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Skakoon-Sparling S, Card KG, Novick JR, Berlin GW, Lachowsky NJ, Adam B, Brennan DJ, Sang JM, Noor SW, Cox J, Moore DM, Grace D, Grey C, Daroya E, Hart TA. The relevance of communal altruism for sexual minority men in contemporary contexts. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1461-1478. [PMID: 35932490 DOI: 10.1002/jcop.22923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 05/23/2023]
Abstract
There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well-being of their community/in-group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus (HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer-sex-related attitudes (e.g., HIV treatment optimism-skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well-being of their in-group (i.e., the GBM community).
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Affiliation(s)
- Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jake R Novick
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Graham W Berlin
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Barry Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Ontario, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Kinesiology & Health Science, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Joseph Cox
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornel Grey
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emerich Daroya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Process description of developing HIV prevention monitoring indicators for a province-wide pre-exposure prophylaxis (PrEP) program in British Columbia, Canada. PLoS One 2023; 18:e0283025. [PMID: 36920956 PMCID: PMC10016663 DOI: 10.1371/journal.pone.0283025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
In 2018, the pre-exposure prophylaxis (PrEP) program was initiated in British Columbia (BC), Canada, providing PrEP at no cost to qualifying residents. This observational study discussed the steps to develop key evidence-based monitoring indicators and their calculation using real-time data. The indicators were conceptualized, developed, assessed and approved by the Technical Monitoring Committee of representatives from five health authority regions in BC, the BC Ministry of Health, the BC Centre for Disease Control, and the BC Centre for Excellence in HIV/AIDS. Indicator development followed the steps adopted from the United States Centers for Disease Control and Prevention framework for program evaluation in public health. The assessment involved eight selection criteria: data quality, indicator validity, existing scientific evidence, indicator informativeness, indicator computing feasibility, clients' confidentiality maintenance capacity, indicator accuracy, and administrative considerations. Clients' data from the provincial-wide PrEP program (January 2018-December 2020) shows the indicators' calculation. The finalized 14 indicators included gender, age, health authority, new clients enrolled by provider type and by the health authority, new clients dispensed PrEP, clients per provider, key qualifying HIV risk factor(s), client status, PrEP usage type, PrEP quantity dispensed, syphilis and HIV testing and incident cases, and adverse drug reaction events. Cumulative clients' data (n = 6966; 99% cis-gender males) identified an increased new client enrollment and an unexpected drop during the COVID-19 pandemic. About 80% dispensed PrEP from the Vancouver Coastal health authority. The HIV incidence risk index for men who have sex with men score ≥10 was the most common qualifying risk factor. The framework we developed integrating indicators was applied to monitor our PrEP program, which could help reduce the public health impact of HIV.
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Sang JM, McAllister K, Wang L, Barath J, Lal A, Parlette A, Noor SW, Apelian H, Skakoon‐Sparling S, Hull M, Moore DM, Cox J, Hart TA, Lambert G, Grace D, Jollimore J, Hogg RS, Lachowsky NJ. Examining provincial PrEP coverage and characterizing PrEP awareness and use among gay, bisexual and other men who have sex with men in Vancouver, Toronto and Montreal, 2017-2020. J Int AIDS Soc 2022; 25:e26017. [PMID: 36306245 PMCID: PMC9616170 DOI: 10.1002/jia2.26017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Accessibility of pre-exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out-of-pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use. METHODS Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent-driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self-reported HIV-negative/unknown GBM. RESULTS Of 2008 self-identified HIV-negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all p<0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (p<0.001), Toronto 21.4-31.4% (p<0.001) and Vancouver 21.7-59.5% (p<0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60-2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68-1.18). CONCLUSIONS Full free-of-charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.
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Affiliation(s)
- Jordan M. Sang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Kate McAllister
- School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | | | - Syed W. Noor
- Ryerson UniversityTorontoOntarioCanada,School of Human SciencesLouisiana State University ShreveportShreveportLouisianaUSA
| | - Herak Apelian
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | | | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Joseph Cox
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | - Trevor A. Hart
- Ryerson UniversityTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Gilles Lambert
- Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada,Institut national de santé publique du QuébecMontréalQuebecCanada
| | | | - Jody Jollimore
- Community Based Research CentreVancouverBritish ColumbiaCanada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,Simon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada,Community Based Research CentreVancouverBritish ColumbiaCanada
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Brennan DJ, Kesler MA, Davies AWJ, Ablona A, Collict D. Online Sexual Health Information Seeking Patterns Differentiated by Social Location and Physical Location among Gay and Bisexual Men in Ontario, Canada. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:627-643. [PMID: 38596392 PMCID: PMC10903633 DOI: 10.1080/19317611.2022.2091076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 04/11/2024]
Abstract
Objective This research aimed to understand the varying needs of diverse gay and bisexual men (GBM) in relation to online sexual health information-seeking dependent upon differing social sociodemographic variables and geographic location. Methods A total of 1802 GBM in Ontario participated in this study. Multivariable regressions were conducted to analyze differences in information-seeking based on ethnicity group, HIV status, recent sexual behavior and regionality (urban and rural location). Results There were significant differences in online sexual health information-seeking content based on these demographic variables. Conclusions Implications for sexual health outreach and service provision for diverse GBM are discussed as well.
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Maya A. Kesler
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Adam W. J. Davies
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Aidan Ablona
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - David Collict
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
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5
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Hart TA, Noor SW, Berlin GW, Skakoon-Sparling S, Tavangar F, Tan D, Lambert G, Grace D, Lachowsky NJ, Jollimore J, Sang J, Parlette A, Lal A, Apelian H, Moore D, Cox J. Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men. Sex Transm Infect 2022; 99:167-172. [PMID: 35701145 PMCID: PMC10176373 DOI: 10.1136/sextrans-2021-055381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES While pre-exposure prophylaxis (PrEP) prevents HIV acquisition among gay, bisexual and other men who have sex with men (GBM), PrEP-using GBM may be more likely to engage in sexual behaviours associated with bacterial STIs. We examined associations between PrEP use, condomless anal sex (CAS), number of anal sex partners, oral sex and bacterial STI diagnoses among GBM living in Canada's three largest cities. METHODS Among HIV-negative/unknown-status GBM in the baseline of the Engage cohort study, we fit a structural equation model of the associations between any PrEP use, sexual behaviours and bacterial STI diagnosis. We estimated direct and indirect paths between PrEP use and STI via CAS, number of anal sex partners and oral sex. RESULTS The sample included 2007 HIV-negative/unknown status GBM in Montreal, Toronto and Vancouver. There was a significant direct association between PrEP use and current STI diagnosis (β=0.181; 95% CI: 0.112 to 0.247; p<0.001), CAS (β=0.275; 95% CI: 0.189 to 0.361; p<0.001) and number of anal sex partners (β=0.193; 95% CI: 0.161 to 0.225; p<0.001). In the mediated model, the direct association between PrEP use and STIs was non-significant. However, the indirect paths from PrEP to CAS to STIs (β=0.064; 95% CI: 0.025 to 0.120; p=0.008), and from PrEP to greater number of anal sex partners to CAS to STIs were significant (β=0.059; 95% CI: 0.024 to 0.108; p=0.007). CONCLUSIONS Our study adds to the growing awareness that PrEP use among GBM may be associated with bacterial STIs because PrEP users have more anal sex partners and are more likely to engage in CAS. The results underscore the importance of providing effective STI counselling and regular testing to PrEP users, adapting PrEP care and related STI testing to individual needs, and the need for effective prevention strategies for bacterial STIs.
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Affiliation(s)
- Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Department of Kinesiology and Health Science, Louisiana State University in Shreveport, Shreveport, Louisiana, USA
| | - Graham W Berlin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | | | - Farideh Tavangar
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.,Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada
| | - Darrell Tan
- Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gilles Lambert
- Direction Régionale de Santé Publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montreal, Quebec, Canada.,Direction des Risques Biologiques et de la Santé au Travail, Institut national de santé publique du Québec Montréal, Montreal, Quebec, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nathan John Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.,Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Jody Jollimore
- Community Based Research Centre, Vancouver, British Columbia, Canada
| | - Jordan Sang
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Abbie Parlette
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Allan Lal
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - David Moore
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.,Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal du Québec, Montreal, Quebec, Canada
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6
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Colyer S, Lachowsky NJ, Schmidt AJ, Adam BD, Paquette D, Hart TA, Brennan DJ, Blais M, Kroch AE. Measures of HIV Pre-exposure Prophylaxis Uptake Among Gay, Bisexual, and Other Men Who Have Sex with Men in Canada and Demographic Disparities Among Those at Elevated Likelihood for HIV Acquisition. AIDS Behav 2021; 25:3638-3650. [PMID: 34114164 DOI: 10.1007/s10461-021-03336-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30-49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.
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Mehrotra ML, Westreich D, Glymour MM, Geng E, Glidden DV. Transporting Subgroup Analyses of Randomized Controlled Trials for Planning Implementation of New Interventions. Am J Epidemiol 2021; 190:1671-1680. [PMID: 33615327 DOI: 10.1093/aje/kwab045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/19/2020] [Accepted: 02/18/2021] [Indexed: 02/01/2023] Open
Abstract
Subgroup analyses of randomized controlled trials guide resource allocation and implementation of new interventions by identifying groups of individuals who are likely to benefit most from the intervention. Unfortunately, trial populations are rarely representative of the target populations of public health or clinical interest. Unless the relevant differences between trial and target populations are accounted for, subgroup results from trials might not reflect which groups in the target population will benefit most from the intervention. Transportability provides a rigorous framework for applying results derived in potentially highly selected study populations to external target populations. The method requires that researchers measure and adjust for all variables that 1) modify the effect of interest and 2) differ between the target and trial populations. To date, applications of transportability have focused on the external validity of overall study results and understanding within-trial heterogeneity; however, this approach has not yet been used for subgroup analyses of trials. Through an example from the Iniciativa Profilaxis Pre-Exposición (iPrEx) study (multiple countries, 2007-2010) of preexposure prophylaxis for human immunodeficiency virus, we illustrate how transporting subgroup analyses can produce target-specific subgroup effect estimates and numbers needed to treat. This approach could lead to more tailored and accurate guidance for resource allocation and cost-effectiveness analyses.
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8
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Sinno J, Doria N, Cochkanoff N, Numer M, Neyedli H, Tan D. Attitudes and Practices of a Sample of Nova Scotian Physicians for the Implementation of HIV Pre-Exposure Prophylaxis. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:157-170. [PMID: 33574712 PMCID: PMC7872901 DOI: 10.2147/hiv.s287201] [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: 10/19/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
Introduction Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that requires the ongoing support of physicians to be accessible. Recently, Nova Scotia experienced a 100% increase in HIV diagnoses. The purpose of this study is to explore the relationship between physicians' support of PrEP, knowledge of PrEP, and PrEP prescribing history using the information-motivation-behavioral (IMB) skills model. Methods An online survey was distributed to physicians in Nova Scotia, Canada, and eighty physicians participated. Two exploratory factor analyses were conducted with items from the Support of PrEP scale and Knowledge of PrEP scale. A mediation analysis was conducted to assess if knowledge of PrEP mediated the relationship between support of PrEP and whether physicians have prescribed PrEP in the past. Results On average, physicians reported strong support for PrEP, and as support for PrEP increased so did knowledge of PrEP. Further, physicians who had prescribed PrEP demonstrated strong knowledge of PrEP and physicians who had not prescribed PrEP reported feeling neutral. The 95% bootstrap confidence interval indirect effect of Support for PrEP on prescription history did not include zero (B = 1.59, 95% BsCI [0.83, 3.57]) demonstrating that the effect of support for PrEP is mediated by knowledge of PrEP. The most commonly identified barrier to prescribing PrEP was the lack of drug coverage among patients. Conclusion The results of the mediation analysis support the IMB skills model regarding support for PrEP, Knowledge of PrEP, and having prescribed PrEP in the past. Our findings suggest that to improve PrEP uptake in Nova Scotia, educational interventions for physicians and universal coverage of the drug would be necessary.
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Affiliation(s)
- Jad Sinno
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nicole Doria
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Nicholas Cochkanoff
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Matthew Numer
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Heather Neyedli
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Darrell Tan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Picard J, Jacka B, Høj S, Laverdière É, Cox J, Roy É, Bruneau J. Real-World Eligibility for HIV Pre-exposure Prophylaxis Among People Who Inject Drugs. AIDS Behav 2020; 24:2400-2408. [PMID: 31997057 PMCID: PMC10710293 DOI: 10.1007/s10461-020-02800-w] [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] [Indexed: 10/25/2022]
Abstract
Recent studies have highlighted the efficacy of and willingness to use pre-exposure prophylaxis (PrEP) to prevent HIV infection among people who inject drugs (PWID), however knowledge of real-world applicability is limited. We aimed to quantify the real-world eligibility for HIV-PrEP among HIV-negative PWID in Montreal, Canada (n = 718). Eligibility was calculated according to US Centers for Disease Control and Prevention (CDC) guidelines and compared to risk of HIV acquisition according to the assessing the risk of contracting HIV (ARCH-IDU) risk screening tool. Over one-third of participants (37%) were eligible for HIV PrEP, with 1/3 of these eligible due to sexual risk alone. Half of participants were considered high risk of HIV acquisition according to ARCH-IDU, but there was poor agreement between the two measures. Although a large proportion of PWID were eligible for HIV-PrEP, better tools that are context- and location-informed are needed to identify PWID at higher risk of HIV acquisition.
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Affiliation(s)
- Jonathan Picard
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Brendan Jacka
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Stine Høj
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada
| | - Émélie Laverdière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | - Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Regional Public Health Department, CIUSSS du Centre-Sud-de-L'Ile-de-Montréal, Montréal, Canada
| | - Élise Roy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
- Direction des risques biologiques et de sa santé au travail, Institut National de Santé Publique du Québec, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de L'Université de Montréal (CRCHUM), 900 rue Saint-Denis, Montréal, QC, H2X0A9, Canada.
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada.
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10
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Pharaon J, Bauch CT. The Impact of Pre-exposure Prophylaxis for Human Immunodeficiency Virus on Gonorrhea Prevalence. Bull Math Biol 2020; 82:85. [PMID: 32613297 DOI: 10.1007/s11538-020-00762-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in reducing the risk of HIV infection in gay and bisexual men who have sex with men (GbMSM). However, PrEP does not protect against other sexually transmitted infections (STIs). In some populations, PrEP has also led to riskier behavior such as reduced condom usage, with the result that the prevalence of bacterial STIs like gonorrhea has increased. Here, we develop a compartmental model of the transmission of HIV and gonorrhea and the impacts of PrEP, condom usage, STI testing frequency and potential changes in sexual risk behavior stemming from the introduction of PrEP in a population of GbMSM. We find that introducing PrEP causes an increase in gonorrhea prevalence for a wide range of parameter values, including at the currently recommended frequency of STI testing once every three months for individuals on PrEP. Moreover, the model predicts that a higher STI testing frequency alone is not enough to prevent a rise in gonorrhea prevalence, unless the testing frequency is increased to impractical levels. However, testing every 2 months in combination with a 10-25 % reduction in risky behavior by individuals on PrEP would maintain gonorrhea prevalence at pre-PrEP levels. The results emphasize that programs making PrEP more available should be accompanied by efforts to support condom usage and frequent STI testing, in order to avoid an increase in the prevalence of gonorrhea and other bacterial STIs.
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Affiliation(s)
- Joe Pharaon
- Department of Applied Mathematics, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
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11
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Plomer AS, McCool-Myers M, Apfelbacher C. Perspectives on HIV PrEP care in Germany: qualitative insights from primary care physicians and specialists. AIDS Care 2020; 32:994-1000. [PMID: 32539453 DOI: 10.1080/09540121.2020.1778626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recently, research has shifted from investigating the effectiveness of HIV pre-exposure prophylaxis (PrEP) to strategizing its implementation. Several European studies have explored physicians' perspectives on implementing PrEP in diverse settings, yet there are no data on the situation in Germany. The purpose of this study was to explore physicians' perspectives on current PrEP care in Germany. From April to July 2018, we conducted 16 semi-structured interviews with HIV providers (HIVPs) and primary care physicians (PCPs). Transcripts were analyzed using thematic content analysis. Physicians showed varying levels of PrEP expertise. Many PCPs lacked knowledge about PrEP. Some PCPs did not support the idea of PrEP as a prophylactic option. Opinions about PCPs' role in PrEP care were diverging, yet most PCPs favored referring PrEP clients to an HIVP or opted for a shared-care arrangement. Perceived problems included stigma and lack of privacy for PrEP care in rural areas. Our findings highlight the need for tailored physician training, which should be addressed in PrEP implementation in Germany.
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Affiliation(s)
- Anna-Sophie Plomer
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Megan McCool-Myers
- Department of Gynecology and Obstetrics, Jane Fonda Center for Adolescent Reproductive Health, Emory University, Atlanta, GA, USA
| | - Christian Apfelbacher
- Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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12
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Kendall CE, Porter JE, Shoemaker ES, Seoyeon Kang R, Fitzgerald M, Keely E, Afkham A, Crowe L, MacPherson P, Rosenes R, Lundrigan P, Bibeau C, Liddy C. Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service. MDM Policy Pract 2019; 4:2381468319868216. [PMID: 31453365 PMCID: PMC6699006 DOI: 10.1177/2381468319868216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/17/2019] [Indexed: 11/28/2022] Open
Abstract
Background. Electronic consultation (eConsultation) is a potential
strategy to improve access to specialist expertise and facilitate collaborative
care models. The Champlain BASE eConsult service allows for asynchronous
communication between primary care providers (PCP) and specialists on a secure,
web-based system. HIV experts accessible include HIV physician specialists, HIV
pharmacists, and social workers with expertise in HIV. Objective.
This study aims to describe the use, value, and utility of this eConsultation
service in the care of people living with HIV and to characterize the common
question types and clinical topics asked by PCPs. Methods. We
analyzed the data from eConsults sent to the HIV specialty group in Ontario’s
Champlain Local Health Integration Network between February 2015 and December
2017. Usage data and close-out survey responses were analyzed using descriptive
statistics, eConsults were classified using a predefined list of validated
taxonomy, and a thematic analysis was performed on the consultation logs to
identify common clinical themes. Results. Among the 46 eConsults,
the most common question type related to drug treatment (58.7%,
n = 27) and management (19.6%, n = 9). The
main clinical themes involved the care of significant complexities in people
living with HIV, such as comorbidities and drug interactions, and suggestions of
coordinated patient care. As well, eConsult was used for advice regarding
pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection.
PCPs highly valued the eConsult service (average rating 4.8/5).
Conclusion. Overall, this study demonstrates that eConsult
provides an efficient and valuable service to PCPs caring for patients living
with or at risk for HIV by improving access to HIV specialists and facilitating
the delivery of team-based comprehensive care.
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Affiliation(s)
- Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Janessa E Porter
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Esther S Shoemaker
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Rachel Seoyeon Kang
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michael Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amir Afkham
- Champlain Local Health Integration Network, Ottawa, Ontario, Canada
| | - Lois Crowe
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Paul MacPherson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ron Rosenes
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Philip Lundrigan
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Christine Bibeau
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
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13
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Irvine MA, Salway T, Grennan T, Wong J, Gilbert M, Coombs D. Predicting the impact of clustered risk and testing behaviour patterns on the population-level effectiveness of pre-exposure prophylaxis against HIV among gay, bisexual and other men who have sex with men in Greater Vancouver, Canada. Epidemics 2019; 30:100360. [PMID: 31473138 DOI: 10.1016/j.epidem.2019.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/01/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has the potential to greatly reduce transmission of HIV. However, significant questions remain around how behavioural factors may influence its impact within target populations. We used a 2014 sexual behaviour survey to modify and recalibrate a mathematical model of HIV infection dynamics within the population of gay, bisexual and other men who have sex with men (GBMSM) in the Greater Vancouver area of British Columbia, Canada. We performed a clustering analysis on the survey data to divide the population into categories associated with their reported risk of HIV exposure as well as their reported testing habits and attitudes towards PrEP. We found a positive association between reported risk and testing behaviour and level of awareness/interest in PrEP. Using the cluster groups to structure the population, we then estimated the impact of PrEP on HIV transmission in our study population. We found that the association between behaviour and interest in PrEP substantially boosted the population-level effectiveness of PrEP. Within our model, if PrEP adoption was unrelated to risk and testing, an additional 206 (95% credible interval 5-261), new infections representing 15% of total infections are predicted to occur among GBMSM over ten years, compared to where PrEP is adopted by individuals according to their level of interest. Our results underscore the importance of incorporating behavioural data into models when predicting the impact of future public health interventions.
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Affiliation(s)
- Michael A Irvine
- Department of Mathematics and Institute of Applied Mathematics, 1984 Mathematics Road, University of British Columbia, Vancouver, BC V6T 1Z2, Canada; British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, BC, Canada.
| | - Travis Salway
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, BC, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, West 12th Avenue, Vancouver, BC, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, 1984 Mathematics Road, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
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14
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Greenwald ZR, Maheu-Giroux M, Szabo J, Robin JAB, Boissonnault M, Nguyen VK, Thomas R. Cohort profile: l'Actuel Pre-Exposure Prophylaxis (PrEP) Cohort study in Montreal, Canada. BMJ Open 2019; 9:e028768. [PMID: 31248931 PMCID: PMC6597624 DOI: 10.1136/bmjopen-2018-028768] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The l'Actuel PrEP Cohort was established to monitor the uptake, effectiveness, safety and changes in sexual risk behaviours among individuals receiving pre-exposure prophylaxis (PrEP) for the prevention of HIV. This prospective dynamic cohort is based at Clinique médicale l'Actuel, a large sexual health clinic located in Montreal, Canada. PARTICIPANTS Since the cohort inception in January of 2013 through June 2018, 2156 individuals consulted for PrEP as participants in the l'Actuel PrEP Cohort. Median age was 35 years (IQR: 29-44 years) and the majority (96%) were men who have sex with men. Among 1551 individuals who initiated PrEP care, the median duration of follow-up was 9.2 months (IQR: 3.7-19.6), with substantial variation based on year of cohort entry. The l'Actuel PrEP Cohort contains both daily and intermittent 'on-demand' PrEP users and has the largest reported population of intermittent PrEP users (n=406) in North America. FINDINGS TO DATE No incident HIV infections have occurred among individuals using PrEP over 1637 person-years of follow-up. However, retention in PrEP care is essential as three individuals who discontinued PrEP subsequently acquired HIV, translating to an HIV incidence of 3.9 cases per 100 person-years (95% CI: 1.3 to 12.1). Among a sample of participants with 1 year of follow-up before and after PrEP initiation (n=109), a moderate increase in sexually transmitted infections was observed following PrEP start. FUTURE PLANS The l'Actuel PrEP Cohort continues to grow with new participants starting PrEP monthly and extended follow-up for existing users. The cohort data will be used for ongoing monitoring of PrEP and for population-level modelling of the impact of PrEP on HIV incidence in Montreal.
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Affiliation(s)
- Zoë R Greenwald
- Epidemiology, Clinique médicale l'Actuel, Montreal, Quebec, Canada
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Jason Szabo
- Clinical Department, Clinique médicale l'Actuel, Montreal, Quebec, Canada
| | | | | | - Vinh-Kim Nguyen
- Global Health Centre, Institut de Hautes Etudes Internationales et du Developpement, Geneva, Switzerland
| | - Réjean Thomas
- Clinical Department, Clinique médicale l'Actuel, Montreal, Quebec, Canada
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15
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Orser L, O'Byrne P. The role of public health units in the delivery of HIV pre-exposure prophylaxis (PrEP). Canadian Journal of Public Health 2018; 110:72-75. [PMID: 30341481 DOI: 10.17269/s41997-018-0141-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/21/2018] [Indexed: 02/07/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy involving the use of once daily antiretroviral medications to prevent HIV infection. Available research supports that PrEP, when used as prescribed, can prevent HIV transmission by upwards of 96%. Such findings have led to the development of research publications and guidelines supporting PrEP for individuals at high risk for HIV acquisition, such as men who have sex with men (MSM). Despite its benefit, current use of PrEP in clinical settings has been undermined by false impressions of poor efficacy of PrEP and concerns about increased risk-taking among MSM should PrEP be readily available. Furthermore, guidance for the role of public health units in PrEP access has not been well defined. While we maintain that PrEP should be available to any person who requests it, we feel that public health units should focus on those at highest risk for HIV acquisition, and, in doing so, possibly reduce local HIV rates.
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Affiliation(s)
- Lauren Orser
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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Can we eliminate HIV? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:42-43. [PMID: 29358252 PMCID: PMC5962982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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