation-behavioral skills model and received minibooster sessions. Control participants received treatment as usual. Sociodemographic, behavioral, and clinical factors were examined at baseline and 3- and 12-month postintervention. Intent-to-treat analyses examined linkage to PrEP care within 3-month postintervention (primary outcome). Secondary outcomes were PrEP initiation, time to linkage to PrEP care, and time to PrEP initiation. RESULTS Compared with control participants, a significantly greater proportion of the intervention participants were linked to PrEP care within 3 months (24% vs. 11%; P = 0.04) and initiated PrEP (24% vs. 11%; P = 0.05). Among those linked to PrEP care within the study period, intervention participants were linked significantly sooner than control participants [median (interquartile range) days, 26.5 (6.0-141.8) vs. 191.5 (21.5-297.0); P = 0.05]. CONCLUSION Study results support the preliminary efficacy of Partner Services PrEP to improve linkage to PrEP care and PrEP initiation among BMSM/TW.
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Affiliation(s)
- Daniel Teixeira da Silva
- Department of Combined Internal Medicine and Pediatrics, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | | | | | - Billy Davis
- Chicago Center for HIV Elimination, Chicago, IL
| | | | - Maria Pyra
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
| | | | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | - Jade Pagkas-Bather
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL
| | - Jessica P Ridgway
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | - Moira McNulty
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL
- Chicago Center for HIV Elimination, Chicago, IL
- Howard Brown Health, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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