1
|
Coats CS, Goedel WC, Sims-Gomillia CE, Arnold TL, Wrenn-Jones I, Buck B, Chan PA, Mena LA, Nunn AS. "Make it more than a pill, make it an experience of health:" results from an open pilot intervention to retain young African American men who have sex with men in PrEP care. AIDS Care 2024; 36:472-481. [PMID: 37331017 PMCID: PMC10773530 DOI: 10.1080/09540121.2023.2221422] [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: 12/03/2021] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
Uptake and retention in clinical care for pre-exposure prophylaxis (PrEP) is suboptimal, particularly among young African American men who have sex with men (MSM) in the Deep South. We conducted a two-phase study to develop and implement an intervention to increase PrEP persistence. In Phase I, we conducted focus groups with 27 young African American MSM taking PrEP at a community health center in Jackson, Mississippi to elicit recommendations for the PrEP persistence intervention. We developed an intervention based on recommendations in Phase I, and in Phase II, ten participants were enrolled in an open pilot. Eight participants completed Phase II study activities, including a single intervention session, phone call check-ins, and four assessments (Months 0, 1, 3, and 6). Exit interviews demonstrated a high level of acceptability and satisfaction with the intervention. These formative data demonstrate the initial promise of a novel intervention to improve PrEP persistence among young African American MSM.
Collapse
Affiliation(s)
- Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Courtney E. Sims-Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Trisha L. Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Isa Wrenn-Jones
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Byron Buck
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| |
Collapse
|
2
|
Arnold T, Stopka TJ, Gomillia CE, Murphy M, Johnson K, Chan PA, Klasko-Foster L, Rogers B, Soler JH, Monger ML, Jacque E, Coats CS, Willie TC, Ogunbajo A, Mena L, Nunn A. Locating the Risk: Using Participatory Mapping to Contextualize Perceived HIV Risk across Geography and Social Networks among Men Who Have Sex with Men in the Deep South. J Sex Res 2022; 59:931-938. [PMID: 33826434 PMCID: PMC8522442 DOI: 10.1080/00224499.2021.1906397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/12/2023]
Abstract
HIV incidence among African American (AA) young men who have sex with men (YMSM) has remained stable even though they made up the largest number of new HIV diagnoses among men who have sex with men (MSM) in 2017. HIV spreads at increased rates in dense sexual networks. Identifying the location of risk behaviors "activity spaces" could inform geographically circumscribed HIV prevention interventions. Utilizing the modified social ecological model we completed five semi-structured focus groups incorporating a modified social mapping technique, based on Singer et al.'s approach. Participants included 27 AA YMSM. Focus groups explored how and where HIV transmission happens in Jackson, Mississippi. Result themes included: 1) location of sexual behaviors, 2) knowledge of geographic hotspots of HIV infection in Jackson, and 3) traveling to meet partners: at home and away. HIV transmission or "activity spaces" may be occurring outside identified HIV hot spots. Mixed geospatial and qualitative methods offered a comprehensive assessment of where HIV transmission occurs, and suggests that geographically circumscribed interventions may need to focus on where individuals living with HIV reside and in specific geographic locations where they engage in behaviors that raise their HIV acquisition risks.
Collapse
Affiliation(s)
- Trisha Arnold
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thomas J. Stopka
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, United States (U.S.)
| | - Courtney E.S. Gomillia
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- School of Science and Mathematics, Mississippi College, Clinton, MS
| | - Matthew Murphy
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Philip A. Chan
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
| | - Lynne Klasko-Foster
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| | - Brooke Rogers
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
| | | | - Mauda L. Monger
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Erin Jacque
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, United States (U.S.)
| | - Cassandra Sutten Coats
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| | | | - Adedotun Ogunbajo
- Harvard University T H Chan School of Public Health, Department of Epidemiology
| | - Leandro Mena
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Amy Nunn
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- The Miriam Hospital, Providence, Rhode Island
- School of Public Health, Brown University, Providence, Rhode Island
| |
Collapse
|
3
|
Goedel WC, Coats CS, Chan PA, Sims-Gomillia CE, Brock JB, Ward LM, Mena LA, Nunn AS. A Pilot Study of a Patient Navigation Intervention to Improve HIV Pre-exposure Prophylaxis Persistence Among Black/African American Men Who Have Sex With Men. J Acquir Immune Defic Syndr 2022; 90:276-282. [PMID: 35312652 PMCID: PMC9203974 DOI: 10.1097/qai.0000000000002954] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suboptimal HIV pre-exposure prophylaxis (PrEP) care outcomes among Black/African American men who have sex with men (MSM) limits its population-level effects on HIV incidence. We conducted a pilot study of a brief patient navigation intervention aimed at improving PrEP initiation and persistence among Black/African American MSM in the Southern United States. SETTING Community health center in Jackson, MS. METHODS We recruited 60 Black/African American MSM aged 18-34 years who were newly prescribed PrEP. Participants were randomized to receive the clinic's current standard of care or an intervention condition including a single patient navigation session to discuss and address perceived barriers to initiating and maintaining access to PrEP and biweekly check-ins. Participants were followed over 6 months using survey assessments, medical chart review, and pharmacy purchase records to ascertain PrEP initiation and persistence. RESULTS Participants in the intervention condition were more likely to pick up their initial PrEP prescription [RR: 1.47; 95% confidence interval (CI): 1.10 to 1.97], be retained in PrEP care at 3 months (RR: 1.62; 95% CI: 1.01 to 2.59) and 6 months (RR: 1.38; 95% CI: 0.64 to 2.93), and have access to PrEP medications greater than 80% of all study days based on pharmacy fill records (RR: 3.00; 95% CI: 1.50 to 5.98). CONCLUSION A brief patient navigation intervention demonstrated proof-of-concept in improving PrEP initiation and persistence among Black/African American MSM in the Southern United States.
Collapse
Affiliation(s)
- William C. Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Courtney E. Sims-Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - James B. Brock
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| |
Collapse
|
4
|
Goedel WC, Sutten Coats C, Sowemimo-Coker G, Moitra E, Murphy MJ, van den Berg JJ, Chan PA, Nunn AS. Gay and Bisexual Men's Recommendations for Effective Digital Social Marketing Campaigns to Enhance HIV Prevention and Care Continuity. AIDS Behav 2021; 25:1619-1625. [PMID: 33231845 DOI: 10.1007/s10461-020-03078-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
Because use of geosocial-networking smartphone applications ('apps') is ubiquitous among men who have sex with men (MSM), online-to-offline service models that include advertisements on these apps may improve engagement with effective HIV prevention and treatment services. Through our formative qualitative study, we conducted individual in-depth interviews (n = 30) and focus group discussions (n = 18) with MSM in Rhode Island to develop a digital social marketing campaign aimed at increasing HIV testing, including how best to reach men by advertising on apps. Qualitative data analysis revealed that participants were frequently exposed to pop-up advertisements on apps. These advertisements are viewed as invasive and, as such, many expressed a preference for other formats (e.g., direct messages, banner advertisements). Men expressed a preference for provocative images and phrases to catch their attention followed with fact-driven messaging to motivate them to engage with services offline. Findings from this study offer several practical recommendations for developing a social marketing campaign that uses advertisements on apps to increase HIV testing among MSM, including using formats other than pop-up advertisements and pairing fact-driven messaging with eye-catching images to direct them to trusted local clinical services.
Collapse
|
5
|
Nunn AS, Goedel WC, Gomillia CE, Coats CS, Patel RR, Murphy MJ, Chu CT, Chan PA, Mena LA. False information on PrEP in direct-to-consumer advertising. Lancet HIV 2020; 7:e455-e456. [PMID: 32032537 DOI: 10.1016/s2352-3018(20)30034-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Amy S Nunn
- Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA.
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912, USA
| | - Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University, Providence, RI 02912, USA
| | - Rupa R Patel
- John T Milliken Department of Internal Medicine, School of Medicine, Washington University in St Louis, Saint Louis, MO, USA
| | - Matthew J Murphy
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Christina T Chu
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI 02912, USA
| | - Leandro A Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
6
|
Goedel WC, Jin H, Sutten Coats C, Ogunbajo A, Restar AJ. Predictors of User Engagement With Facebook Posts Generated by a National Sample of Lesbian, Gay, Bisexual, Transgender, and Queer Community Centers in the United States: Content Analysis. JMIR Public Health Surveill 2020; 6:e16382. [PMID: 32012104 PMCID: PMC7013651 DOI: 10.2196/16382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/24/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer (LGBTQ) community centers remain important venues for reaching and providing crucial health and social services to LGBTQ individuals in the United States. These organizations commonly use Facebook to reach their target audiences, but little is known about factors associated with user engagement with their social media presence. OBJECTIVE This study aimed to identify factors associated with engagement with Facebook content generated by LGBTQ community centers in the United States. METHODS Content generated by LGBTQ community centers in 2017 was downloaded using Facebook's application programming interface. Posts were classified by their content and sentiment. Correlates of user engagement were identified using negative binomial regression. RESULTS A total of 32,014 posts from 175 community centers were collected. Posts with photos (incidence rate ratio, [IRR] 1.07; 95% CI 1.06-1.09) and videos (IRR 1.54; 95% CI 1.52-1.56) that contained a direct invitation for engagement (IRR 1.03; 95% CI 1.02-1.04), that expressed a positive sentiment (IRR 1.11; 95% CI 1.10-1.12), and that contained content related to stigma (IRR 1.16; 95% CI 1.14-1.17), mental health (IRR 1.33; 95% CI 1.31-1.35), and politics (IRR 1.28; 95% CI 1.27-1.29) received higher levels of engagement. CONCLUSIONS The results of this study provide support for the use of Facebook to extend the reach of LGBTQ community centers and highlight multiple factors that can be leveraged to optimize engagement.
Collapse
Affiliation(s)
- William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Harry Jin
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States
| | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Arjee J Restar
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| |
Collapse
|
7
|
Kamaara E, Oketch D, Chesire I, Coats CS, Thomas G, Ransome Y, Willie TC, Nunn A. Faith and healthcare providers' perspectives about enhancing HIV biomedical interventions in Western Kenya. Glob Public Health 2019; 14:1744-1756. [PMID: 31390958 DOI: 10.1080/17441692.2019.1647263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adult HIV prevalence in Kenya was 5.9% in 2017. However, in the counties of Kisumu, Siaya, and Homa Bay, HIV prevalence was over 15%. Biomedical interventions, including home-based testing and counselling (HBTC), HIV treatment and pre-exposure prophylaxis (PrEP) provide opportunities to reduce HIV transmission, particularly in rural communities with limited access to health services. Faith-based institutions play an important role in the Kenyan social fabric, providing over 40% of all health care services in Kenya, but have played limited roles in promoting HIV prevention interventions. We conducted qualitative interviews with 45 medical professionals and focus groups with 93 faith leaders in Kisumu and Busia Counties, Kenya. We explored their knowledge, opinions, and experiences in promoting biomedical HIV prevention modalities, including HBTC and PrEP. Knowledge about and engagement in efforts to promote HIV prevention modalities varied; few health providers had partnered with faith leaders on HIV prevention programmes. Faith leaders and health providers agreed about the importance of increasing faith leaders' participation in HIV prevention and were positive about increasing their HIV prevention partnerships. Most faith leaders requested capacity building to better understand biomedical HIV prevention modalities and expressed interest in collaborating with clinical partners to spread awareness about HIV prevention modalities.
Collapse
Affiliation(s)
- Eunice Kamaara
- Department of Philosophy & Religious Studies, Moi University , Eldoret , Kenya
| | - Dismas Oketch
- Kenya Medical Research Institute (KEMRI)/CDC Clinical Research Center , Kisumu , Kenya
| | - Irene Chesire
- Department of Behavioral Science, School of Medicine, Moi University , Eldoret , Kenya
| | - Cassandra Sutten Coats
- Center for Health Equity Research, Brown University School of Public Health , Providence , RI , USA
| | - Gladys Thomas
- Department of Behavioral and Social Science, Brown University School of Public Health , Providence , RI , USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health , Hartford , CT , USA
| | - Tiara C Willie
- Department of Medicine, Brown University Warren Alpert Medical School , Providence , RI , USA
| | - Amy Nunn
- Center for Health Equity Research, Brown University School of Public Health , Providence , RI , USA.,Department of Behavioral and Social Science, Brown University School of Public Health , Providence , RI , USA
| |
Collapse
|
8
|
Chan PA, Patel RR, Mena L, Marshall BDL, Rose J, Sutten Coats C, Montgomery MC, Tao J, Sosnowy C, Mayer KH, Nunn A. Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States. J Int AIDS Soc 2019; 22:e25385. [PMID: 31423756 PMCID: PMC6698689 DOI: 10.1002/jia2.25385] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Retention in HIV pre-exposure prophylaxis (PrEP) care in real-world settings, outside of controlled trials or demonstration projects, remains poorly understood. METHODS We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients' actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. RESULTS From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow-up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow-up visit, having attended a visit three months after initiation. However, 76% had a follow-up visit within eight months. Thirty-percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16-month endpoint. Self-reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow-up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. CONCLUSIONS Measuring retention in PrEP care using three-month follow-up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real-world settings and should be the focus of future interventions.
Collapse
Affiliation(s)
- Philip A Chan
- Department of MedicineBrown UniversityProvidenceRIUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Rupa R Patel
- Department of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Leandro Mena
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMSUSA
| | - Brandon DL Marshall
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | | | - Cassandra Sutten Coats
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Madeline C Montgomery
- Department of MedicineBrown UniversityProvidenceRIUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Jun Tao
- Department of MedicineBrown UniversityProvidenceRIUSA
| | | | - Kenneth H Mayer
- The Fenway InstituteBostonMAUSA
- Division of Infectious DiseasesBeth Israel Deaconess Medical CenterBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Amy Nunn
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| |
Collapse
|
9
|
Chan PA, Patel RR, Mena L, Marshall BD, Rose J, Sutten Coats C, Montgomery MC, Tao J, Sosnowy C, Mayer KH, Nunn A. Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States. J Int AIDS Soc 2019. [PMID: 31423756 DOI: 10.1002/jia] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Retention in HIV pre-exposure prophylaxis (PrEP) care in real-world settings, outside of controlled trials or demonstration projects, remains poorly understood. METHODS We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients' actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. RESULTS From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow-up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow-up visit, having attended a visit three months after initiation. However, 76% had a follow-up visit within eight months. Thirty-percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16-month endpoint. Self-reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow-up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. CONCLUSIONS Measuring retention in PrEP care using three-month follow-up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real-world settings and should be the focus of future interventions.
Collapse
Affiliation(s)
- Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Rupa R Patel
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Leandro Mena
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon Dl Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Madeline C Montgomery
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jun Tao
- Department of Medicine, Brown University, Providence, RI, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Amy Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
10
|
Gamarel KE, Sevelius JM, Reisner SL, Coats CS, Nemoto T, Operario D. Commitment, interpersonal stigma, and mental health in romantic relationships between transgender women and cisgender male partners. J Soc Pers Relat 2019; 36:2180-2201. [PMID: 31086428 PMCID: PMC6510026 DOI: 10.1177/0265407518785768] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The goals of this study were to: (a) examine associations between interpersonal stigma and psychological distress among a sample of transgender women and their cisgender male partners; and (b) identify whether commitment moderates the association between interpersonal stigma and psychological distress. To address these aims, 191 couples consisting of transgender women and their cisgender male partners completed a one-time survey. Actor-partner interdependence models (APIM) were fit to examine stigma, commitment, and their interaction on psychological distress. More frequent experiences of interpersonal stigma were associated with elevated psychological distress for both partners. For transgender women, higher commitment was associated with lower psychological distress. There was a significant interaction effect such that the association between interpersonal stigma and psychological distress was attenuated by greater commitment for transgender women, but not for their cisgender male partners. Findings provide preliminary support for associations between interpersonal stigma and mental health of both partners, and identify commitment as a potential stress buffer for transgender women.
Collapse
Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Jae M. Sevelius
- Department of Family & Community Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Sari L. Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Division of General Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
- The Fenway Institute, Fenway Health, Boston, MA USA
| | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
| | | | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
| |
Collapse
|
11
|
Magno L, Dourado I, Sutten Coats C, Wilhite D, da Silva LAV, Oni-Orisan O, Brown J, Soares F, Kerr L, Ransome Y, Chan PA, Nunn A. Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil. Glob Public Health 2019; 14:1098-1111. [PMID: 30717633 DOI: 10.1080/17441692.2019.1571090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants' knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants' opinions about PrEP's contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil's civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.
Collapse
Affiliation(s)
- Laio Magno
- a Departamento de Ciências da Vida, Universidade do Estado da Bahia , Salvador , Brazil.,b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil
| | - Inês Dourado
- b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil
| | - Cassandra Sutten Coats
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Daniel Wilhite
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Luís Augusto V da Silva
- b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil.,d Instituto de Humanidades, Artes e Ciências , Salvador , Brazil
| | - Oluwadamilola Oni-Orisan
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Julianna Brown
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Fabiane Soares
- b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil
| | - Lígia Kerr
- e Departamento de Saúde Comunitária , Universidade Federal do Ceará , Fortaleza , Brazil
| | - Yusuf Ransome
- f Social and Behavioral Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Philip Andrew Chan
- g Division of Infectious Diseases , The Miriam Hospital, Brown University , Providence , RI , USA
| | - Amy Nunn
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| |
Collapse
|
12
|
Nunn A, Parker S, McCoy K, Monger M, Bender M, Poceta J, Harvey J, Thomas G, Johnson K, Ransome Y, Sutten Coats C, Chan P, Mena L. African American Clergy Perspectives About the HIV Care Continuum: Results From a Qualitative Study in Jackson, Mississippi. Ethn Dis 2018; 28:85-92. [PMID: 29725192 DOI: 10.18865/ed.28.2.85] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mississippi has some of the most pronounced racial disparities in HIV infection in the country; African Americans comprised 37% of the Mississippi population but represented 80% of new HIV cases in 2015. Improving outcomes along the HIV care continuum, including linking and retaining more individuals and enhancing adherence to medication, may reduce the disparities faced by African Americans in Mississippi. Little is understood about clergy's views about the HIV care continuum. We assessed knowledge of African American pastors and ministers in Jackson, Mississippi about HIV and the HIV care continuum. We also assessed their willingness to promote HIV screening and biomedical prevention technologies as well as efforts to enhance linkage and retention in care with their congregations. Four focus groups were conducted with 19 African American clergy. Clergy noted pervasive stigma associated with HIV and believed they had a moral imperative to promote HIV awareness and testing; they provided recommendations on how to normalize conversations related to HIV testing and treatment. Overall, clergy were willing to promote and help assist with linking and retaining HIV positive individuals in care but knew little about how HIV treatment can enhance prevention or new biomedical technologies such as pre-exposure prophylaxis (PrEP). Clergy underscored the importance of building coalitions to promote a collective local response to the epidemic. The results of this study highlight important public health opportunities to engage African American clergy in the HIV care continuum in order to reduce racial disparities in HIV infection.
Collapse
Affiliation(s)
- Amy Nunn
- Center for Health Equity Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Sharon Parker
- Department of Sociology and Social Work, North Carolina Agriculture and Technology State University, Greensboro, North Carolina
| | - Katryna McCoy
- University of Washington Bothell, School of Nursing & Health Studies, Bothell, Washington
| | - Mauda Monger
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Melverta Bender
- University of Mississippi Medical Center, Jackson, Mississippi
| | - Joanna Poceta
- Center for Health Equity Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Julia Harvey
- Center for Health Equity Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Gladys Thomas
- Center for Health Equity Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Kendra Johnson
- Mississippi State Department of Health, Jackson, Mississippi
| | - Yusuf Ransome
- Yale School of Public Health, New Haven, Connecticut
| | - Cassandra Sutten Coats
- Center for Health Equity Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Phil Chan
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,The Miriam Hospital, Providence, Rhode Island
| | - Leandro Mena
- University of Mississippi Medical Center, Jackson, Mississippi
| |
Collapse
|