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Weinstein ER, Broos HC, Lozano A, Jones MA, Serrano LP, Harkness A. Longitudinal predictors of post-exposure prophylaxis awareness among latino sexual minority men in South Florida. J Behav Med 2024; 47:434-445. [PMID: 38409554 DOI: 10.1007/s10865-024-00466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024]
Abstract
Biomedical tools for HIV prevention such as post-exposure prophylaxis (PEP) continue to be underutilized by subgroups experiencing significant HIV inequities. Specifically, factors associated with both PEP awareness and uptake both cross-sectionally and longitudinally are under-researched, despite PEP being a part of the United States' Plan for Ending the HIV Epidemic. The current study examined longitudinal predictors of PEP awareness among Latino sexual minority men (LSMM) living in South Florida. This current study (N = 290) employed hierarchal linear modeling across three timepoints (baseline, 4-months, 8-months) to assess within-person and between-person effects over time for several psychosocial and structural factors. Most participants (67.5%) reported little to no awareness of PEP at baseline with general PEP awareness growing slightly across the study (60.5% reporting little to no awareness of PEP at 8 months). Results of the final conditional model suggest significant within-person effects of PrEP knowledge (p = 0.02) and PrEP self-efficacy (p < 0.001), as well as a significant positive between-person effect of PrEP knowledge (p < 0.01) on PEP awareness. Between-person HIV knowledge was also a significant predictor in this model (p = 0.01). This longitudinal analysis of LSMM's PEP awareness indicates that more must be done to increase PEP awareness among this subgroup. Future studies should explore how to build on existing interventions focused on HIV and PrEP knowledge and PrEP self-efficacy to incorporate information about PEP to increase the reach of this effective biomedical HIV prevention tool.
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Affiliation(s)
| | - Hannah C Broos
- Department of Psychology, University of Miami, Coral Gables, USA
| | - Alyssa Lozano
- School of Nursing and Health Studies, University of Miami, Coral Gables, USA
| | - Megan A Jones
- Department of Psychology, University of Miami, Coral Gables, USA
| | | | - Audrey Harkness
- Department of Psychology, University of Miami, Coral Gables, USA.
- School of Nursing and Health Studies, University of Miami, Coral Gables, USA.
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McCormick CD, Sullivan PS, Qato DM, Crawford SY, Schumock GT, Lee TA. Adherence and persistence of HIV pre-exposure prophylaxis use in the United States. Pharmacoepidemiol Drug Saf 2024; 33:e5729. [PMID: 37937883 DOI: 10.1002/pds.5729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/21/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To describe medication adherence and persistence of HIV PrEP overall and compare between sex and age groups of commercially insured individuals in the United States. METHODS We conducted a national retrospective cohort study of the Merative MarketScan Claims Database from 2011 to 2019 to describe adherence and persistence of PrEP overall and compared between sex and age groups. High adherence was defined as ≥80% of proportion of days covered and persistence was measured in days from initiation to the first day of a 60-day treatment gap. RESULTS A total of 29 689 new PrEP users identified. Overall adherence was high (81.9%; 95% confidence interval [CI]: 81.5%-82.3%). Females were more adherent than males (adjusted odds ratio [aOR] 1.87; 95% CI: 1.50-2.34), while those ≥45-years were less adherent than individuals <45-years (aOR 0.87: 95% CI: 0.81-0.93). More than half of individuals discontinued therapy within the first year (median 238.0 days; interquartile range 99.0-507.0 days). Females were less persistent than males (hazard ratio [HR] 1.49; 95% CI: 1.34-1.65), and people ≥45-years old were more persistent (i.e., lower risk of discontinuation) than those <45-years (HR 0.43; 95% CI: 0.33-0.55). CONCLUSIONS These findings show adherence to daily PrEP is high among commercially insured individuals but the majority still discontinue in the first year. Future research should investigate what factors influence PrEP discontinuation among this population and ways to reduce barriers to therapy maintenance to ensure the population-level benefits of PrEP treatment.
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Affiliation(s)
- Carter D McCormick
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California, School of Pharmacy, Los Angeles, California, USA
- USC Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
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Ma J, Chase GE, Black A, Klaphake J, Garcia-Myers K, Baker JV, Horvath KJ. Attitudes Toward and Beliefs in the Effectiveness of Biomedical HIV Prevention Strategies Among Emerging and Young Adult Sexual Minority Men. Int J Behav Med 2023:10.1007/s12529-023-10244-4. [PMID: 38114707 DOI: 10.1007/s12529-023-10244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) and HIV treatment as prevention, which underlies the Undetectable = Untransmittable (U = U) campaign, are two effective biomedical approaches for HIV prevention among sexual minority men (SMM). Attitudes toward PrEP and U = U may differ between SMM emerging adults (EA: 18-24 years old) and young adults (YA: 25-29 years old) to drive differences in sexual behavior. However, to date, few studies assessed the degree to which YAs and EAs differ in their beliefs in the effectiveness of PrEP and U = U. METHOD A national sample of 80 SMM in the USA (Mage = 25.1 years; 53.7% racial/ethnic minority; 38.8% EA; 61.3% YA) participated in a 6-month mHealth intervention for PrEP adherence. Non-parametric tests assessed differences in sexual behaviors and attitudes toward the effectiveness of PrEP and U = U between EAs and YAs using baseline data. RESULTS Compared to EAs, higher proportions of YAs trusted PrEP's effectiveness and considered condom use unnecessary after taking PrEP. More YAs than EAs were willing to engage in sexual behaviors that they felt too risky before learning about U = U and were more comfortable having condomless sex with HIV-positive partners. Conversely, a greater proportion of EAs than YAs preferred to use condoms even when their partners are on anti-HIV medications. CONCLUSION Overall, YAs trusted the effectiveness of U = U and PrEP more than EAs, underscoring developmental differences in SMM's perspectives on biomedical HIV prevention tools. Our findings underscore the importance of tailoring messages on biomedical HIV prevention options differently for EAs and YAs to optimize uptake.
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Affiliation(s)
- Junye Ma
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA.
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
| | - Gregory E Chase
- Department of Psychology, The University of North Carolina at Greensboro, 296 Eberhart Building, Greensboro, NC, 27402, USA
| | - Ashley Black
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Jonathan Klaphake
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Kelly Garcia-Myers
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, 701 Park Avenue, Minneapolis, MN, 55415, USA
- Department of Medicine, University of Minnesota, 401 East River Parkway VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA
| | - Keith J Horvath
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
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Zhang Y, Shi L, Fu G, Yang C, Zaller ND, Wei C, Yan H. Willingness to use and intention to adhere to pre-exposure prophylaxis (PrEP) among men who have sex with men in Jiangsu Province, China. AIDS Care 2023; 35:1386-1394. [PMID: 37075742 PMCID: PMC10523904 DOI: 10.1080/09540121.2023.2200992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2023] [Indexed: 04/21/2023]
Abstract
ABSTRACTPre-exposure prophylaxis (PrEP) is a biomedical prevention approach that significantly reduces HIV acquisition. Our study aimed to explore factors associated with PrEP willingness and intention to adhere to PrEP among MSM through a cross-sectional survey in Nanjing, Jiangsu province, China. Location sampling (TLS) and online recruitment were used to recruit participants to gauge their PrEP willingness and intention to adhere. Of 309 HIV-negative/unknown serostatus MSM, 75.7% were willing to use PrEP and 55.3% had high intention to take PrEP daily. Willingness to use PrEP was positively associated with having a college degree or higher (AOR = 1.90, 95%CI: 1.11-3.26) and higher anticipated HIV stigma (AOR = 2.74, 95%CI: 1.13-6.61). Facilitators of intention to adhere included higher education levels (AOR = 2.12, 95%CI: 1.33-3.39) and higher anticipated HIV stigma (AOR = 3.65, 95%CI: 1.36-9.80), whereas a primary barrier was community homophobia (AOR = 0.43, 95%CI: 0.20-0.92). This study documented high willingness to use PrEP, yet lower intention to adhere to PrEP in a sample of MSM in China. Public interventions and programs to promote adherence of PrEP for MSM is urgently needed in China. Psychosocial factors should be addressed and taken into consideration for PrEP implementation and adherence programs.
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Affiliation(s)
- Ying Zhang
- Xuzhou Center for Disease Control and Prevention, Xuzhou, China
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Cui Yang
- Johns Hopkins Bloomberg School of Public Health
| | - Nickolas D Zaller
- College of Public Health, University of Arkansas for Medical Sciences
| | | | - Hongjing Yan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Haberer JE, Mujugira A, Mayer KH. The future of HIV pre-exposure prophylaxis adherence: reducing barriers and increasing opportunities. Lancet HIV 2023:S2352-3018(23)00079-6. [PMID: 37178710 DOI: 10.1016/s2352-3018(23)00079-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 05/15/2023]
Abstract
The effectiveness of HIV pre-exposure prophylaxis (PrEP) hinges on adherence, which has been restricted by multifaceted barriers. Uptake of PrEP has been impeded by poor access resulting from high costs, provider uncertainty, discrimination, stigma, and poor understanding within the health-care community and the public of who can benefit from PrEP. Other important barriers to adherence and persistence over time relate to individuals (eg, depression) and their community, partners, and family (eg, poor support), and their effects vary substantially with each person, population, and setting. Despite these challenges, key opportunities for improving PrEP adherence exist, including novel delivery systems, tailored individual interventions, mobile health and digital health interventions, and long-acting formulations. Objective monitoring strategies will help to improve adherence interventions and alignment of PrEP use with the need for HIV prevention (ie, prevention-effective adherence). The future of PrEP adherence lies in person-centred approaches to service delivery that meet the needs of individuals while creating supportive environments and facilitating health-care access and delivery.
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Affiliation(s)
- Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala, Uganda; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kenneth H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA; The Fenway Institute, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Sullivan PS, Hall E, Bradley H, Sanchez T, Woodyatt CR, Russell ES. Estimating HIV Incident Diagnoses Among Men Who Have Sex With Men Eligible for Pre-exposure Prophylaxis but Not Taking It: Protocol and Feasibility Assessment of Data Sources and Methods. JMIR Res Protoc 2023; 12:e42267. [PMID: 36881450 PMCID: PMC10031441 DOI: 10.2196/42267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/27/2022] [Accepted: 01/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND HIV incidence estimates are published each year for all Ending the HIV Epidemic (EHE) counties, but they are not stratified by the demographic variables highly associated with risk of infection. Regularly updated estimates of HIV incident diagnoses available at local levels are required to monitor the epidemic in the United States over time and could contribute to background incidence rate estimates for alternative clinical trial designs for new HIV prevention products. OBJECTIVE We describe methods using existing, robust data sources within areas in the United States to reliably estimate longitudinal HIV incident diagnoses stratified by race and age categories among men who have sex with other men (MSM) eligible for pre-exposure prophylaxis (PrEP) but not taking it. METHODS This is a secondary analysis of existing data sources to develop new estimates of incident HIV diagnoses in MSM. We reviewed past methods used to estimate incident diagnoses and explored opportunities to improve these estimates. We will use existing surveillance data sources and population sizes of HIV PrEP-eligible MSM estimated from population-based data sources (eg, US Census data and pharmaceutical prescription databases) to develop metropolitan statistical area-level estimates of new HIV diagnoses among PrEP-eligible MSM. Required parameters are number of new diagnoses among MSM, estimates of MSM with an indication for PrEP, and prevalent PrEP use including median duration of use; these parameters will be stratified by jurisdiction and age group or race or ethnicity. Preliminary outputs will be available in 2023, and updated estimates will be produced annually thereafter. RESULTS Data to parameterize new HIV diagnoses among PrEP-eligible MSM are available with varying levels of public availability and timeliness. In early 2023, the most recent available data on new HIV diagnoses were from the 2020 HIV surveillance report, which reports 30,689 new HIV infections in 2020, and 24,724 of them occurred in an MSA with a population of ≥500,000. Updated estimates for PrEP coverage based on commercial pharmacy claims data through February 2023 will be generated. The rate of new HIV diagnoses among MSM can be estimated from new diagnoses within each demographic group (numerator) and the total person-time at risk of diagnosis for each group (denominator) by metropolitan statistical area and year. To estimate time at risk, the person-time of individuals on PrEP or person-time after incident HIV infection but before diagnosis should be removed from stratified population size estimates of the total number of person-years with indications for PrEP. CONCLUSIONS Reliable, serial, cross-sectional estimates for rates of new HIV diagnoses for MSM with PrEP indications can serve as benchmark community estimates of failures of HIV prevention and opportunities to improve services and will support public health epidemic monitoring and alternative clinical trial designs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42267.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Eric Hall
- Department of Epidemiology, School of Public Health, Oregon Health Sciences University, Portland, OR, United States
| | - Heather Bradley
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cory R Woodyatt
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Mansergh G, Kota KK, Carnes N, Gelaude D. Brief Report: Refusal of Daily Oral PrEP: Implementation Considerations and Reported Likelihood of Using Various HIV Prophylaxis Products in a Diverse Sample of MSM. J Acquir Immune Defic Syndr 2023; 92:212-6. [PMID: 36442153 DOI: 10.1097/QAI.0000000000003134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND An important subgroup of gay, bisexual, and other men who have sex with men (MSM) with behavioral indications refuse daily oral pre-exposure prophylaxis (PrEP) when recommended by a provider. Emerging HIV prophylaxis products (eg, injectable, event-driven) offer more options to MSM who refuse daily PrEP. In this article, we assess reasons for refusal and likelihood to use various products among MSM who refused PrEP. METHODS MSM who reported anal sex without condoms or PrEP and refused daily oral PrEP in the past 6 months were recruited through clinics, community venues, and online in Atlanta, Chicago, and Raleigh-Durham. Men were asked their main reason for recently refusing daily PrEP and likelihood of using various PrEP options in the future. Bivariate and multivariable regression models were used to estimate associations. RESULTS MSM (n = 93; 70% Black, 48% age 18-29 years) reported their main reason for refusing daily PrEP were potential side effects (35%), a daily pill regimen (22%), and not having enough information (18%). Reported likelihood of using PrEP products was 58% for penile gel, 54% for event-driven oral, 52% for injectable, and 50% for daily PrEP. MSM who reported daily regimen as the main reason for refusing PrEP had greater odds of likelihood to use an injectable [adjusted odds ratio (AOR) = 5.21, 95% confidence interval (CI): 1.32 to 20.52]. Younger men (18-29 vs 30+ years) had greater odds of likelihood to use condoms (AOR = 3.40, 95% CI: 1.15 to 10.04) and daily PrEP (AOR = 2.76, 95% CI: 1.06 to 7.16); there were no product preference differences by race. CONCLUSION Most men who refused daily PrEP indicated likelihood of using some form of PrEP in the future.
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Philpot SP, Murphy D, Chan C, Haire B, Wells N, Fraser D, Grulich AE, Bavinton BR. Identifying Patterns of Discontinuing and Recommencing Pre-exposure Prophylaxis in the Context of Sexual Behavior Among Gay and Bisexual Men in Australia. AIDS Behav 2023:10.1007/s10461-023-04013-3. [PMID: 36811738 PMCID: PMC9945832 DOI: 10.1007/s10461-023-04013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/24/2023]
Abstract
We mapped gay and bisexual men's (GBM) patterns of using pre-exposure prophylaxis (PrEP) over time and explored sexual behavior as PrEP use changed. We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBM living in Australia who had changed their PrEP use since initiating. There was considerable diversity in patterns of discontinuation, suspension, and recommencement of PrEP. Reasons for changing PrEP use mostly centered on accurate perceived changes to HIV risk. Twelve participants reported condomless anal intercourse with casual or fuckbuddy partners after discontinuing PrEP. These sex events were unanticipated, condoms were not a preferred option, and other risk reduction strategies were applied inconsistently. Service delivery and health promotion can support safer sex among GBM when PrEP use fluctuates by promoting event-driven PrEP and/or non-condom-based risk reduction methods during periods off daily PrEP, and guiding GBM to better recognize changing circumstances of risk and when to recommence PrEP.
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Affiliation(s)
- Steven P. Philpot
- Level 6, Wallace Wurth Building, High St, Kensington, NSW 2052 Australia
| | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia ,Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | | | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, Australia
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Mansergh G, Sullivan PS, Kota KK, Daskalakis D. Pre-exposure prophylaxis in the era of emerging methods for men who have sex with men in the USA: the HIV Prevention Cycle of Care model. Lancet HIV 2023; 10:e134-42. [PMID: 36525980 DOI: 10.1016/S2352-3018(22)00309-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
Expanding on previous work, we present an HIV Prevention Cycle of Care model to facilitate understanding of the complexity of issues involved in pre-exposure prophylaxis implementation for gay, bisexual, and other men who have sex with men (MSM) in the USA, including individual, client-provider, and overarching issues such as health equity, stigma, and prevention nomenclature. The HIV prevention cycle of care applies to MSM who test negative for HIV. The Prevention Cycle of Care model includes seven steps: prevention knowledge, prevention self-awareness and preferences, prevention motivation, health-care access and cost, provider issues, adherence and persistence, and periodic reassessment and adjustment. HIV prevention is complex in an era of emerging multiple modalities, and more research is needed to successfully implement pre-exposure prophylaxis options over time and across diverse communities of MSM who are sexually active.
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Meanley S, Egan JE, Ware D, Brennan-Ing M, Haberlen SA, Detels R, Palella F, Friedman MR, Plankey MW. Self-Reported Combination HIV Prevention Strategies Enacted by a Prospective Cohort of Midlife and Older Men Who Have Sex with Men in the United States: A Latent Class Analysis. AIDS Patient Care STDS 2022; 36:462-473. [PMID: 36394465 PMCID: PMC9839341 DOI: 10.1089/apc.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Insights into combination HIV prevention (CHP) strategies to reduce HIV incidence among midlife and older adult men who have sex with men (MSM) are limited. The current study is a secondary data analysis evaluating CHP in a sample of sexually active midlife and older adult MSM (N = 566) from the Multicenter AIDS Cohort Study Healthy Aging Substudy. Stratified by HIV serostatus, we used latent class analyses to identify CHP classes based on self-reported sociobehavioral and biobehavioral prevention strategies that participants and their male partners used in the prior 6 months. We identified three CHP classes among men living without HIV (MLWOH), including the following: high CHP overall (43.0%), high anal sex abstention (15.0%), and low prevention overall (42.0%). Among men living with HIV (MLWH), we identified four CHP classes, including the following: high CHP overall (20.9%), high CHP/low condom use (27.1%), high condom reliance (22.3%), and low prevention overall (29.7%). There were small differences by sociodemographic characteristics and sexual behavior practices between the classes; however, poppers use was often linked to being in high CHP groups. Our findings support that CHP is not one-size-fits-all for midlife and older adult MSM. There remains a need to scale up clinical providers' sexual health communication practices to assist midlife and older MSM incorporate prevention strategies, particularly biobehavioral prevention strategies that align with their patients' lived experiences.
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Affiliation(s)
- Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York City, New York, USA
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roger Detels
- Department of Epidemiology and Infectious Diseases, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Frank Palella
- Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mackey R. Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michael W. Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
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Argenyi MS, Molotnikov LE, Leach DH, Roosevelt KA, Klevens RM, Hsu KK. Gaps in HIV PrEP Care Following State Partner Services for Massachusetts Primary and Secondary Syphilis Cases, 2017-2018. Sex Transm Dis 2022. [PMID: 35797587 DOI: 10.1097/OLQ.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Murphy M, Sosnowy C, Rogers B, Napoleon S, Galipeau D, Scott T, Tao J, Berk J, Clarke J, Nunn A, Chan PA. Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2022; 11:e31928. [PMID: 35142633 PMCID: PMC8874820 DOI: 10.2196/31928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background HIV disproportionately impacts criminal justice–involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. Objective The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition. Methods This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. Results The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. Conclusions Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic. International Registered Report Identifier (IRRID) DERR1-10.2196/31928
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Affiliation(s)
| | | | | | | | | | - Ty Scott
- Brown University, Providence, RI, United States
| | - Jun Tao
- Brown University, Providence, RI, United States
| | - Justin Berk
- Brown University, Providence, RI, United States
| | | | - Amy Nunn
- Brown University, Providence, RI, United States
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Dai M, Calabrese C. Socio-behavioral factors related to PrEP non-adherence among gay male PrEP users living in California and New York: A behavioral theory informed approach. J Behav Med 2022. [PMID: 34989927 DOI: 10.1007/s10865-021-00275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
One effective preventative measure to reduce the number of new HIV infections is through the uptake of daily oral HIV pre-exposure prophylaxis (PrEP). Although previous clinical trials have proven the effectiveness of on-demand PrEP uptake, daily PrEP uptake is the most popular prevention method among PrEP users and is still recommended by most healthcare professionals and organizations. Informed by the integrative model of behavioral prediction, the current study examined the socio-behavioral factors associated with PrEP non-adherence. The present study conducted a cross-sectional survey of 210 gay male daily PrEP users living in California and New York. The results showed more than two-thirds of the sample indicated that they had skipped taking PrEP within the last 30 days, averaging around four to five missed doses. General attitudes toward desirable and undesirable outcomes, perceived behavioral control, and social-level barriers were associated with daily PrEP uptake non-adherence. The findings highlight providers' role in PrEP adherence and the importance of habit-forming, which can be enhanced by cost-effective strategies and technological innovations.
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Azhar S, Tao X, Jokhakar V, Fisher CB. Barriers and Facilitators to Participation in Long-Acting Injectable PrEP Research Trials for MSM, Transgender Women, and Gender-Nonconforming People of Color. AIDS Educ Prev 2021; 33:465-482. [PMID: 34874761 PMCID: PMC10916744 DOI: 10.1521/aeap.2021.33.6.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We collected 216 responses from sexually active MSM, transgender women, and gender-nonconforming (GNC) people of color through a web-based survey to understand the facilitators and barriers to research participation in a hypothetical LAI PrEP trial. In adjusted models, these items were found to be significantly associated with research participation likelihood: ever participated in HIV research study; comfort with taking daily pill; comfort with providing urine sample; and concerns over potential side effects of shot. Asian participants were more concerned about others knowing they were being recruited than were Black and Latinx respondents F(2, 216) = 3.98; p < .05. Asian respondents were also less comfortable with being recruited at organizations serving communities of color than Black and Latinx respondents, F(2, 216) = 5.10; p < .05. Cisgender respondents were more comfortable with being recruited by a friend or colleague than were transgender/GNC respondents, F(1, 215) = 4.8; p < .05.
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