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Mauldin RL, Al Rawwad T, Amith M, Kuhns LM, Schneider JA, Fujimoto K. Community-clinic linkages for promoting HIV prevention: organizational networks for PrEP client referrals and collaborations. AIDS Care 2022; 34:340-348. [PMID: 34085893 PMCID: PMC8642466 DOI: 10.1080/09540121.2021.1936445] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Community-clinic linkages may help communities increase HIV pre-exposure prophylaxis (PrEP) uptake. Referrals from community-based organizations may be particularly important for linking Black men who have sex with men (MSM) to PrEP. This study describes PrEP referral and HIV/STI prevention networks among organizations that serve MSM in Houston, TX (N = 40), and Chicago, IL (N = 28), and compares network positions of organizations based on percentage of Black/African American clients. A majority of organizations conducted PrEP awareness/promotion activities, but fewer made PrEP referrals, with little overlap between the collaboration and referral networks. The networks tended to have a densely connected core group of organizations and more a peripheral group of organizations linking into the core with relatively few times among themselves; this core/periphery structure is efficient, but vulnerable to disruptions. The percentage of Black/African American clients organizations served was not related to most measures of network centrality. However, in Houston's collaboration network, higher Black-serving organizations tended not to hold as influential positions for controlling communications or flows of resources. The findings indicate a potential to leverage collaborations into PrEP referral pathways to enhance PrEP promotion efforts and identify opportunities to address racial disparities in PrEP uptake.
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Affiliation(s)
- Rebecca L. Mauldin
- The University of Texas at Arlington School of Social Work, Arlington, TX,,Corresponding author: Rebecca L. Mauldin, 211 South Cooper Street, University of Texas at Arlington, Arlington, TX 76019;
| | | | - Muhammad Amith
- The University of Texas Health Science Center at Houston, School of Biomedical Informatics, Houston, TX
| | - Lisa M. Kuhns
- Ann & Robert H. Lurie Children’s Hospital, Northwestern University, Chicago, IL
| | - John A. Schneider
- University of Chicago, Department of Public Health Sciences, Chicago, IL, USA
| | - Kayo Fujimoto
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX
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Fujimoto K, Paraskevis D, Kuo JC, Hallmark CJ, Zhao J, Hochi A, Kuhns LM, Hwang LY, Hatzakis A, Schneider JA. Integrated molecular and affiliation network analysis: Core-periphery social clustering is associated with HIV transmission patterns. Soc Networks 2022; 68:107-117. [PMID: 34262236 PMCID: PMC8274587 DOI: 10.1016/j.socnet.2021.05.003] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study investigates the two-mode core-periphery structures of venue affiliation networks of younger Black men who have sex with men (YBMSM). We examined the association between these structures and HIV phylogenetic clusters, defined as members who share highly similar HIV strains that are regarded as a proxy for sexual affiliation networks. Using data from 114 YBMSM who are living with HIV in two large U.S. cities, we found that HIV phylogenetic clustering patterns were associated with social clustering patterns whose members share affiliation with core venues that overlap with those of YBMSM. Distinct HIV transmission patterns were found in each city, a finding that can help to inform tailored venue-based and network intervention strategies.
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Affiliation(s)
- Kayo Fujimoto
- Department of Health Promotion, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX 77030
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jacky C. Kuo
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
| | | | - Jing Zhao
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Andre Hochi
- Department of Health Promotion, The University of Texas Health Science Center at Houston, 7000 Fannin Street, UCT 2514, Houston, TX 77030
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital, and Northwestern University, Feinberg School of Medicine, Department of Pediatrics, 225 E. Chicago Avenue, #161, Chicago, IL 60611
| | - Lu-Yu Hwang
- Department of Epidemiology, Human Genetics, and Environmental Science, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houston, TX 77030
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John A. Schneider
- Department of Medicine and Public Health Sciences and the Chicago Center for HIV Elimination, University of Chicago, 5837 South Maryland Avenue MC 5065, Chicago, IL 60637
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Serota DP, Rosenberg ES, Sullivan PS, Thorne AL, Rolle CPM, Del Rio C, Cutro S, Luisi N, Siegler AJ, Sanchez TH, Kelley CF. Pre-exposure Prophylaxis Uptake and Discontinuation Among Young Black Men Who Have Sex With Men in Atlanta, Georgia: A Prospective Cohort Study. Clin Infect Dis 2021; 71:574-582. [PMID: 31499518 DOI: 10.1093/cid/ciz894] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has great potential to reduce HIV incidence among young black men who have sex with men (YBMSM); however, initiation and persistence for this group remain low. We sought to understand the patterns and predictors of PrEP uptake and discontinuation among YBMSM in Atlanta, Georgia. METHODS PrEP was offered to all participants in a prospective cohort of YBMSM aged 18-29 years not living with HIV. Time to PrEP uptake, first discontinuation, and final discontinuation were assessed using the Kaplan-Meier method. Cox proportional hazard models were used to identify predictors of uptake and discontinuation. RESULTS After 440 person-years of follow-up, 44% of YBMSM initiated PrEP through the study after a median of 122 days. Of PrEP initiators, 69% had a first discontinuation and 40% had a final discontinuation during the study period. The median time to first PrEP discontinuation was 159 days. Factors associated with PrEP uptake included higher self-efficacy, sexually transmitted infection (STI), and condomless anal intercourse. Factors associated with discontinuation included younger age, cannabis use, STI, and fewer sex partners. HIV incidence was 5.23/100 person-years (95% confidence interval [CI], 3.40-7.23), with a lower rate among those who started PrEP (incidence rate ratio, 0.39; 95% CI, .16-.92). CONCLUSIONS Persistent PrEP coverage in this cohort of YBMSM was suboptimal, and discontinuations were common despite additional support services available through the study. Interventions to support PrEP uptake and persistence, especially for younger and substance-using YBMSM, are necessary to achieve full PrEP effectiveness. CLINICAL TRIALS REGISTRATION NCT02503618.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, University of Albany School of Public Health, State University of New York, Rensselaer, New York, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Annie L Thorne
- Department of Behavioral Science and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Scott Cutro
- Department of Infectious Diseases, Kaiser Permanente, Atlanta, Georgia, USA
| | - Nicole Luisi
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Aaron J Siegler
- Department of Behavioral Science and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Travis H Sanchez
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Serota DP, Rosenberg ES, Thorne AL, Sullivan PS, Kelley CF. Lack of health insurance is associated with delays in PrEP initiation among young black men who have sex with men in Atlanta, US: a longitudinal cohort study. J Int AIDS Soc 2019; 22:e25399. [PMID: 31592575 PMCID: PMC6781266 DOI: 10.1002/jia2.25399] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 04/23/2019] [Accepted: 09/06/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Delays between receiving a PrEP prescription and taking a first dose increase the risk of HIV infection. This is especially relevant in populations with high HIV incidence, such as young black men who have sex with men (YBMSM) in the United States. Additionally, YBMSM have relatively low levels of health insurance. We investigated whether lack of health insurance and reliance on PrEP funding through the manufacturer assistance programme (MAP) leads to delays in initiation of PrEP. METHODS HIV-negative YBMSM were offered PrEP as part of a prospective cohort. Enrolment began in June 2015 with follow-up through February 2019. Interested participants attended a PrEP clinician visit and received a prescription. Those with health insurance received a copay assistance card; those without insurance accessed PrEP using the MAP. The primary outcome was the days between prescription and initiation. The effect of insurance status on this delay was modelled using a Cox proportional hazards model. RESULTS AND DISCUSSION The median delay between receipt of a PrEP prescription and taking a first dose was 12 days (IQR 3 to 32). Compared to uninsured participants, the adjusted hazard ratio for PrEP initiation for those with insurance was 2.72 (95% CI 1.82 to 4.06). The adjusted median time to initiation for insured participants was 5 days versus 21 days for those without insurance (p < 0.0001). Older age and STI diagnosis were also associated with faster PrEP initiation. Despite equivalent access to PrEP provided by the study, YBMSM without insurance had longer delays in initiation after receipt of a prescription. Overall, the observed delay in PrEP initiation increases the chances of HIV infection and the possibility of PrEP initiation after undetected seroconversion. CONCLUSIONS The extended time period between PrEP prescription and taking a first dose increases the risk of HIV transmission. Younger YBMSM and those without health insurance had longer delays in PrEP initiation. Immediate PrEP initiation programmes could decrease the likelihood of this occurrence and mitigate the disparity in initiation between those with and without health insurance. Clinical Trial Number: NCT02503618.
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Affiliation(s)
- David P Serota
- Department of Medicine, Division of Infectious DiseasesEmory University School of MedicineAtlantaGAUnited States
| | - Eli S Rosenberg
- Department of Epidemiology and BiostatisticsSchool of Public HealthSUNYUniversity of AlbanyRensselaerNYUnited States
| | - Annie L Thorne
- Department of Behavioral Science and Health EducationEmory University Rollins School of Public HealthAtlantaGAUnited States
| | - Patrick S Sullivan
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUnited States
| | - Colleen F Kelley
- Department of Medicine, Division of Infectious DiseasesEmory University School of MedicineAtlantaGAUnited States
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