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Gafos M, South A, Hanley B, Brodnicki E, Hodson M, McCormack S, Witzel TC, Harbottle J, Vale C. "PROUD to have been involved": an evaluation of participant and community involvement in the PROUD HIV prevention trial. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:13. [PMID: 32322408 PMCID: PMC7164163 DOI: 10.1186/s40900-020-00189-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND The PROUD trial, a HIV prevention trial in men who have sex with men and trans women, set out to involve community representatives and trial participants in several ways. PROUD also aimed to evaluate participant involvement, to learn lessons and make recommendations for future clinical trials. METHODS Two structured surveys, one of participant and community representatives involved in the PROUD study, and the other of researchers from the PROUD team, were carried out in 2017. The results from the surveys were reviewed quantitatively and qualitatively, and themes emerging from the data identified and synthesised. RESULTS Survey invitations were sent to 88 involved participants, 11 community representatives and 10 researchers. The overall response rate was 55% (60/109). Overall, participants were younger than community representatives, and the majority were from Greater London. As expected, participants were predominantly involved in participant involvement meetings and community representatives in management committees.Participants and community representatives cited different motivations for getting involved in PROUD. Overall, participants were positive about their involvement; only two participants rated their experience unfavourably. Community representatives were also broadly positive. Most participants and all community representatives felt their involvement made a difference to the trial, themselves and / or the organisations they represented. However, some participant answers reflected the impact of participation in the trial rather than involvement in PPI activities.Researchers felt that PPI had positive impact across the entire trial cycle. Half felt they would have liked there to have been more PPI activity in PROUD. Researchers noted some challenges and recommendations for the future, including need for adequate funding, more engagement in PPI by all researchers, the need for PPI expertise to facilitate involvement activities and training and mentoring in PPI. CONCLUSIONS Involving clinical trial participants and wider community representatives as active partners in PPI is feasible and valuable in trials. Researchers are encouraged to consider and appropriately resource participant involvement and prospectively evaluate all PPI within their trials.
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Affiliation(s)
- Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, WC1H 9SN UK
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Annabelle South
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - Bec Hanley
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | | | - Matthew Hodson
- NAM / aidsmap, Unit 19, St Mark’s Studios, 14 Chillingworth Road, London, N7 8QJ UK
| | - Sheena McCormack
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
| | - T. Charles Witzel
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Claire Vale
- MRC Clinical Trials Unit at UCL, 90 High Holborn, London, WC1V 6LJ UK
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O'Halloran C, Rice B, White E, Desai M, Dunn DT, McCormack S, Sullivan AK, White D, McOwan A, Gafos M. Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:246-254. [PMID: 31739177 PMCID: PMC6913514 DOI: 10.1016/j.drugpo.2019.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants. METHODS The PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI). RESULTS 1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90-1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline. CONCLUSIONS These analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.
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Affiliation(s)
- Charlotte O'Halloran
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Brian Rice
- LSHTM, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Ellen White
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Monica Desai
- University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - David T Dunn
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, 90 High Holborn, London WC1V 6LJ, United Kingdom.
| | - Ann K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, United Kingdom.
| | - David White
- Department of Infection, Hawthorn house, Heartlands Hospital, University of Birmingham Hospitals NHS Trust, Birmingham B9 5SS, United Kingdom.
| | - Alan McOwan
- Chelsea and Westminster Hospital NHS Foundation Trust, 56 Dean Street, London W1D 6AE, United Kingdom.
| | - Mitzy Gafos
- LSHTM, Faculty of Public Health and Policy, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
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Masyuko S, Mukui I, Njathi O, Kimani M, Oluoch P, Wamicwe J, Mutegi J, Njogo S, Anyona M, Muchiri P, Maikweki L, Musyoki H, Bahati P, Kyongo J, Marwa T, Irungu E, Kiragu M, Kioko U, Ogando J, Were D, Bartilol K, Sirengo M, Mugo N, Baeten JM, Cherutich P, PrEP Technical Working Group OBOT. Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study. Sex Health 2019; 15:578-586. [PMID: 30408432 DOI: 10.1071/sh18090] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/29/2018] [Indexed: 12/20/2022]
Abstract
Background While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden. METHODS This paper details Kenya's experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs. RESULTS PrEP is now offered in over 900 facilities countrywide. There are currently over 14000 PrEP users 1 year after launching PrEP. CONCLUSIONS Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics.
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Affiliation(s)
- Sarah Masyuko
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Irene Mukui
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Olivia Njathi
- Clinton Health Access Initiative, Timau Plaza, 3rd Floor, Argwings Kodhek Road, Nairobi, Kenya
| | - Maureen Kimani
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Patricia Oluoch
- Centers for Disease Control, KEMRI Complex, Mbagathi Road off Mbagathi Way, Nairobi, Kenya
| | - Joyce Wamicwe
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Jane Mutegi
- Jhpiego, Ring Road, 14 Riverside, Nairobi, Kenya
| | - Susan Njogo
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Micah Anyona
- Jhpiego, Ring Road, 14 Riverside, Nairobi, Kenya
| | - Phillip Muchiri
- Clinton Health Access Initiative, Timau Plaza, 3rd Floor, Argwings Kodhek Road, Nairobi, Kenya
| | - Lucy Maikweki
- Population Services International, Lenana Road, Jumuia Place, Wing B, 2nd Floor, Nairobi, Kenya
| | - Helgar Musyoki
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Prince Bahati
- International AIDS Vaccine Initiative, ABC Place, Building 2, 3rd Floor, Waiyaki Way, Nairobi, Kenya
| | | | - Tom Marwa
- Jhpiego, Ring Road, 14 Riverside, Nairobi, Kenya
| | - Elizabeth Irungu
- Kenya Medical Research Institute, Centre for Clinical Research Laboratories, Nairobi, Kenya
| | | | - Urbanus Kioko
- University of Nairobi, School of Economics, Nairobi, Kenya
| | - Justus Ogando
- Clinton Health Access Initiative, Timau Plaza, 3rd Floor, Argwings Kodhek Road, Nairobi, Kenya
| | - Dan Were
- Jhpiego, Ring Road, 14 Riverside, Nairobi, Kenya
| | - Kigen Bartilol
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Martin Sirengo
- The National AIDS and STI Control Program, Ministry of Health, Afya Annex, Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Nelly Mugo
- Kenya Medical Research Institute, Centre for Clinical Research Laboratories, Nairobi, Kenya
| | - Jared M Baeten
- University of Washington, 510 San Juan Road, Seattle, WA 98195, USA
| | - Peter Cherutich
- Ministry of Health - Department of Preventive and Promotive Services, Cathedral Road, Nairobi, Kenya
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The Context of Sexual Risk Behaviour Among Men Who Have Sex with Men Seeking PrEP, and the Impact of PrEP on Sexual Behaviour. AIDS Behav 2019; 23:1708-1720. [PMID: 30306439 PMCID: PMC6570678 DOI: 10.1007/s10461-018-2300-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There are still important gaps in our understanding of how people will incorporate PrEP into their existing HIV prevention strategies. In this paper, we explore how PrEP use impacted existing sexual risk behaviours and risk reduction strategies using qualitative data from the PROUD study. From February 2014 to January 2016, we conducted 41 in-depth interviews with gay, bisexual and other men who have sex with men (GBMSM) enrolled in the PROUD PrEP study at sexual health clinics in England. The interviews were conducted in English and were audio-recorded. The recordings were transcribed, coded and analysed using framework analysis. In the interviews, we explored participants’ sexual behaviour before joining the study and among those using or who had used PrEP, changes to sexual behaviour after starting PrEP. Participants described the risk behaviour and management strategies before using PrEP, which included irregular condom use, sero-sorting, and strategic positioning. Participants described their sexual risk taking before initiating PrEP in the context of the sexualised use of drugs, geographical spaces linked with higher risk sexual norms, and digitised sexual networking, as well as problematic psychological factors that exacerbated risk taking. The findings highlight that in the main, individuals who were already having frequent condomless sex, added PrEP to the existing range of risk management strategies, influencing the boundaries of the ‘rules’ for some but not all. While approximately half the participants reduced other risk reduction strategies after starting PrEP, the other half did not alter their behaviours. PrEP provided an additional HIV prevention option to a cohort of GBMSM at high risk of HIV due to inconsistent use of other prevention options. In summary, PrEP provides a critical and necessary additional HIV prevention option that individuals can add to existing strategies in order to enhance protection, at least from HIV. As a daily pill, PrEP offers protection in the context of the sex cultures associated with sexualised drug use, digitised sexual applications and shifting social norms around sexual fulfilment and risk taking. PrEP can offer short or longer-term options for individuals as their sexual desires change over their life course offering protection from HIV during periods of heightened risk. PrEP should not be perceived or positioned in opposition to the existing HIV prevention toolkit, but rather as additive and as a tool that can and is having a substantial impact on HIV.
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Witzel TC, Nutland W, Bourne A. What are the motivations and barriers to pre-exposure prophylaxis (PrEP) use among black men who have sex with men aged 18-45 in London? Results from a qualitative study. Sex Transm Infect 2019; 95:262-266. [PMID: 30833366 PMCID: PMC6585870 DOI: 10.1136/sextrans-2018-053773] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/11/2018] [Accepted: 01/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Black men who have sex with men (BMSM) have higher HIV incidence and prevalence when compared with other men who have sex with men, despite similar risk profiles. New prevention technologies, including pre-exposure prophylaxis (PrEP), may be effective in responding to these inequalities, provided they are appropriately targeted and acceptable to their intended beneficiaries. This study aims to understand the motivations and barriers of BMSM aged 18-45 to PrEP uptake. METHODS Twenty-five BMSM recruited through geolocation social networking apps took part in in-depth interviews between April and August 2016. Intersectionality theory was used as an organising principle. Interviews were transcribed verbatim and analysed using a thematic framework analysis. RESULTS For BMSM with heterogeneous social groups, discussions about sexual health were challenging because of the intersection of ethnic background, family history and religion. This limited conversations about PrEP to gay male friends who often held stigmatising views of condomless anal intercourse. BMSM reported exclusion from gay male spaces (online and offline) which could serve to restrict exposure to PrEP messages. Stereotypes of BMSM intersected with negative conceptions of PrEP users, limiting acknowledgement of PrEP candidacy. For those who had attempted to or successfully accessed it, PrEP was framed as a strategy to mitigate risk and to guard against further stigma associated with HIV infection. DISCUSSION BMSM operate within a complex set of circumstances related to the intersection of their sexual, ethnic, cultural and religious identities, which shape PrEP acceptability. Interventions which seek to facilitate uptake in this group must be attentive to these. Health promotion and clinical services could seek to facilitate nuanced discussions about the merits of PrEP for those at frequent risk, perhaps while also providing publicly visible PrEP role models for BMSM and other marginalised groups.
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Affiliation(s)
- T Charles Witzel
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Will Nutland
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre for Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
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Gooding K, Phiri M, Peterson I, Parker M, Desmond N. Six dimensions of research trial acceptability: how much, what, when, in what circumstances, to whom and why? Soc Sci Med 2018; 213:190-198. [PMID: 30142500 PMCID: PMC7614255 DOI: 10.1016/j.socscimed.2018.07.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
Ethics guidelines emphasise that research should be acceptable to the people invited to take part. However, acceptability is subjective and dependent on context, complicating its assessment and use as an ethical standard. This paper examines the concept of acceptability in relation to parents' perspectives on a paediatric vaccine trial in Malawi. We examined decisions on participation and experiences of the trial through interviews with parents in 41 households invited to enrol their children and participant observation of trial processes. Fieldwork took place in Chikwawa, Southern Malawi from February-October 2016. Parents were not neatly split between those who saw the trial as acceptable and those who did not; instead there were mixed and changing feelings among parents who enrolled their children, and among those who withdrew or did not take part. Some parents agreed to participate but had concerns about the trial, while others expressed satisfaction with the trial but still did not take part. These experiences indicate substantial variation in the nature of acceptance. We describe these variations in relation to six dimensions of acceptability: how acceptable the trial is, what aspects are acceptable, changes over time, circumstances affecting acceptability, variations between people, and reasons for participation or non-participation. The findings illustrate the difficulty of determining whether a trial is sufficiently acceptable to potential participants. We suggest that clarifying definitions of acceptability and examining how acceptability varies in degree, between trial components, over time, and between people and contexts may help researchers generate more nuanced descriptions of acceptability that support responsive and ethical trial design.
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Affiliation(s)
- Kate Gooding
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Mackwellings Phiri
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.
| | - Ingrid Peterson
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Michael Parker
- Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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