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Hatch MA, Laschober TC, Paschen-Wolff M, Ertl MM, Nelson CM, Wright L, Lancaster C, Feaster DJ, Forrest D, Hankey C, Monger M, Fegley JP, Irving R, Young C, Rose J, Spector A, Dresser L, Moran L, Jelstrom E, Tross S. PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high. Drug Alcohol Depend 2024; 257:111133. [PMID: 38447393 DOI: 10.1016/j.drugalcdep.2024.111133] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence. METHODS HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models. RESULTS Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex. CONCLUSIONS PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP.
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Affiliation(s)
- Mary A Hatch
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA.
| | - Tanja C Laschober
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA
| | - Margaret Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, NY 10032, USA
| | - Melissa M Ertl
- University of Minnesota-Twin Cities, Department of Psychology, Minneapolis, MN 55455, USA
| | - C Mindy Nelson
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA
| | - Lynette Wright
- University of Washington Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98185, USA
| | - Chloe Lancaster
- University of South Florida, Department of Leadership, Policy, and Lifelong Learning, Tampa, FL 33620, USA
| | - Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL 33136, USA
| | - David Forrest
- University of Miami, Department of Anthropology, Coral Gables, FL, USA
| | - Colby Hankey
- Aspire Health Partners, HIV Services, Orlando, FL 32804, USA
| | - Mauda Monger
- My Brother's Keeper, 710 Avignon Dr, Ridgeland, MS 39157, USA
| | - Joshua P Fegley
- CrescentCare, 330 Tulane Ave, 1st Floor, New Orleans, LA 70119, USA
| | - Rhonda Irving
- Capitol Area Reentry Program, Baton Rouge, LA 70807, USA
| | - Cynthia Young
- Capitol Area Reentry Program, Baton Rouge, LA 70807, USA
| | - Juliana Rose
- Gateway Community Services, Research Department, Jacksonville, FL, USA
| | - Anya Spector
- Stella and Charles Guttman Community College, City University of New York, New York, NY, USA
| | | | - Landhing Moran
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA
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Paschen-Wolff M, Greenfield SF, Kathryn McHugh R, Burlew K, Pavlicova M, Choo TH, Barbosa-Leiker C, Ruglass LM, Mennenga S, Rotrosen J, Nunes EV, Campbell ANC. Clinical and psychosocial outcomes by sex among individuals prescribed buprenorphine-naloxone (BUP-NX) or extended-release naltrexone (XR-NTX) for opioid use disorder. Am J Addict 2023; 32:584-592. [PMID: 37583120 PMCID: PMC10841329 DOI: 10.1111/ajad.13463] [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: 04/17/2023] [Revised: 07/18/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Limited research has explored sex differences in opioid use disorder medication (MOUD) treatment outcomes. The purpose of this study was to examine MOUD initiation onto buprenorphine-naloxone (BUP-NX) versus extended-release naltrexone (XR-NTX) by sex, and sex differences in clinical and psychosocial outcomes. METHODS Using data from a 24-week open-label comparative effectiveness trial of BUP-NX or XR-NTX, this study examined MOUD initiation (i.e., receiving a minimum one XR-NTX injection or first BUP-NX dose) and 24-week self-report outcomes. We used regression models to estimate the probability of MOUD initiation failure among the intent-to-treat sample (N = 570), and the main and interaction effects of sex on outcomes of interest among the subsample of participants who successfully initiated MOUD (n = 474). RESULTS In the intent-to-treat sample, the odds of treatment initiation failure were not significantly different by sex. In the subsample of successful MOUD initiates, the effect of treatment on employment at week 24 was significantly moderated by sex (p = .003); odds of employment were not significantly different among males by MOUD type; females randomized to XR-NTX versus BUP-NX had 4.63 times greater odds of employment (p < .001). Males had significantly lower odds of past 30-day exchanging sex for drugs versus females (adjusted odds ratios [aOR] = 0.10, p = .004), controlling for treatment and baseline outcomes. DISCUSSION AND CONCLUSIONS Further research should explore how to integrate employment support into OUD treatment to improve patient outcomes, particularly among women. SCIENTIFIC SIGNIFICANCE The current study addressed gaps in the literature by examining sex differences in MOUD initiation and diverse treatment outcomes in a large, national sample.
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Affiliation(s)
- Margaret Paschen-Wolff
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, Unit 120, New York, NY 10032
| | - Shelly F. Greenfield
- McLean Hospital, 115 Mill Street, Belmont, MA 02478
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St. Boston, MA 02115
| | - R. Kathryn McHugh
- McLean Hospital, 115 Mill Street, Belmont, MA 02478
- Harvard Medical School, Department of Psychiatry, 25 Shattuck St. Boston, MA 02115
| | - Kathleen Burlew
- University of Cincinnati, College of Arts & Sciences, Department of Psychology, 155 B Arts & Sciences Hall, Cincinnati, OH 45221
| | - Martina Pavlicova
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 West 168 Street, New York, NY
| | - Tse-Hwei Choo
- Mental Health Data Science Division, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, New York, NY
| | | | - Lesia M. Ruglass
- City College of New York, Department of Psychology, 160 Convent Avenue New York, NY 10031
| | - Sarah Mennenga
- New York University Grossman School of Medicine, Department of Psychiatry, 550 1 Avenue, New York, NY 10016
| | - John Rotrosen
- New York University Grossman School of Medicine, Department of Psychiatry, One Park Avenue, 8 Floor, New York, NY 10016
| | - Edward V. Nunes
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, Unit 120, New York, NY 10032
| | - Aimee N. C. Campbell
- Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, Division on Substance Use Disorders, 1051 Riverside Drive, Unit 120, New York, NY 10032
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Everett BG, Turner B, Hughes TL, Veldhuis CB, Paschen-Wolff M, Phillips G. Sexual Orientation Disparities in Pregnancy Risk Behaviors and Pregnancy Among Sexually Active Teenage Girls: Updates from the Youth Risk Behavior Survey. LGBT Health 2020; 6:342-349. [PMID: 31618165 DOI: 10.1089/lgbt.2018.0206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/12/2022] Open
Abstract
Purpose: The purpose of this study was to determine the extent to which sexual identity and/or sexual behaviors were associated with pregnancy risk factors (condom use, alcohol or other drug use before sex, and World Health Organization [WHO] Tier 1 [i.e., intrauterine device, implant] or Tier 2 [i.e., injectable, pill, patch, or ring] contraception use) and teen pregnancy among female high school students who reported having a sexual relationship with a male partner. Methods: Data were from the Youth Risk Behavior Survey (YRBS; 2005-2015) (n = 63,313). Logistic regression was used to analyze sexual identity and behavior disparities in pregnancy risk behaviors and teen pregnancy. Interactions between sexual identity and behavior were also tested. All models adjusted for the YRBS complex sampling frame. Results: Girls who reported being unsure of their sexual identity were less likely to use condoms or a WHO Tier 1 or Tier 2 contraceptive method at last sex, and more likely to report alcohol or other drug use at last sex than heterosexual girls. Girls who identified as lesbian were also less likely to use a condom at last sex, and girls who reported both male and female sexual partners were more likely to report alcohol or other drug use and less likely to use condoms at last sex. Girls who identified as bisexual were more likely to report pregnancy during teenage years than girls who identified as heterosexual. Conclusion: Our results support the need to assess both sexual identity and sexual behavior in research on teen pregnancy and pregnancy risk. Furthermore, the finding that girls who were unsure of their sexual identity showed heightened risk highlights the need for additional research that includes this group.
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Affiliation(s)
| | - Blair Turner
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Tonda L Hughes
- School of Nursing, Columbia University, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | | | - Margaret Paschen-Wolff
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
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Porsch L, Zhang H, Paschen-Wolff M, Grosskopf N, Grov C. Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth. LGBT Health 2020; 7:321-331. [PMID: 32808867 DOI: 10.1089/lgbt.2020.0013] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Methods: Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Results: Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Conclusion: Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.
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Affiliation(s)
- Lauren Porsch
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hongbin Zhang
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Margaret Paschen-Wolff
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, USA
| | - Nicholas Grosskopf
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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Porsch L, Zhang H, Paschen-Wolff M, Grosskopf N, Grov C. Dimensions of Sexual Orientation as Predictors of STI-Related Outcomes Among Women: An Examination of 2011-2017 National Survey of Family Growth Data. J Womens Health (Larchmt) 2020; 29:1385-1391. [PMID: 32609040 DOI: 10.1089/jwh.2019.8289] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To estimate sexual orientation associated disparities in sexually transmitted infection (STI)-related outcomes across multiple dimensions of sexual orientation. Methods: Using pooled 2011-2017 National Survey of Family Growth data (N = 16,854), we performed bivariate and multivariable logistic and multinomial regression analyses to estimate associations between sexual identity, behavior in the past 12 months, and attraction, and past-year STI treatment, receipt of the human papillomavirus (HPV) vaccine, and age at first HPV vaccination in cisgender women. Results: Bisexual-identified women (adjusted odds ratio [AOR] = 1.53, 95% confidence interval [CI] = 1.10-2.14) and who were sexually active with both men and women in the past 12 months (AOR = 1.64, 95% CI = 1.03-2.55) had significantly higher odds of past-year STI treatment, compared with their nonsexual minority counterparts. Lesbian-identified women (AOR = 0.44, 95% CI = 0.27-0.75) and women with female partners only (AOR = 0.32, 95% CI = 0.12-0.87) had significantly decreased odds of having initiated the HPV vaccine compared with their heterosexual counterparts. Women with both male and female partners who initiated the HPV vaccine had significantly higher odds of having received the vaccine during the latest age range, 18-25 years old (AOR = 2.32, 95% CI = 1.21-4.45) compared with women with male partners only. Conclusions: Sexual minority women continue to be at risk for poor sexual health outcomes, and these outcomes differ by specific components of sexual orientation.
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Affiliation(s)
- Lauren Porsch
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hongbin Zhang
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Margaret Paschen-Wolff
- Columbia University HIV Center for Clinical and Behavioral Studies, New York, New York, USA
| | - Nicholas Grosskopf
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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