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Meisner A, Xia F, Chan KCG, Mayer K, Wheeler D, Zangeneh S, Donnell D. Estimating the Effect of PrEP in Black Men Who Have Sex with Men: A Framework to Utilize Data from Multiple Non-Randomized Studies to Estimate Causal Effects. medRxiv 2024:2024.01.10.24301113. [PMID: 38260494 PMCID: PMC10802753 DOI: 10.1101/2024.01.10.24301113] [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: 01/24/2024]
Abstract
Black men who have sex with men (MSM) are disproportionately burdened by the HIV epidemic in the US. The effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection has been demonstrated through randomized placebo-controlled clinical trials in several populations. Importantly, no such trial has been conducted exclusively among Black MSM in the US, and it would be unethical and infeasible to do so now. To estimate the causal effects of PrEP access, initiation, and adherence on HIV risk, we utilized causal inference methods to combine data from two non-randomized studies that exclusively enrolled Black MSM. The estimated relative risks of HIV were: (i) 0.52 (95% confidence interval: 0.21, 1.22) for individuals with versus without PrEP access, (ii) 0.48 (0.12, 0.89) for individuals who initiated PrEP but were not adherent versus those who did not initiate, and (iii) 0.23 (0.02, 0.80) for individuals who were adherent to PrEP versus those who did not initiate. Beyond addressing the knowledge gap around the effect of PrEP in Black MSM in the US, which may have ramifications for public health, we have provided a framework to combine data from multiple non-randomized studies to estimate causal effects, which has broad utility.
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Affiliation(s)
- Allison Meisner
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, US
| | - Fan Xia
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
| | - Kwun C G Chan
- Department of Biostatistics, University of Washington, Seattle, WA, US
| | - Kenneth Mayer
- Harvard Medical School, Boston, MA, US
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, US
- The Fenway Institute, Boston, MA, US
- Infectious Diseases Division, Beth Israel Deaconess Medical Center, Boston, MA, US
| | - Darrell Wheeler
- State University of New York at New Paltz, New Paltz, NY, US
| | - Sahar Zangeneh
- RTI International, Research Triangle Park, NC, US
- School of Public Health, University of Washington, Seattle, WA, US
| | - Deborah Donnell
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, WA, US
- Department of Global Health, University of Washington, Seattle, WA, US
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Frye V, Nandi V, Paige MQ, McCrossin J, Lucy D, Gwadz M, Sullivan PS, Hoover DR, Wilton L. TRUST: Assessing the Efficacy of an Intervention to Increase HIV Self-Testing Among Young Black Men Who have Sex with Men (MSM) and Transwomen. AIDS Behav 2021; 25:1219-1235. [PMID: 33190178 PMCID: PMC7666714 DOI: 10.1007/s10461-020-03091-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Accepted: 11/08/2020] [Indexed: 12/31/2022]
Abstract
HIV testing among young Black MSM and transwomen (YBMSM/TW) is the gateway to biomedical HIV prevention or treatment. HIV self-testing (HST) is a method that may increase consistent HIV testing. TRUST, a brief, peer-based behavioral intervention, was designed to increase uptake of consistent (every three months) HST among YBMSM/TW in New York City. To test the efficacy of the intervention, we randomized 200 friend pairs into either the intervention condition (TRUST) or a time and attention control condition. A modified intent-to-treat analysis found that self-reported HST at 3-month follow-up was statistically significantly higher (uOR 2.29; 95% CI 1.15, 4.58) and at 6-month follow-up was marginally statistically significantly higher (uOR 1.94; 95% CI 1.00, 3.75) in the intervention arm as compared with the control arm. There were no statistically significant differences by arm at 9- or 12-month follow-up. TRUST, a culturally-congruent intervention to increase HST among YBMSM/TW, had short-term impact on past-three month HST. Clinical Trials Registration ClinicalTrial.gov NCT04210271.
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Affiliation(s)
- Victoria Frye
- Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, City College of New York, City University of New York, New York, NY, USA
| | - Vijay Nandi
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Mark Q Paige
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Jermaine McCrossin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Debbie Lucy
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | | | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, The State University of New Jersey, Piscataway, NJ, USA
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs (CCPA), State University of New York At Binghamton, 4400 Vestal Parkway East, Binghamton, NY, 13902, USA.
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.
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Quinn KG, Zarwell M, John SA, Christenson E, Walsh JL. Perceptions of PrEP Use Within Primary Relationships Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men. Arch Sex Behav 2020; 49:2117-2128. [PMID: 32240437 PMCID: PMC7321890 DOI: 10.1007/s10508-020-01683-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Received: 10/22/2019] [Revised: 02/29/2020] [Accepted: 03/08/2020] [Indexed: 05/12/2023]
Abstract
A significant proportion of new HIV infections among gay, bisexual, and other men who have sex with men (MSM) occur within primary relationships. Although PrEP use continues to increase, there is a need to better understand the factors that contribute to PrEP decision-making within primary relationships. We qualitatively examined how relationship context influences perceptions of PrEP and decisions to initiate and discontinue PrEP among young Black MSM to provide a nuanced understanding of PrEP use within relationships. Between late 2017 and mid-2018, we conducted 10 focus groups with young Black MSM (n = 80) in Milwaukee, WI, Minneapolis, MN, Kansas City, KS, and Detroit, MI. We used inductive thematic analysis to examine how young Black MSM make decisions about PrEP use within the context of primary relationships. We identified three primary themes: (1) perceptions of PrEP as an indication of distrust and infidelity, (2) perceptions of PrEP use as necessary, even in primary relationships, and (3) the influence of partners on PrEP. Our results demonstrate the considerable variation in how young Black MSM view PrEP within primary relationships and the influence of primary partners in PrEP use decisions. The dynamics between two or more individuals can shape an individual's conceptualizations of and decisions around PrEP use, and these may be key drivers of racial disparities in HIV and PrEP use.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA.
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina, Charlotte, Charlotte, NC, USA
| | - Steven A John
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Erika Christenson
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, USA
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Kelly JA, Amirkhanian YA, Walsh JL, Brown KD, Quinn KG, Petroll AE, Pearson BM, Rosado AN, Ertl T. Social network intervention to increase pre-exposure prophylaxis (PrEP) awareness, interest, and use among African American men who have sex with men. AIDS Care 2020; 32:40-46. [PMID: 32167374 DOI: 10.1080/09540121.2020.1739207] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/05/2023]
Abstract
In the U.S., HIV incidence is highest among Black men who have sex with men (MSM) but PrEP uptake is low, in part due to lack of normative support for using PrEP. This research pilot tested a social network-level intervention designed to increase PrEP use willingness, interest, and peer supports among Black MSM in Milwaukee. Five community social networks (n = 40 participants) of racial minority MSM were assessed at baseline with measures of PrEP knowledge, interest, attitudes, and action taking. Persons most interconnected with others in each network attended an intervention that provided training to increase knowledge about PrEPbenefits, address PrEP concerns, endorse PrEP use as a symbol of pride and health, and deliver these messages to others in their social networks. All network members were re-administered the same measures at 3-month followup. Significant increases over time were found in network members' PrEP knowledge, attitudes, norm perceptions, self-efficacy, and willingness to use PrEP. Participants more often talked with friends about HIV and with their health care providers about PrEP. The percentage of participants who reported using PrEP increased from 3% to 11%. Larger-scale evaluations of this intervention model are needed.
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Affiliation(s)
- Jeffrey A Kelly
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yuri A Amirkhanian
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin D Brown
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E Petroll
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Broderick M Pearson
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - A Noel Rosado
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thom Ertl
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Watson CC, Wilton L, Lucas JP, Bryant L, Victorianne GD, Aradhya K, Fields SD, Wheeler DP. Development of a Black Caucus within the HIV Prevention Trials Network (HPTN): Representing the Perspectives of Black Men Who Have Sex with Men (MSM). Int J Environ Res Public Health 2020; 17:ijerph17030871. [PMID: 32028553 PMCID: PMC7037695 DOI: 10.3390/ijerph17030871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
Black men who have sex with men (MSM) have disproportionate HIV disease burden in the United States. Black MSM have been underrepresented in biomedical research, including HIV clinical trials, due to a myriad of socio-structural, socio-cultural, and psychosocial factors. The HIV Prevention Trials Network (HPTN) 061, a feasibility study of a multi-component HIV prevention intervention for Black MSM in six US cities, incorporated the development and implementation of a Black Caucus as a culturally grounded model for the integration of Black MSM in clinical trials and research in HPTN. Based on a qualitative methodological approach, we describe the formation and implementation of the Black Caucus from the perspective of Black MSM key community stakeholders. Three major themes emerged from the qualitative narratives: (1) the role of the Black Caucus in shaping the HPTN, (2) how the Black Caucus addresses the needs of Black MSM communities pertaining to the influence of race and sexual identity, and (3) socio-cultural needs of Black MSM. These findings have implications for the provision of culturally congruent expertise, community engagement, cultural mistrust, recruitment and retention of Black MSM in HIV clinical trials, culturally-relevant study design and implementation, and the role of developing Black MSM prevention researchers.
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Affiliation(s)
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY 13902, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg 2006, South Africa
- Correspondence: ; Tel.: +1-607-777-9215
| | - Jonathan Paul Lucas
- Science Facilitation Department, FHI 360, Durham, NC 27701, USA; (J.P.L.); (K.A.)
| | - Lawrence Bryant
- Department of Health Administration, School of Nursing and Health Sciences, Capella University, Minneapolis, MN 55402, USA;
| | - Gregory D. Victorianne
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90024, USA;
| | - Kerry Aradhya
- Science Facilitation Department, FHI 360, Durham, NC 27701, USA; (J.P.L.); (K.A.)
- Invitae, San Francisco, CA 93103, USA
| | - Sheldon D. Fields
- Harriet Rothkopf Heilbrunn School of Nursing, Long Island University-Brooklyn, Brooklyn, NY 11201, USA;
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Maksut JL, Gicquelais RE, Jackman KM, Eaton LA, Friedman MR, Matthews DD, Bukowski LA, Stall RD. Injection drug use, unknown HIV positive status, and self-reported current PrEP use among Black men who have sex with men attending U.S. Black pride events, 2014-2017. Drug Alcohol Depend 2020; 207:107808. [PMID: 31855657 DOI: 10.1016/j.drugalcdep.2019.107808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Black gay, bisexual, and other men who have sex with men (BMSM) are at elevated risk for HIV infection in the United States. BMSM who inject drugs may be face even higher HIV risk. METHODS Random time-location sampling was used to survey BMSM attending Black Pride events in 6 U.S. cities about HIV risk and protective behaviors, including injection drug use, prior HIV testing, and pre-exposure prophylaxis (PrEP). 3429 individuals who reported a HIV negative/unknown serostatus at enrollment were included in the analysis. HIV status was determined by in-field rapid HIV testing. RESULTS 3.6% of BMSM had injected drugs in their lifetime and 58.5% of BMSM who had injected drugs reported sharing syringes in the past six months. BMSM who had injected drugs more commonly reported current PrEP use than BMSM who had never injected (32.5% vs. 8.2%, p < 0.001). BMSM who had injected drugs were 3.6-fold (95% CI: 2.4, 5.4) more likely to report currently using PrEP than BMSM who had never injected after adjustment for sociodemographic, substance use, and sexual risk characteristics. Among BMSM who reported ever injecting drugs (n = 123), 31.7% tested HIV positive. HIV prevalence did not differ by self-reported PrEP use among BMSM who had injected drugs (p = 0.59). CONCLUSIONS BMSM who inject drugs who reported currently using PrEP were no less likely to test positive for HIV than those who did not use PrEP. Wrap-around services to support consistent PrEP use and long-acting PrEP formulations may improve the effectiveness of PrEP among BMSM who inject drugs.
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McNair OS, Gipson JA, Denson D, Thompson DV, Sutton MY, Hickson DA. The Associations of Resilience and HIV Risk Behaviors Among Black Gay, Bisexual, Other Men Who Have Sex with Men (MSM) in the Deep South: The MARI Study. AIDS Behav 2018; 22:1679-87. [PMID: 28856456 DOI: 10.1007/s10461-017-1881-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Resilience is an understudied intrapersonal factor that may reduce HIV risk among men who have sex with men (MSM). Multivariable Poisson regression models were used to estimate the prevalence ratio (PR) of sexual risk behaviors, HIV prevalence, and history of sexually transmitted infections (STIs) with resilience scores in a population-based study among 364 black MSM in the Deep South. Participants with higher resilience scores had a lower prevalence of condomless anal sex with casual sexual partners in past 12 months (PR = 0.80, p value = 0.001) and during their last sexual encounter (PR = 0.81; p value = 0.009). Resilience was inversely associated with a lower prevalence of condomless anal sex with main sexual partners, participating in a sex party/orgy and having a STI in the past 12 months. Resilience may have a protective effect on HIV among black MSM, especially in the Deep South, and should be further explored in studies with prospective designs.
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