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Cohen C, Hunter LA, Beltran RM, Serpico J, Packel L, Ochoa AM, McCoy SI, Conron KJ. Willingness of Pharmacists to Prescribe Medication Abortion in California. JAMA Netw Open 2024; 7:e246018. [PMID: 38598235 PMCID: PMC11007579 DOI: 10.1001/jamanetworkopen.2024.6018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/13/2024] [Indexed: 04/11/2024] Open
Abstract
Importance Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. Objective To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. Design, Setting, and Participants A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Main Outcomes and Measures Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Results Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). Conclusions and Relevance The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.
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Affiliation(s)
- Cathren Cohen
- Center on Reproductive Health, Law, and Policy, UCLA (University of California, Los Angeles) School of Law
| | | | - Raiza M. Beltran
- Luskin School of Public Affairs, UCLA
- Now with School of Public Health, University of Minnesota, Minneapolis
| | - Jaclyn Serpico
- Center on Reproductive Health, Law, and Policy, UCLA (University of California, Los Angeles) School of Law
| | - Laura Packel
- School of Public Health, University of California, Berkeley
- Now with Malkia Klabu Program, University of California, San Francisco
| | | | | | - Kerith J. Conron
- Center on Reproductive Health, Law, and Policy, UCLA (University of California, Los Angeles) School of Law
- Williams Institute, UCLA School of Law
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Hunter LA, Packel LJ, Chitle P, Beltran RM, Rafie S, De Martini L, Dong B, Harris O, Holloway IW, Miyashita Ochoa A, McCoy SI. Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California. Open Forum Infect Dis 2023; 10:ofad549. [PMID: 38023549 PMCID: PMC10651201 DOI: 10.1093/ofid/ofad549] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP. Methods From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment. Results Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services. Conclusions Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.
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Affiliation(s)
- Lauren A Hunter
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Laura J Packel
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Pooja Chitle
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Raiza M Beltran
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Sally Rafie
- Birth Control Pharmacist, San Diego, California, USA
- University of California, San Diego Health, San Diego, California, USA
| | - Loriann De Martini
- California Society of Health-System Pharmacists, Sacramento, California, USA
| | - Betty Dong
- School of Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Orlando Harris
- School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Ian W Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Ayako Miyashita Ochoa
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | - Sandra I McCoy
- School of Public Health, Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
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Hong C, Ochoa AM, Wilson BDM, Wu ESC, Thomas D, Holloway IW. The associations between HIV stigma and mental health symptoms, life satisfaction, and quality of life among Black sexual minority men with HIV. Qual Life Res 2023; 32:1693-1702. [PMID: 36648570 PMCID: PMC10953729 DOI: 10.1007/s11136-023-03342-z] [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] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE With the advancement of antiretroviral therapy (ART), HIV/AIDS has become a manageable illness, similar to other chronic conditions. This study examined the associations between HIV stigma and patient-reported outcomes including mental health symptoms, life satisfaction, and quality of life among Black sexual minority men with HIV. METHODS We analyzed baseline data from a randomized comparison trial of a mobile app intervention aimed to address the social work and legal needs of Black sexual minority men with HIV in Los Angeles County. We used validated scales including the Berger HIV stigma scale, the Patient Health Questionnaire-9 & the General Anxiety Disorder-7, the Satisfaction with Life Scale, and the Ladder Scale to assess HIV stigma, depressive symptoms, anxiety, life satisfaction, and quality of life, and we conducted multivariable linear regression to examine their associations. RESULTS Participants experienced HIV stigma especially about disclosure concerns (e.g., 81.9% participants indicated "I am very careful who I tell that I have HIV") and public attitudes (52.3% believed "Most people with HIV are rejected when others find out"). In the multivariable models, higher overall stigma scores were associated with higher likelihood of experiencing depression (adjusted b = 0.235, p < 0.001) and anxiety (adjusted b = 0.188, p = 0.002), and lower life satisfaction (adjusted b = - 0.236, p < 0.001) and quality of life (adjusted b = - 0.053, p = 0.013), adjusting for clinical characteristics including ART initiation, viral load suppression, and medication adherence. In addition, being attacked or harassed in the past year were significantly associated with lower life satisfaction and quality of life (adjusted b = - 3.028, p = 0.046; adjusted b = - 1.438, p = 0.002). CONCLUSION Our findings highlight the need for focused HIV stigma reduction interventions to promote the overall well-being of Black sexual minority men with HIV. Strategies to promote the patient-reported outcomes may benefit from trauma-informed approaches.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA.
| | - Ayako Miyashita Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
| | - Bianca D M Wilson
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA, USA
| | - Elizabeth S C Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
| | | | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California Los Angeles, 3250-Public Affairs Building, Los Angeles, CA, 90095-1656, USA
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Small L, Beltran RM, Cordero L, Lau C, Shanur S, Ochoa AM. The invisibility of Black and Latina women in sexual health care: shifting from biological individualism to intersectionality. Cult Health Sex 2022:1-17. [PMID: 36190726 PMCID: PMC10171736 DOI: 10.1080/13691058.2022.2124458] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Black and Latinx women have long endured racist healthcare practices and policies that influence their sexual health outcomes. Despite having increased health care access, Black and Latina women continue to have higher rates of sexually transmitted infections compared to their white counterparts. We utilised Critical Race Theory to examine the myriad ways in which Black and Latina women and their unmet needs may be invisible to healthcare providers and to better understand the compounding factors that may affect Black and Latina women's engagement with sexual health services. Eighteen individual semi-structured interviews were conducted with healthcare providers, administrators and policy advocates working to address sexual health needs of Black and Latina women in California. Interviews were recorded and transcribed verbatim. Qualitative data were analysed using an inductive thematic approach. Two primary themes and subthemes were developed during our analysis. Within the healthcare system there is a lack of recognition of (1) intersectional identities of Black and Latina women, including intersectional oppressions and systemic vulnerabilities; and (2) structural barriers that mediate their sexual health treatment engagement. Recognition of intersectional identities and addressing structural barriers can potentially improve the sexual health of Black and Latina women and support efforts to address disparities in sexual health care.
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Affiliation(s)
- Latoya Small
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
- Corresponding Author: Latoya Small.
| | - Raiza M. Beltran
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Luisita Cordero
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Caitlin Lau
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Sharmin Shanur
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
| | - Ayako Miyashita Ochoa
- Department of Social Welfare, University of California Los Angeles, Los Angeles, CA, USA
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Holloway IW, Garner A, Tan D, Ochoa AM, Santos GM, Howell S. Associations Between Physical Distancing and Mental Health, Sexual Health and Technology Use Among Gay, Bisexual and Other Men Who Have Sex With Men During the COVID-19 Pandemic. J Homosex 2021; 68:692-708. [PMID: 33528316 DOI: 10.1080/00918369.2020.1868191] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 05/23/2023]
Abstract
Physical distancing measures, designed to limit the spread of COVID-19, have been implemented globally. We sought to understand how physical distancing impacts gay, bisexual and other men who have sex with men (GBMSM), a group disproportionately affected by poor health outcomes. A cross-sectional online survey on Hornet, a networking application (N = 10,079), measured sociodemographics, physical distancing, mental health outcomes, and sexual behavior. Nearly two-thirds of participants (63%) reported only leaving their home for essentials. Those who practiced physical distancing were more likely to feel anxious (aOR = 1.37), feel lonely (aOR = 1.36), to report their sex life being impacted (aOR = 2.95), and less likely to be satisfied with their current sex life (aOR = 0.76). Those who practiced physical distancing were more likely to use social technologies to stay in touch with others. Risk reduction and telehealth opportunities may alleviate health challenges for GBMSM in the COVID-19 era.
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Affiliation(s)
- Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs , Los Angeles, California, USA
- Gay Sexuality and Social Policy Initiative, UCLA Luskin School of Public Affairs , Los Angeles, California, USA
| | - Alex Garner
- Gay Sexuality and Social Policy Initiative, UCLA Luskin School of Public Affairs , Los Angeles, California, USA
- Hornet Social Network , Los Angeles, California, USA
| | - Diane Tan
- Department of Health Policy and Management, UCLA Fielding School of Public Health , Los Angeles, California, USA
| | - Ayako Miyashita Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs , Los Angeles, California, USA
| | - Glen Milo Santos
- Community Health Systems Department, University of California San Francisco , San Francisco, California, USA
- San Francisco Department of Public Health, Center of Public Health Research , San Francisco, California, USA
| | - Sean Howell
- LGBT Foundation , San Francisco, California, USA
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Miyashita Ochoa A, Paneda CC, Wu ES, Maxwell KE, Garth G, Smith T, Holloway IW. A Community-Developed, Web-Based Mobile App Intervention Addressing Social Work and Legal Needs of Black Sexual Minority Men Living With HIV: Protocol for a Randomized Comparison Trial. JMIR Res Protoc 2021; 10:e19770. [PMID: 33404514 PMCID: PMC7817362 DOI: 10.2196/19770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/05/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Black sexual minority men (BSMM) are disproportionately affected by HIV. Los Angeles County (LAC) carries a substantial burden of the HIV epidemic in California. Negative effects of both psychosocial and structural barriers highlight the timely need to increase HIV treatment among BSMM. Successful HIV interventions based on social media and mobile phone technology have been demonstrated. This protocol describes LINX LA, a study that tests LINX, a web-based mobile app that provides tailored social services, legal resources, and peer support for BSMM living with HIV (BSMM+) in LAC using a randomized comparison trial. Objective During phase 1, the LINX LA study aims to engage in an iterative design process to develop the LINX App using qualitative data to inform and tailor the mobile app technology and its functionality. In phase 2 of LINX LA, we will test the efficacy of the LINX App compared with the LINX App Plus to improve HIV treatment outcomes (ie, antiretroviral therapy adherence, viral suppression) among BSMM+ in LAC by addressing social work and legal needs and developing a forum for peer support. Methods In this study funded by the California HIV/AIDS Research Program, we will recruit and enroll BSMM+ participants (aged ≥18 years) in LAC (N=400) to participate in a 12-month study that includes access to the LINX App, which provides a forum for peer support and tailored content aimed at improving the use of social and legal resources. All participants will also receive survey-based interviews at 3 time points (at baseline and 6- and 12-month intervals) and weekly text message surveys that assess medication and treatment adherence. Treatment adherence and viral suppression will be extracted from medical record data. Half of the participants will also be randomly assigned to receive 3 individualized coaching sessions (at 1-, 3-, and 6-month intervals) and the ability to directly message their coach via the LINX App. Over the course of the study, LINX App participants will receive a minimum of US $130 in cash and LINX App Plus participants will receive a minimum of US $190. We hypothesize that participants enrolled in LINX App Plus will demonstrate greater improvement in HIV outcomes compared with LINX App participants. Results The LINX study will test the efficacy of a web-based mobile app intervention for BSMM+ in LAC (N=400). The LINX App seeks to increase participants’ knowledge of HIV; to facilitate access to necessary social and legal services, including information and referrals; and to increase social support across participants by providing a mediated forum for engagement. Conclusions The implementation of LINX LA aims to develop and test a culturally tailored approach to improve the HIV treatment outcomes of BSMM+. International Registered Report Identifier (IRRID) PRR1-10.2196/19770
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Affiliation(s)
- Ayako Miyashita Ochoa
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
| | - Christian Corpuz Paneda
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
| | - Elizabeth Sc Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
| | | | - Gerald Garth
- Arming Minorities Against Addiction and Disease (AMAAD) Institute, Los Angeles, CA, United States
| | | | - Ian Walter Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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Holloway IW, C Spaulding A, Miyashita Ochoa A, A Randall L, R King A, Frew PM. COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies. J Int AIDS Soc 2020; 23:e25551. [PMID: 32640098 PMCID: PMC7300636 DOI: 10.1002/jia2.25551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ian W Holloway
- Department of Social WelfareUCLA Luskin School of Public AffairsLos AngelesCAUSA
| | | | | | - Laura A Randall
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
| | - Adrian R King
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
| | - The HBOU Study Team
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
| | - Paula M Frew
- UNLV School of Public Health and UNLV Population Health & Health Equity InitiativeUniversity of Nevada Las VegasLas VegasNVUSA
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Holloway IW, Miyashita Ochoa A, Wu ESC, Himmelstein R, Wong JO, Wilson BDM. Perspectives on academic mentorship from sexual and gender minority students pursuing careers in the health sciences. Am J Orthopsychiatry 2019; 89:343-353. [PMID: 31070420 DOI: 10.1037/ort0000410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High-quality academic mentorship is key to the success of students pursuing careers in the health sciences. Mentorship may take on additional importance for sexual and gender minority (SGM) students, who often face stressors related to stigmatized identities. We conducted an anonymous online survey to assess the mentorship experiences of SGM students pursuing careers in the health sciences and to elicit their perspectives on what makes an effective mentor. Students (N = 166) were pursuing a variety of health-related careers, including medicine (12.7%), nursing (7.8%), public health (21.1%), and social work (19.3%). Overall, students rated the quality of their mentorship experiences as (very) good: 83.8% among participants who reported having had an academic mentor that openly identified as SGM and 79.5% among participants who had a non-SGM identified mentor (ns). Participants recommended individual, dyadic and structural level activities that could be undertaken by academic mentors of SGM students to promote the students' academic success and positive career trajectories. Education on SGM issues, direct conversation about experiences of homophobia and transphobia in academic settings, and advocacy for including SGM content in coursework were among the suggestions provided by participants. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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