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Holt M, Chan C, Broady TR, MacGibbon J, Mao L, Smith AKJ, Rule J, Bavinton BR. Variations in HIV Prevention Coverage in Subpopulations of Australian Gay and Bisexual Men, 2017-2021: Implications for Reducing Inequities in the Combination Prevention Era. AIDS Behav 2024; 28:1469-1484. [PMID: 37755522 PMCID: PMC11069488 DOI: 10.1007/s10461-023-04172-3] [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: 09/08/2023] [Indexed: 09/28/2023]
Abstract
Using repeated behavioural surveillance data collected from gay and bisexual men (GBM) across Australia, we assessed trends in HIV prevention coverage (the level of 'safe sex' achieved in the population by the use of effective prevention methods, including condoms, pre-exposure prophylaxis [PrEP] and having an undetectable viral load). We stratified these trends by age, country of birth/recency of arrival, sexual identity, and the proportion of gay residents in the participant's suburb. Among 25,865 participants with casual male partners, HIV prevention coverage increased from 69.8% in 2017 to 75.2% in 2021, lower than the UNAIDS target of 95%. Higher levels of coverage were achieved among older GBM (≥ 45 years), non-recently-arrived migrants, and in suburbs with ≥ 10% gay residents. The lowest levels of prevention coverage (and highest levels of HIV risk) were recorded among younger GBM (< 25 years) and bisexual and other-identified participants. Younger, recently-arrived, and bisexual GBM were the most likely to use condoms, while PrEP use was concentrated among gay men, 25-44-year-olds, and in suburbs with more gay residents. The use of undetectable viral load was most common among participants aged ≥ 45 years. Our analysis shows that high HIV prevention coverage can be achieved through a mixture of condom use, PrEP use, and undetectable viral load, or by emphasising PrEP use. In the Australian context, younger, bisexual and other-identified GBM should be prioritised for enhanced access to effective HIV prevention methods. We encourage other jurisdictions to assess the level of coverage achieved by combination prevention, and variations in uptake.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - John Rule
- National Association of People With HIV Australia, Sydney, Australia
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Beauchamp G, Hosek S, Donnell D, Chan KCG, Anderson PL, Dye BJ, Mgodi N, Bekker LG, Delany-Moretlwe S, Celum C. The Effect of Disclosure of PrEP Use on Adherence Among African Young Women in an Open-Label PrEP Study: Findings from HPTN 082. AIDS Behav 2024; 28:1512-1521. [PMID: 37768427 PMCID: PMC11069481 DOI: 10.1007/s10461-023-04175-0] [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: 09/09/2023] [Indexed: 09/29/2023]
Abstract
To develop effective PrEP adherence interventions, it is important to understand the interplay between disclosure of pre-exposure prophalxis (PrEP) use, social support, and PrEP adherence. We leveraged the HPTN 082 study conducted among 451 adolescent girls and young women (AGYW) (ages 16 to 25 years, 2016 to 2019) in South Africa and Zimbabwe. Among the 349 who had month three disclosure and PrEP adherence data, 60% (n = 206) felt supported by adults, and 89% (n = 309) disclosed PrEP use to at least one person. PrEP disclosure was not associated with increased adherence, measured by intracellular tenofovir-diphosphate concentrations in dried blood spots. Women who reported having supportive adults, and disclosed to their parents, had higher adherence at 6 months with an increase of 177 fmol/punch (95% CI 12 to 343, t = 2.11, p = 0.04). PrEP interventions that help AGYW identify supportive relationships and effectively communicate the benefits of PrEP may improve PrEP adherence.Clinicaltrials.gov ID number: NCT02732730.
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Affiliation(s)
- Geetha Beauchamp
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, Seattle, WA, 98109, USA.
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Deborah Donnell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Mail Stop M2-C200, Seattle, WA, 98109, USA
| | - Kwun C G Chan
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
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Goodreau SM, Barry MP, Hamilton DT, Williams AM, Wang LY, Sanchez TH, Katz DA, Delaney KP. Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States. AIDS Behav 2024; 28:1766-1780. [PMID: 38411799 DOI: 10.1007/s10461-024-04281-7] [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: 01/25/2024] [Indexed: 02/28/2024]
Abstract
This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014-2019 cycles of the American Men's Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15 years, in which ~ 10% of each year's sample is drawn from the previous year. Among those surveyed for 2 years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15-24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18-24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Campus Box 353100, Seattle, WA, 98122, USA.
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA.
| | - Michael P Barry
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Center for AIDS & STD, University of Washington, Seattle, WA, USA
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Austin M Williams
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kevin P Delaney
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mpirirwe R, Segawa I, Ojiambo KO, Kamacooko O, Nangendo J, Semitala FC, Kyambadde P, Kalyango JN, Kiragga A, Karamagi C, Katahoire A, Kamya M, Mujugira A. HIV pre-exposure prophylaxis uptake, retention and adherence among female sex workers in sub-Saharan Africa: a systematic review. BMJ Open 2024; 14:e076545. [PMID: 38670600 PMCID: PMC11057315 DOI: 10.1136/bmjopen-2023-076545] [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: 06/13/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To evaluate oral pre-exposure prophylaxis (PrEP) uptake, retention and adherence among female sex workers (FSWs) receiving care through community and facility delivery models in sub-Saharan Africa (SSA). DESIGN Systematic review and meta-analysis. DATA SOURCES We searched online databases (PubMed, MEDLINE, SCOPUS, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews and Web of Science) between January 2012 and 3 April 2022. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials, cohort studies, cross-sectional studies and quasi-experimental studies with PrEP uptake, adherence and retention outcomes among FSWs in SSA. DATA EXTRACTION AND SYNTHESIS Seven coders extracted data. The framework of the Cochrane Consumers and Communication Review Group guided data synthesis. The Risk of Bias In Non-Randomized Studies of Interventions tool was used to evaluate the risk of bias. Meta-analysis was conducted using a random-effects model. A narrative synthesis was performed to analyse the primary outcomes of PrEP uptake, adherence and retention. RESULTS Of 8538 records evaluated, 23 studies with 40 669 FSWs were included in this analysis. The pooled proportion of FSWs initiating PrEP was 70% (95% CI: 56% to 85%) in studies that reported on facility-based models and 49% (95% CI: 10% to 87%) in community-based models. At 6 months, the pooled proportion of FSWs retained was 66% (95% CI: 15% to 100%) for facility-based models and 83% (95% CI: 75% to 91%) for community-based models. Factors associated with increased PrEP uptake were visiting a sex worker programme (adjusted OR (aOR) 2.92; 95% CI: 1.91 to 4.46), having ≥10 clients per day (aOR 1.71; 95% CI: 1.06 to 2.76) and lack of access to free healthcare in government-run health clinics (relative risk: 1.16; 95% CI: 1.06 to 1.26). CONCLUSIONS A hybrid approach incorporating both facility-based strategies for increasing uptake and community-based strategies for improving retention and adherence may effectively improve PrEP coverage among FSWs. PROSPERO REGISTRATION NUMBER CRD42020219363.
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Affiliation(s)
- Ruth Mpirirwe
- Clinical Epidemiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Segawa
- Clinical Epidemiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kevin Ouma Ojiambo
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | | | - Joan N Kalyango
- Clinical Epidemiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- College of Health Sciences, Makerere University, Kampala, Uganda
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Hlongwa M, Basera W, Nicol E. Comparing PrEP initiation rates by service delivery models among high risk adolescent boys and young men in KwaZulu-Natal, South Africa: findings from a population-based prospective study. BMC Public Health 2024; 24:1151. [PMID: 38658900 PMCID: PMC11043044 DOI: 10.1186/s12889-024-18660-1] [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: 06/07/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that can reduce the risk of HIV acquisition by more than 90% if taken consistently. Although South Africa has been implementing PrEP since 2016, initially for selected population groups before expanding access to more people, there is a dearth of research focused on PrEP among adolescent boys and young men (ABYM), despite them experiencing high rates of HIV infection. To address this gap, we compared PrEP initiation rates by service delivery points (SDPs) among ABYM in KwaZulu-Natal, South Africa. METHODS We conducted a population-based prospective study in 22 SDPs from July 2021 to July 2022 in KwaZulu-Natal, South Africa. Sexually active ABYM aged 15-35 years who tested HIV negative were recruited at purposively selected PrEP SDPs (i.e., healthcare facilities, secondary schools and Technical Vocational Education and Training (TVET) colleges, and community-based youth zones). We collected baseline quantitative data from each participant using self-administered electronic questionnaires built into REDCap, including demographic information such as age, sex, employment status and level of education, as well as PrEP initiation outcomes. We extracted data from REDCap and exported it to Stata version 17.0 for analysis, and then eliminated discrepancies and removed duplicates. We described baseline characteristics using summary and descriptive statistics (median, interquartile range [IQR] and proportions) and reported PrEP initiation proportions overall and by SDPs. RESULTS The study included 1104 ABYM, with a median age of 24 years (interquartile range (IQR): 21-28)). Almost all participants were black African (n = 1090, 99%), with more than half aged 15-24 years (n = 603, 55%) and 45% (n = 501) aged 25-35 years. The majority (n = 963; 87%) had attained a secondary level of education. Overall PREP initiation rate among adolescent boys and young men was low: among 1078 participants who were eligible for PrEP, 13% (n = 141) were started on PrEP. Among the participants who were initiated on PrEP, over three quarters (78%, n = 58) were initiated from high schools, compared with community-based youth zones (40%, n = 37), TVET colleges (26%, n = 16) and healthcare facilities (4%, n = 30). CONCLUSIONS This study provided evidence suggesting that expanding PrEP services to non-traditional settings, such as high schools, TVET colleges, and community-based organizations, may have a potential to increase PrEP access among ABYM in South Africa.
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Affiliation(s)
- Mbuzeleni Hlongwa
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria, South Africa.
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
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Warzywoda S, Dyda A, Fitzgerald L, Mullens A, Debattista J, Durham J, Gu Z, Wenham K, Ariana A, Gilks CF, Bell SFE, Dean JA. A cross-sectional investigation of the factors associated with awareness of PEP and PrEP among Queensland university students. Aust N Z J Public Health 2024; 48:100136. [PMID: 38432178 DOI: 10.1016/j.anzjph.2024.100136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/11/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE University creates unique social environments for many young people that can result in behaviour changes that can impact sexual health-related risks and facilitate transmission of HIV. Little is known about HIV knowledge, risk, and awareness of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) among Australian university students. METHODS A 2019 online survey distributed through Queensland universities, using active recruitment/snowball sampling. Descriptive and logistical regression analysis investigated HIV knowledge/risk and PrEP/PEP awareness. RESULTS Of the 4,291 responses, 60.4% were 20-29 years old, 57.0% identified as heterosexual, and 31.8% were born-overseas. Mean HIV knowledge score was 9.8/12. HIV risk scores were higher among men-who-have-sex-with-men (MSM) (mean=5.2/40) compared to all other sexual behaviours (mean=3.1/40). Logistic regression indicated PrEP and PEP awareness was associated with older age (p<0.05), being non-binary/gender-diverse (p<0.05), and MSM (p<0.05). Lower odds of PrEP awareness were associated with international student status (p<0.05). CONCLUSION This study highlights the need for future health promotion targeting younger Australians at risk of HIV to increase uptake of PrEP/PEP, particularly among overseas-born young people and those ineligible for appropriate health care in Australia. IMPLICATIONS FOR PUBLIC HEALTH Addressing these gaps will improve sexual health outcomes for young Australians at risk of HIV and work towards virtual elimination of HIV transmission in Australia.
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Affiliation(s)
- Sarah Warzywoda
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Amalie Dyda
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amy Mullens
- School of Psychology and Wellbeing, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Australia
| | - Jo Durham
- School of Public Health and Social Work, Queensland University of Technology, Australia
| | - Zhihong Gu
- Ethnic Communities Council of Queensland, Australia
| | - Kathryn Wenham
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Australia
| | - Armin Ariana
- School of Medicine and Dentistry, Griffith University, Australia
| | - Charles F Gilks
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sara F E Bell
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Andrade EA, Stoukides G, Santoro AF, Karasz A, Arnsten J, Patel VV. Individual and Health System Factors for Uptake of Pre-exposure Prophylaxis Among Young Black and Latino Gay Men. J Gen Intern Med 2023; 38:2768-2774. [PMID: 37429976 PMCID: PMC10507000 DOI: 10.1007/s11606-023-08274-5] [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: 12/06/2022] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Young Black and Latino men who have sex with men (YBLMSM) have the highest rates of new HIV infections in the USA and use PrEP at lower rates than White MSM. OBJECTIVE To explore YBLMSM's perspectives and experiences of PrEP use to identify factors enabling or impeding uptake. DESIGN Qualitative study using semi-structured interviews conducted between August 2015 and April 2016. PARTICIPANTS Black and Latino MSM, 18-20 years of age, who live, socialize, or work in the Bronx, and were fluent in English or Spanish. APPROACH We used a thematic analysis to identify themes related to not taking PrEP and PrEP uptake. KEY RESULTS Half the participants (n = 9) were currently using PrEP, a majority had Medicaid (n = 13), all reported having a PCP, all identified English as their primary language (n = 15), and all identified as gay. Salient themes included concerns over-side effects, stigma related to HIV and sexuality, mistrust of medical providers, provider's refusal to prescribe PrEP, and insurance and cost. CONCLUSIONS Modifiable barriers for PrEP uptake and persistence were reported by most participants, with an emphasis on PrEP misinformation and the pervasiveness of intersectional stigma, providers' low awareness, and hesitant attitudes towards PrEP and barriers created by insurance companies. Supportive infrastructures for PrEP providers and patients are needed.
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Affiliation(s)
- Elí A Andrade
- Division of General Internal Medicine, Montefiore Health System, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Georgianna Stoukides
- New York Institute of Technology College of Osteopathic Medicine, New York, NY, USA
| | - Anthony F Santoro
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA
| | - Alison Karasz
- Chan Medical School, University of Massachusetts, North Worcester, MA, USA
| | - Julia Arnsten
- Division of General Internal Medicine, Montefiore Health System, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Viraj V Patel
- Division of General Internal Medicine, Montefiore Health System, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Pico-Espinosa OJ, Hull M, MacPherson P, Grace D, Lachowsky N, Gaspar M, Mohammed S, Truong R, Tan DHS. Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey. CMAJ Open 2023; 11:E560-E568. [PMID: 37369522 PMCID: PMC10310342 DOI: 10.9778/cmajo.20220113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV is underutilized. We aimed to identify barriers to use of PrEP and strategies that may facilitate its uptake. METHODS Gay, bisexual and other men who have sex with men, aged 19 years or older and living in Ontario and British Columbia, Canada, completed a cross-sectional survey in 2019-2020. Participants who met Canadian PrEP guideline criteria and were not already using PrEP identified relevant barriers and which strategies would make them more likely to start PrEP. We described the barriers and strategies separately for Ontario and BC. RESULTS Of 1527 survey responses, 260 respondents who never used PrEP and met criteria for PrEP were included. In Ontario, the most common barriers were affordability (43%) and concern about adverse effects (42%). In BC, the most common reasons were concern about adverse effects (41%) and not feeling at high enough risk (36%). In Ontario, preferred strategies were short waiting time (63%), the health care provider informing about their HIV risk being higher than perceived (62%), and a written step-by-step guide (60%). In BC, strategies were short waiting time (68%), people speaking publicly about PrEP (68%), and the health care provider counselling about their HIV risk being higher than perceived (64%), adverse effects of PrEP (65%) and how well PrEP works (62%). INTERPRETATION Concern about adverse effects and not self-identifying as having high risk for HIV were common barriers, and shorter waiting times may increase PrEP uptake. In Ontario, the findings suggested lack of affordability, whereas in BC, strategies involving health care providers were valued.
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Affiliation(s)
- Oscar Javier Pico-Espinosa
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Hull
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Paul MacPherson
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Daniel Grace
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Nathan Lachowsky
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Gaspar
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Saira Mohammed
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Robinson Truong
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Darrell H S Tan
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
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Burgess R, Feliciano JT, Lizbinski L, Ransome Y. Trends and Characteristics of #HIVPrevention Tweets Posted Between 2014 and 2019: Retrospective Infodemiology Study. JMIR Public Health Surveill 2022; 8:e35937. [PMID: 35969453 PMCID: PMC9412898 DOI: 10.2196/35937] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Twitter is becoming an increasingly important avenue for people to seek information about HIV prevention. Tweets about HIV prevention may reflect or influence current norms about the acceptability of different HIV prevention methods. Therefore, it may be useful to empirically investigate trends in the level of attention paid to different HIV prevention topics on Twitter over time. OBJECTIVE The primary objective of this study was to investigate temporal trends in the frequency of tweets about different HIV prevention topics on Twitter between 2014 and 2019. METHODS We used the Twitter application programming interface to obtain English-language tweets employing #HIVPrevention between January 1, 2014, and December 31, 2019 (n=69,197, globally). Using iterative qualitative content analysis on samples of tweets, we developed a keyword list to categorize the tweets into 10 prevention topics (eg, condom use, preexposure prophylaxis [PrEP]) and compared the frequency of tweets mentioning each topic over time. We assessed the overall change in the proportions of #HIVPrevention tweets mentioning each prevention topic in 2019 as compared with 2014 using chi-square and Fisher exact tests. We also conducted descriptive analyses to identify the accounts posting the most original tweets, the accounts retweeted most frequently, the most frequently used word pairings, and the spatial distribution of tweets in the United States compared with the number of state-level HIV cases. RESULTS PrEP (13,895 tweets; 20.08% of all included tweets) and HIV testing (7688, 11.11%) were the most frequently mentioned topics, whereas condom use (2941, 4.25%) and postexposure prophylaxis (PEP; 823, 1.19%) were mentioned relatively less frequently. The proportions of tweets mentioning PrEP (327/2251, 14.53%, in 2014, 5067/12,971, 39.1%, in 2019; P≤.001), HIV testing (208/2251, 9.24%, in 2014, 2193/12,971, 16.91% in 2019; P≤.001), and PEP (25/2251, 1.11%, in 2014, 342/12,971, 2.64%, in 2019; P≤.001) were higher in 2019 compared with 2014, whereas the proportions of tweets mentioning abstinence, condom use, circumcision, harm reduction, and gender inequity were lower in 2019 compared with 2014. The top retweeted accounts were mostly UN-affiliated entities; celebrities and HIV advocates were also represented. Geotagged #HIVPrevention tweets in the United States between 2014 and 2019 (n=514) were positively correlated with the number of state-level HIV cases in 2019 (r=0.81, P≤.01). CONCLUSIONS Twitter may be a useful source for identifying HIV prevention trends. During our evaluation period (2014-2019), the most frequently mentioned prevention topics were PrEP and HIV testing in tweets using #HIVPrevention. Strategic responses to these tweets that provide information about where to get tested or how to obtain PrEP may be potential approaches to reduce HIV incidence.
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Affiliation(s)
- Raquel Burgess
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Josemari T Feliciano
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Leonardo Lizbinski
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
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10
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Wang H, Wang Z, Huang X, Chen Y, Wang H, Cui S, Zhang J, Chu Z, Hu Q, Ding H, Qian H, Zou H, Tang W, Gao Y, Jin X, Liu Z, Zhang L, Zhao J, He X, Jiang Y, Geng W, Xu J, Shang H. Association of HIV Preexposure Prophylaxis Use With HIV Incidence Among Men Who Have Sex With Men in China: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2148782. [PMID: 35171258 PMCID: PMC8851305 DOI: 10.1001/jamanetworkopen.2021.48782] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Evidence on HIV preexposure prophylaxis (PrEP) among Chinese men who have sex with men (MSM) is critical to guide its large-scale implementation in low- and middle-income countries. OBJECTIVE To evaluate incident HIV infection, adherence, safety, and changes in sexual behaviors among MSM using daily PrEP (D-PrEP) and event-driven PrEP (ED-PrEP) in 4 cities in China. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted among HIV-seronegative MSM from December 11, 2018, to November 30, 2020, in Beijing, Shenyang, Chongqing, and Shenzhen. Participants self-chose D-PrEP or ED-PrEP regimens at baseline and could switch regimens during the 12-month study period. HIV-negative MSM who declined to initiate PrEP (nonusers) in the same cities joined a separate parallel prospective cohort and served as control individuals. INTERVENTIONS PrEP consisted of coformulated tenofovir disoproxil fumarate, 300 mg, and emtricitabine, 200 mg. MAIN OUTCOMES AND MEASURES The main outcome was incident HIV infection. Poisson regression was used to obtain the HIV incidence rate ratio (IRR). RESULTS A total of 1530 MSM were included in the analysis (median age, 30 [IQR, 25-37] years). At baseline, 520 MSM chose D-PrEP (median age, 29 [IQR, 25-35] years) and 503 chose ED-PrEP (median age, 29 [IQR, 25-36] years). The median HIV Risk Index score was 18 (IQR, 12-22) among D-PrEP users and 18 (IQR, 11-22) among ED-PrEP users. Among 507 PrEP nonusers, the median age was 33 (IQR, 27-43) years, and the median HIV Risk Index score was 12 (IQR, 7-18). Although PrEP users had more baseline behaviors associated with HIV risk, the HIV incidence was lower among all PrEP users (adjusted IRR, 0.09 [95% CI, 0.04-0.21]), ED-PrEP users (adjusted IRR, 0.05 [95% CI, 0.01-0.22]), and D-PrEP users (adjusted IRR, 0.12 [95% CI, 0.04-0.33]) compared with PrEP nonusers. There was no difference in HIV incidence between D-PrEP users and ED-PrEP users (IRR, 0.33 [95% CI, 0.06-2.04]). Event-driven PrEP users consumed 40% fewer tablets than D-PrEP users during the study period. Adherence, defined as the proportion of self-reported days with sexual intercourse in which PrEP was taken according to prescription of at least 90%, increased over time among ED-PrEP users (from 57.4% to 77.8%; P < .001 for trend) and decreased over time among D-PrEP users (from 75.1% to 72.1%; P = .02 for trend). Daily PrEP users reported fewer adverse events than ED-PrEP users (193 of 520 [37.1%] vs 241 of 503 [47.9%]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that D-PrEP and ED-PrEP regimens are associated with lower incidence of HIV and a good safety profile among high-risk MSM in China. TRIAL REGISTRATION Chinese Clinical Trial Registry number: ChiCTR-IIN-17013762.
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Affiliation(s)
- Hongyi Wang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Chongqing Public Health Medical Center, Chongqing, China
| | - Hui Wang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People’s Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Sitong Cui
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qinghai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hanzhu Qian
- School of Public Health, Yale University, New Haven, Connecticut
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project–China, Guangzhou, China
| | - Yangyang Gao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xia Jin
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhaozhen Liu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lukun Zhang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People’s Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention Shenzhen, Guangdong, China
| | - Xiaoqing He
- Chongqing Public Health Medical Center, Chongqing, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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11
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Asiago-Reddy EA, McPeak J, Scarpa R, Braksmajer A, Ruszkowski N, McMahon J, London AS. Perceived access to PrEP as a critical step in engagement: A qualitative analysis and discrete choice experiment among young men who have sex with men. PLoS One 2022; 17:e0258530. [PMID: 35081116 PMCID: PMC8791519 DOI: 10.1371/journal.pone.0258530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
Young Men who have Sex with Men (MSM) continue to face disproportionate HIV risk. Despite its well accepted role in HIV prevention, pre-exposure prophylaxis (PrEP) uptake remains below desired goals. Systemic barriers to PrEP access, including insurance complexity, cost, and wait times to start PrEP may contribute to low PrEP engagement. We conducted in-depth interviews and designed a discrete choice experiment (DCE) to assess preferences for and barriers to PrEP access in the United States. Methods: We conducted in-depth interviews with 18 MSM aged 18–30 years old who were not on PrEP and created a DCE based on the results. For the DCE, a convenience sample of young MSM in the United States who reported recent condomless anal sex was recruited through social media applications. Consenting participants provided sociodemographic information and responded to a series of 10 choice tasks about PrEP access. Preferences were analyzed utilizing marginal willingness-to-pay (mWTP) methods. Results: In-depth interviews revealed preferences for highly effective PrEP and concerns about barriers to access due to insurance coverage and privacy. The online DCE was completed by 236 eligible MSM aged 18–30. The most-preferred PrEP package—with all elements significantly preferred over other options—was insurance covered, could be maintained confidential from parents and employers, was available immediately, and had an online option. Need to take out new insurance or add a supplemental insurance in order to cover PrEP significantly detracted from willingness to pay for a PrEP program. Attributes most associated with willingness to pay for PrEP were PrEP being covered by an insurance the client already has and insurance coverage that was private. Conclusions: Young MSM at high risk for HIV in the United States who are not currently on PrEP showed strong preferences for PrEP options that were covered by insurance and could be kept confidential from parents and employers. Lack of these options may present major barriers to PrEP access among young MSM who are at particularly high risk. Rapid access to PrEP, as well as the option of receiving some care online, may also enhance PrEP uptake.
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Affiliation(s)
- Elizabeth A. Asiago-Reddy
- Division of Infectious Disease, Department of Medicine, SUNY Upstate Medical University Hospital, Syracuse, New York, United States of America
- * E-mail:
| | - John McPeak
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, United States of America
| | - Riccardo Scarpa
- Waikato Management School, University of Waikato, Waikato, New Zealand
| | - Amy Braksmajer
- Department of Sociology, SUNY Geneseo, Geneseo, New York, United States of America
| | - Nicola Ruszkowski
- Division of Infectious Disease, Department of Pediatrics, SUNY Upstate Medical University Hospital, Syracuse, New York, United States of America
| | - James McMahon
- University of Rochester School of Nursing, Rochester, New York, United States of America
| | - Andrew S. London
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, United States of America
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12
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Meireles P, Moreira C, Rocha M, Plankey M, Barros H. Transitions Between Preexposure Prophylaxis Eligibility States and HIV Infection in the Lisbon Cohort of HIV-Negative Men Who Have Sex With Men: A Multistate Model Analysis. Am J Epidemiol 2022; 191:287-297. [PMID: 34718381 DOI: 10.1093/aje/kwab260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to describe transitions between preexposure prophylaxis (PrEP) eligibility and human immunodeficiency virus (HIV) infection among HIV-negative men who have sex with men (MSM). We used data from 1,885 MSM, who had not used PrEP, enrolled in the Lisbon Cohort of MSM, with at least 2 consecutive measurements of PrEP eligibility from 2014-2020. A time-homogeneous Markov multistate model was applied to describe the transitions between states of PrEP eligibility-eligible and ineligible-and from these to HIV infection (HIV). The intensities of the transitions were closer for ineligible-to-eligible and eligible-to-ineligible transitions (intensity ratio, 1.107, 95% confidence interval (CI): 1.080, 1.176), while the intensity of the eligible-to-HIV transition was higher than that for ineligible-to-HIV transition (intensity ratio, 9.558, 95% CI: 0.738, 65.048). The probabilities of transitions increased with time; for 90 days, the probabilities were similar for the ineligible-to-eligible and eligible-to-ineligible transitions (0.285 (95% CI: 0.252, 0.319) vs. 0.258 (95% CI: 0.228, 0.287)), while the eligible-to-HIV transition was more likely than ineligible-to-HIV (0.004 (95% CI: 0.003, 0.007) vs. 0.001 (95% CI: 0.001, 0.008)) but tended to become closer with time. Being classified as ineligible was a short-term indicator of a lower probability of acquiring HIV. Once an individual moved to eligible, he was at a higher risk of seroconversion, demanding a timely delivery ofPrEP.
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13
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Zhang L, Wang J, von Kleist M. Numerical approaches for the rapid analysis of prophylactic efficacy against HIV with arbitrary drug-dosing schemes. PLoS Comput Biol 2021; 17:e1009295. [PMID: 34941864 PMCID: PMC8741042 DOI: 10.1371/journal.pcbi.1009295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/07/2022] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an important pillar to prevent HIV transmission. Because of experimental and clinical shortcomings, mathematical models that integrate pharmacological, viral- and host factors are frequently used to quantify clinical efficacy of PrEP. Stochastic simulations of these models provides sample statistics from which the clinical efficacy is approximated. However, many stochastic simulations are needed to reduce the associated sampling error. To remedy the shortcomings of stochastic simulation, we developed a numerical method that allows predicting the efficacy of arbitrary prophylactic regimen directly from a viral dynamics model, without sampling. We apply the method to various hypothetical dolutegravir (DTG) prophylaxis scenarios. The approach is verified against state-of-the-art stochastic simulation. While the method is more accurate than stochastic simulation, it is superior in terms of computational performance. For example, a continuous 6-month prophylactic profile is computed within a few seconds on a laptop computer. The method’s computational performance, therefore, substantially expands the horizon of feasible analysis in the context of PrEP, and possibly other applications. Pre-exposure prophylaxis (PrEP) is an important tool to prevent HIV transmission. However, experimental identification of parameters that determine prophylactic efficacy is extremely difficult. Clues about these parameters could prove essential for the design of next-generation PrEP compounds. Integrative mathematical models can fill this void: Based on stochastic simulation, a sample statistic can be generated, from which the prophylactic efficacy is estimated. However, for this sample statistic to be accurate, many simulations need to be performed. Here, we introduce a numerical method to directly compute the prophylactic efficacy from a viral dynamics model, without the need for sampling. Based on several examples with dolutegravir (DTG) -based short- and long-term PrEP, as well as post-exposure prophylaxis we demonstrate the correctness of the new method and its outstanding computational performance. Due to the method’s computational performance, a number of analyses, including formal sensitivity analysis, are becoming feasible with the proposed method.
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Affiliation(s)
- Lanxin Zhang
- Project group 5 “Systems Medicine of Infectious Disease”, Robert Koch Institute, Berlin, Germany
| | - Junyu Wang
- Project group 5 “Systems Medicine of Infectious Disease”, Robert Koch Institute, Berlin, Germany
| | - Max von Kleist
- Project group 5 “Systems Medicine of Infectious Disease”, Robert Koch Institute, Berlin, Germany
- * E-mail:
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14
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Stutterheim SE, van Dijk M, Wang H, Jonas KJ. The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis. PLoS One 2021; 16:e0260063. [PMID: 34851961 PMCID: PMC8635361 DOI: 10.1371/journal.pone.0260063] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.
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Affiliation(s)
- Sarah E. Stutterheim
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mart van Dijk
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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15
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Rees H, Chersich MF, Munthali RJ, Brumskine W, Palanee-Phillips T, Nkala B, Ahmed K, Sebe M, Mabude Z, Nchabeleng M, Bekker LG, Kotze P, Mogodiri T, Naidoo I, Panchia R, Myer L, Lombard C, Doncel GF, Gray G, Delany-Moretlwe S. HIV Incidence Among Pregnant and Nonpregnant Women in the FACTS-001 Trial: Implications for HIV Prevention, Especially PrEP Use. J Acquir Immune Defic Syndr 2021; 88:376-383. [PMID: 34710071 DOI: 10.1097/qai.0000000000002785] [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] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND During pregnancy and postpartum period, the sexual behaviors of women and their partners change in ways that may either increase or reduce HIV risks. Pregnant women are a priority population for reducing both horizontal and vertical HIV transmission. SETTING Nine sites in 4 South African provinces. METHODS Women aged 18-30 years were randomized to receive pericoital tenofovir 1% gel or placebo gel and required to use reliable modern contraception. We compared HIV incidence in women before, during, and after pregnancy and used multivariate Cox Proportional hazards models to compare HIV incidence by pregnancy status. RESULTS Rates of pregnancy were 7.1 per 100 woman-years (95% confidence interval [CI]: 6.3 to 8.1) and highest in those who reported oral contraceptive use (25.1 per 100 woman-years; adjusted hazard ratio 22.97 higher than other women; 95% CI: 5.0 to 105.4) or had 2 children. Birth outcomes were similar between trial arms, with 59.8% having full-term live births. No difference was detected in incident HIV during pregnancy compared with nonpregnant women (2.1 versus 4.3%; hazard ratio = 0.56, 95% CI: 0.14 to 2.26). Sexual activity was low in pregnancy and the early postpartum period, as was consistent condom use. CONCLUSIONS Pregnancy incidence was high despite trial participation being contingent on contraceptive use. We found no evidence that rates of HIV acquisition were elevated in pregnancy when compared with those in nonpregnant women. Risks from reductions in condom use may be offset by reduced sexual activity. Nevertheless, high HIV incidence in both pregnant and nonpregnant women supports consideration of introducing antiretroviral-containing pre-exposure prophylaxis for pregnant and nonpregnant women in high HIV prevalence settings.
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Affiliation(s)
- Helen Rees
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Francis Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard J Munthali
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Zonke Mabude
- MATCH, University of the Witwatersrand, Johannesburg, South Africa
| | - Maphoshane Nchabeleng
- Mecru Clinical Research Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Philip Kotze
- Qhakaza Mbokodo Research Centre, Ladysmith, South Africa
| | - Thembisile Mogodiri
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ishana Naidoo
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa ; and
- Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Glenda Gray
- Setshaba Research Centre, Soshanguve, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Gaskins M, Sammons MK, Kutscha F, Nast A, Werner RN. Factors that motivate men who have sex with men in Berlin, Germany, to use or consider using HIV pre-exposure prophylaxis-A multi-methods analysis of data from a multicentre survey. PLoS One 2021; 16:e0260168. [PMID: 34793575 PMCID: PMC8601504 DOI: 10.1371/journal.pone.0260168] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While our knowledge of what motivates men who have sex with men (MSM) to use HIV pre-exposure prophylaxis (PrEP) has grown in recent years, quantitative survey-based studies have not asked MSM explicitly to name their motivations. We did so using a qualitative open-ended question and aimed to categorise the responses and explore whether these were related to where MSM were located along a conceptual continuum of PrEP care. METHODS In a multicentre survey examining knowledge and use of PrEP among MSM in Berlin, Germany, we additionally asked an open-ended question about motivations for using or considering PrEP. Data were collected from 10/2017-04/2018. One researcher developed a thematic framework deductively from the literature and another did so inductively from the free-text data, and a merged framework was used to code responses independently. We used Fisher's exact test to assess whether the frequency of motivations differed significantly between respondents using or considering PrEP. RESULTS Of 875 questionnaires, 473 were returned and 228 contained a free-text response. Motivations in the following categories were reported: (1) Safety/protection against HIV (80.2% of participants, including general safety; additional protection to condoms), (2) Mental well-being and quality of life (23.5%, including reduced anxiety; better quality of life), (3) Condom attitudes (18.9% intent not to use condoms), (4) Expectations about sexuality (14.4%, including worry-free sex or more pleasurable sex, with explicit mention of sex or sexuality), (5) Norms/social perspectives (0.8%). The difference in frequencies of motivations between those using or considering PrEP was not statistically significant. CONCLUSIONS Safety and protection against HIV, particularly having additional protection if condoms fail, were the most common motivations for using or considering PrEP, followed by mental well-being and quality of life. Many respondents reported several motivations, and responses overall were heterogeneous. This suggests that approaches to increase PrEP uptake that focus exclusively on its effectiveness in preventing HIV are unlikely to be as successful as a holistic approach that emphasises multiple motivations and how these fit into the broader sexual and psychological health of MSM.
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Affiliation(s)
- Matthew Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mary Katherine Sammons
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Kutscha
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ricardo Niklas Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Schlenker NW, Irvin NA, Galetto GG, Dashler GM, Jones JL, Ricketts EP, Barrow GM, Saheed MO, Greenbaum AH, Rothman RE, Hsieh YH. Identifying Missed Opportunities in the Prevention of Acute HIV Infection: The Need to Provide Pre-exposure Prophylaxis Referrals to Emergency Department Patients With Increased Risk for Acquiring HIV. J Acquir Immune Defic Syndr 2021; 88:e22. [PMID: 34321413 DOI: 10.1097/qai.0000000000002773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | - Joyce L Jones
- Division of Infectious Diseases, Department of Medicine; School of Medicine, Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Richard E Rothman
- Department of Emergency Medicine
- Division of Infectious Diseases, Department of Medicine; School of Medicine, Johns Hopkins University, Baltimore, MD
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18
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Seddik AH, Schiener C, Ostwald DA, Schramm S, Huels J, Katsarava Z. Social Impact of Prophylactic Migraine Treatments in Germany: A State-Transition and Open Cohort Approach. Value Health 2021; 24:1446-1453. [PMID: 34593167 DOI: 10.1016/j.jval.2021.04.1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Migraine is a highly prevalent neurological disorder. The most characteristic symptom of migraine is moderate to severe recurrent headache along with other neurological symptoms. In this study, we modeled the potential reduction in migraine days and corresponding avoided productivity losses if erenumab was prescribed to the patient population indicated for prophylactic migraine treatment (≥ 4 monthly migraine days [MMDs]) in Germany from 2020 to the end of 2027. METHODS We simulated the incremental benefits of erenumab against the standard of care. Response rates, transition probabilities, discontinuation rates, and productivity estimates were derived from the erenumab clinical trial program. Patients had a probability of residing in 1 of 7 states, given the MMDs in addition to the probability of death. Based on accrued MMDs in every cycle, days of absenteeism and presenteeism for paid and unpaid work were derived. Paid work was monetized according to gross value added using the human capital approach, whereas unpaid work was valuated according to the proxy good method. In addition, downstream macroeconomic effects were captured using value-added multipliers. Direct medical costs were concomitantly calculated. RESULTS Our results show that prescribing erenumab for the indicated population in Germany could lead to a reduction of 166 million migraine days annually and reduce productivity losses in the range of €27 billion. This includes €13.1 billion from direct productivity and €13.5 billion from economic value chain effects. CONCLUSIONS This study highlights the macroeconomic effects of a systematic introduction of novel inhibitors of the calcitonin gene-related peptide pathway for migraine in Germany.
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Affiliation(s)
- Ahmed H Seddik
- WifOR Institute, Darmstadt, Germany; Daiichi Sankyo Europe GmbH, Munich, Germany
| | | | - Dennis A Ostwald
- WifOR Institute, Darmstadt, Germany; SIBE, Graduate School of the Faculty for Leadership and Management, Steinbeis University, Berlin, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany
| | | | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Germany; Evangelical Hospital Unna, Unna, Germany; EVEX Medical Corporation, Tbilisi, Republic of Georgia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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19
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Hull SJ, Tessema H, Thuku J, Scott RK. Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services. J Acquir Immune Defic Syndr 2021; 88:165-172. [PMID: 34506359 PMCID: PMC8577287 DOI: 10.1097/qai.0000000000002750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 03/03/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice. SETTING We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties. METHOD Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her. RESULTS We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors. CONCLUSIONS Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.
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Affiliation(s)
- Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Hanna Tessema
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Jeri Thuku
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Rachel K Scott
- Center for AIDS Prevention Studies, Prevention Research Center, Division of Prevention Science, University of California, California, San Francisco
- Women's and Infants' Services Department, MedStar Washington Hospital Center, Washington, DC; and
- Georgetown University School of Medicine, Washington, DC
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20
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Billock RM, Samoff E, Lund JL, Pence BW, Powers KA. HIV Viral Suppression and Pre-exposure Prophylaxis in HIV and Syphilis Contact Tracing Networks: An Analysis of Disease Surveillance and Prescription Claims Data. J Acquir Immune Defic Syndr 2021; 88:157-164. [PMID: 34081664 PMCID: PMC8434960 DOI: 10.1097/qai.0000000000002739] [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: 09/21/2020] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV and syphilis contact tracing networks offer efficient platforms for HIV treatment and prevention interventions, but intervention coverage within these networks has not been characterized. SETTING HIV and syphilis sexual contact tracing networks among men who have sex with men (MSM) in North Carolina (NC). METHODS Using surveillance data, we identified 2 types of "network events" that occurred between January 2013 and June 2017 among MSM in NC: being diagnosed with early syphilis or being named as a recent sexual contact of a person diagnosed with HIV or early syphilis. We estimated prevalent and incident HIV viral suppression among persons diagnosed with HIV before the network event, and we assessed the effect of contact tracing services on a 6-month cumulative incidence of viral suppression among previously HIV-diagnosed, virally unsuppressed persons. Using linked prescription claims data, we also evaluated prevalent and incident pre-exposure prophylaxis (PrEP) use in an insured subset of HIV-negative network members. RESULTS Viral suppression prevalence among previously HIV-diagnosed persons was 52.6%. The 6-month cumulative incidence of viral suppression was 35.4% overall and 13.1 (95% confidence interval: 8.8 to 17.4) percentage points higher among persons reached than among those not reached by contact tracing services. Few HIV-negative persons had prevalent (5.4%) or incident (4.1%) PrEP use in the 6 months before or after network events, respectively. CONCLUSIONS Suboptimal viral suppression and PrEP use among MSM in NC in HIV/syphilis contact tracing networks indicate a need for intensified intervention efforts. In particular, expanded services for previously HIV-diagnosed persons could improve viral suppression and reduce HIV transmission within these networks.
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Affiliation(s)
- Rachael M Billock
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erika Samoff
- Division of Public Health, North Carolina Department of Health and Human Services, Communicable Disease Branch, Raleigh, NC
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kimberly A Powers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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21
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Malone J, Reisner SL, Cooney EE, Poteat T, Cannon CM, Schneider JS, Radix A, Mayer KH, Haw JS, Althoff KN, Wawrzyniak AJ, Beyrer C, Wirtz AL. Perceived HIV Acquisition Risk and Low Uptake of PrEP Among a Cohort of Transgender Women With PrEP Indication in the Eastern and Southern United States. J Acquir Immune Defic Syndr 2021. [PMID: 34397742 DOI: 10.1097/qai.0000000000002726]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood. METHODS This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women-specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum. RESULTS PrEP indication prevalence using transgender women-specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk. CONCLUSIONS These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
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Affiliation(s)
- Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | - Asa Radix
- School of Medicine, New York University, New York, NY
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
- Fenway Community Health Center, The Fenway Institute, Boston, MA
| | - J Sonya Haw
- Division of Endocrinology, Metabolism, and Lipids, School of Medicine, Emory University, Atlanta, GA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Chris Beyrer
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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22
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Malone J, Reisner SL, Cooney E, Poteat T, Cannon CM, Schneider J, Radix A, Mayer KH, Haw JS, Althoff KN, Wawrzyniak AJ, Beyrer C, Wirtz AL. Perceived HIV Acquisition Risk and Low Uptake of PrEP Among a Cohort of Transgender Women With PrEP Indication in the Eastern and Southern United States. J Acquir Immune Defic Syndr 2021; 88:10-18. [PMID: 34397742 PMCID: PMC8371736 DOI: 10.1097/qai.0000000000002726] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/22/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) is effective in preventing HIV among adherent users. However, PrEP uptake among transgender women is low, and current prescribing guidelines from the Centers for Disease Control and Prevention (CDC) are not specific to transgender women. Self-perceived risk of HIV among those who are PrEP-indicated is not well understood. METHODS This cross-sectional analysis included 1293 transgender women screened at baseline from March 2018 to May 2020 for a multisite, prospective cohort study. We compared the prevalence of PrEP indication using current CDC prescribing criteria versus transgender women-specific criteria developed by study investigators with community input. We identified factors associated with study-specific PrEP indication and factors associated with self-perceived low to no HIV risk among those who were PrEP-indicated. We also calculated descriptive statistics to depict the PrEP care continuum. RESULTS PrEP indication prevalence using transgender women-specific criteria was 47% (611), 155 more than who were identified using the CDC criteria. Eighty-three percent were aware of PrEP, among whom 38% had ever used PrEP. Among PrEP ever users, 63% were using PrEP at the time of the study. There were 66% of current PrEP users who reported 100% adherence within the previous 7 days. Among those who were PrEP-indicated, 13% were using and adherent to PrEP at the time of the study. More than half (55%) of PrEP-indicated participants had low or no self-perceived HIV risk. CONCLUSIONS These findings suggest that further guidance is needed for health care providers in prescribing PrEP to transgender women. Greater uptake and adherence are also needed for optimal effectiveness.
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Affiliation(s)
- Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sari L. Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women’s Hospital, Boston, MA
| | - Erin Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | - Asa Radix
- New York University School of Medicine, New York, NY
| | - Kenneth H. Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, US
| | - J. Sonya Haw
- Division of Endocrinology, Metabolism, and Lipids, Emory University school of Medicine, Atlanta, GA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew J. Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrea L. Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Hojilla JC, Hurley LB, Marcus JL, Silverberg MJ, Skarbinski J, Satre DD, Volk JE. Characterization of HIV Preexposure Prophylaxis Use Behaviors and HIV Incidence Among US Adults in an Integrated Health Care System. JAMA Netw Open 2021; 4:e2122692. [PMID: 34436609 PMCID: PMC8391097 DOI: 10.1001/jamanetworkopen.2021.22692] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Long-term follow-up is needed to evaluate gaps in HIV preexposure prophylaxis (PrEP) care delivery and to identify individuals at risk for falling out of care. OBJECTIVE To characterize the PrEP continuum of care, including prescription, initiation, discontinuation, and reinitiation, and evaluate incident HIV infections. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the electronic health records (EHR) at Kaiser Permanente Northern California to identify individuals aged 18 years and older who received PrEP care between July 2012 and March 2019. Individuals were followed up from date of linkage (defined as a PrEP referral or PrEP-coded encounter) until March 2019, HIV diagnosis, discontinuation of health plan membership, or death. Data were analyzed from December 2019 to January 2021. EXPOSURES Sociodemographic factors included age, sex, race and ethnicity, and neighborhood deprivation index, and clinical characteristics were extracted from the EHR. MAIN OUTCOMES AND MEASURES The primary outcomes were attrition at each step of the PrEP continuum of care and incident HIV infections. RESULTS Among 13 906 individuals linked to PrEP care, the median (interquartile range [IQR]) age was 33 (27-43) years, 6771 individuals (48.7%) were White, and 13 227 (95.1%) were men. Total follow-up was 26 210 person-years (median [IQR], 1.6 [0.7-2.8] years). Of individuals linked to PrEP care, 88.1% (95% CI, 86.1%-89.9%) were prescribed PrEP and of these, 98.2% (95% CI, 97.2%-98.8%) initiated PrEP. After PrEP initiation, 52.2% (95% CI, 48.9%-55.7%) discontinued PrEP at least once during the study period, and 60.2% (95% CI, 52.2%-68.3%) of these individuals subsequently reinitiated. Compared with individuals aged 18 to 25 years, older individuals were more likely to receive a PrEP prescription (eg, age >45 years: hazard ratio [HR], 1.21 [95% CI, 1.14-1.29]) and initiate PrEP (eg, age >45 years: HR, 1.09 [95% CI, 1.02-1.16]) and less likely to discontinue (eg, age >45 years: HR, 0.46 [95% CI, 0.42-0.52]). Compared with White patients, African American and Latinx individuals were less likely to receive a PrEP prescription (African American: HR, 0.74 [95% CI, 0.69-0.81]; Latinx: HR, 0.88 [95% CI, 0.84-0.93]) and initiate PrEP (African American: HR, 0.87 [95% CI, 0.80-0.95]; Latinx: HR, 0.90 [95% CI, 0.86-0.95]) and more likely to discontinue (African American: HR, 1.36 [95% CI, 1.17-1.57]; Latinx: 1.33 [95% CI, 1.22-1.46]). Similarly, women, individuals with lower neighborhood-level socioeconomic status (SES), and persons with a substance use disorder (SUD) were less likely to be prescribed (women: HR, 0.56 [95% CI, 0.50-0.62]; lowest SES: HR, 0.72 [95% CI, 0.68-0.76]; SUD: HR, 0.88 [95% CI, 0.82-0.94]) and initiate PrEP (women: HR, 0.71 [95% CI, 0.64-0.80]; lower SES: HR, 0.93 [95% CI, 0.87-.0.99]; SUD: HR, 0.88 [95% CI, 0.81-0.95]) and more likely to discontinue (women: HR, 1.99 [95% CI, 1.67-2.38]); lower SES: HR, 1.40 [95% CI, 1.26-1.57]; SUD: HR, 1.23 [95% CI, 1.09-1.39]). HIV incidence was highest among individuals who discontinued PrEP and did not reinitiate PrEP (1.28 [95% CI, 0.93-1.76] infections per 100 person-years). CONCLUSIONS AND RELEVANCE These findings suggest that gaps in the PrEP care continuum were concentrated in populations disproportionately impacted by HIV, including African American individuals, Latinx individuals, young adults (aged 18-25 years), and individuals with SUD. Comprehensive strategies to improve PrEP continuum outcomes are needed to maximize PrEP impact and equity.
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Affiliation(s)
- J. Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Leo B. Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland
- Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Jonathan E. Volk
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California
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Martinelli I, Ciavarella A, Abbattista M, Aliberti S, De Zan V, Folli C, Panigada M, Gori A, Artoni A, Ierardi AM, Carrafiello G, Monzani V, Grasselli G, Blasi F, Peyvandi F. Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19. Intern Emerg Med 2021; 16:1223-1229. [PMID: 33389568 PMCID: PMC7778858 DOI: 10.1007/s11739-020-02585-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023]
Abstract
We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23-0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26-1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding.
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Affiliation(s)
- Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
| | - Alessandro Ciavarella
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Maria Abbattista
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Stefano Aliberti
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valentina De Zan
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Christian Folli
- Department of Medicine-Acute Medical Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Panigada
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Internal Medicine, Infectious Diseases Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Artoni
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Valter Monzani
- Department of Medicine-Acute Medical Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Flora Peyvandi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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25
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Olsen T, Lally-Montgomery Z, Kelsberg G, Safranek S. Is event-driven PrEP dosing for HIV as effective as daily dosing? J Fam Pract 2021; 70:253-255. [PMID: 34410919 DOI: 10.12788/jfp.0207] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBABLY, although there are no head-to-head trials comparing the 2 dosing regimens. Event-driven pre-exposure prophylaxis (PrEP) dosing reduces HIV conversion by 86% compared to placebo (strength of recommendation [SOR]: B, large randomized controlled trial [RCT]). Daily PrEP reduces HIV conversion by 44% to 86% (SOR: B, based on open-label RCTs).Event-driven PrEP regimens may be associated with lower adherence when compared with daily PrEP regimens (average of 70% for event-driven PrEP vs average of 92% for daily PrEP) (SOR: B, based on open-label and cohort trials). Event-driven PrEP regimens have lower medication costs, and they are associated with no difference in the rate of sexually transmitted infections (STIs) (SOR: B, based on prospective cohort studies). Patients may prefer them to daily regimens (75% choose event driven PrEP vs 25% choose daily PrEP) (SOR: BB, based on the preponderance of prospective cohort studies with conflicting results).
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Affiliation(s)
- Tory Olsen
- Valley Family Medicine Residency, University of Washington at Valley, Renton
| | | | - Gary Kelsberg
- Valley Family Medicine Residency, University of Washington at Valley, Renton
| | - Sarah Safranek
- Health Sciences Librarian Emeritus, University of Washington Medical School, Seattle
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26
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Pagkas-Bather J, Khosropour CM, Golden MR, Thibault C, Dombrowski JC. Population-Level Effectiveness of HIV Pre-exposure Prophylaxis Among MSM and Transgender Persons With Bacterial Sexually Transmitted Infections. J Acquir Immune Defic Syndr 2021; 87:769-775. [PMID: 33538527 PMCID: PMC8126498 DOI: 10.1097/qai.0000000000002646] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/11/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly efficacious, but its effectiveness may be limited by poor adherence or discontinuation. Our objective was to estimate the effectiveness of real-world PrEP use in a population at increased risk of HIV infection. SETTING King County, Washington. METHODS We conducted a retrospective cohort study using sexually transmitted infection (STI) partner services (PS) interview data collected January 2014-August 2018 in King County, Washington, USA. During PS interviews, men who have sex with men and transgender persons who have sex with men were asked if they were taking PrEP. We linked STI PS data to HIV surveillance data to estimate HIV incidence among self-reported PrEP users vs. nonusers using Cox proportional hazards regression, adjusting for age, race/ethnicity, and calendar year. RESULTS Among 4368 individuals, 1206 (28%) were taking PrEP at the time of the PS interview. The median observation time was 14 months (interquartile range 6-23 months). Five (0.4%) of 1206 PrEP users and 97 (3%) of 2162 PrEP nonusers were subsequently diagnosed with HIV (P < 0.001). HIV incidence was lower among PrEP users than nonusers [0.17 vs. 1.86 cases per 100 person-years, adjusted hazards ratio 0.21 (95% confidence interval: 0.08 to 0.58)]. Latinx ethnicity, Native Hawaiian/Pacific Islander ethnicity, gonorrhea, and syphilis were also independently associated with higher HIV risk. CONCLUSIONS Self-reported PrEP use was associated with a 79% reduction in HIV incidence among men who have sex with men and transgender persons who have sex with men with STIs in King County.
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Affiliation(s)
| | | | - Matthew R. Golden
- Departments of Medicine; and
- Epidemiology, University of Washington, Seattle, WA; and
- Public Health-Seattle and King County HIV/STI Program, Seattle, WA
| | | | - Julia C. Dombrowski
- Departments of Medicine; and
- Epidemiology, University of Washington, Seattle, WA; and
- Public Health-Seattle and King County HIV/STI Program, Seattle, WA
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27
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Pampati S, Emrick K, Siegler AJ, Jones J. Changes in Sexual Behavior, PrEP Adherence, and Access to Sexual Health Services Because of the COVID-19 Pandemic Among a Cohort of PrEP-Using MSM in the South. J Acquir Immune Defic Syndr 2021; 87:639-643. [PMID: 33512848 PMCID: PMC8533029 DOI: 10.1097/qai.0000000000002640] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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] [Indexed: 01/22/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had unforeseen consequences on the delivery of HIV and sexually transmitted disease (STD) prevention services. However, little is known about how the pandemic has impacted pre-exposure prophylaxis (PrEP)-using men who have sex with men (MSM). METHODS Data come from an online cohort of PrEP-using MSM in the Southern United States from October 2019 to July 2020. Participants were administered 10 surveys in total, including 1 ad hoc survey specifically on COVID-19. We conducted a cross-sectional analysis of this ad hoc survey (n = 56) and present changes in sexual behaviors and utilization of and access to sexual health services. Using linear mixed-effect regression models, we also analyzed data from the larger cohort and document how sexual behaviors and PrEP use varied longitudinally across several months. RESULTS A fifth of participants discontinued or changed how often they take PrEP because of COVID-19. A quarter of the cohort documented challenges when attempting to access PrEP, HIV testing, or STD testing. For all sexual behaviors examined longitudinally-number of male sexual partners, anal sex acts, condomless anal sex, and oral sex (all measured in the past 2 weeks)-there was a decrease from February to April followed by an increase from April to June. DISCUSSION Our findings suggest reduced access to and utilization of STD and HIV services coupled with a continuation of behaviors which confer STD/HIV risk. Ensuring appropriate delivery of STD/HIV prevention services during this pandemic is imperative.
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Affiliation(s)
- Sanjana Pampati
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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28
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Rao A, Rucinski K, Jarrett BA, Ackerman B, Wallach S, Marcus J, Adamson T, Garner A, Santos GM, Beyrer C, Howell S, Baral S. Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries. J Acquir Immune Defic Syndr 2021; 87:644-651. [PMID: 33443963 PMCID: PMC8276834 DOI: 10.1097/qai.0000000000002620] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 10/07/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The coronavirus pandemic has necessitated a range of population-based measures to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM. SETTING Data for this study were collected between April 16, 2020, and May 24, 2020, as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0-100) based on the number and strictness of 9 indicators related to restrictions, closures, and travel bans. METHODS We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services. RESULTS A total of 10,654 MSM across 20 countries were included. Thirty-eight percent (3992/10,396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to pre-exposure prophylaxis, and 10% (990/9542) interruptions to condom access. For every 10-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95% CI: [0·96 to 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95% CI: [0·93 to 0·95]), and a 5% reduction in access to pre-exposure prophylaxis (aPR: 0·95, 95% CI: [0·95 to 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely. CONCLUSIONS More stringent responses were associated with decreased perceived access to services. These results support the need for increasing emphasis on innovative strategies in HIV-related diagnostic, prevention, and treatment services to minimize service interruptions during this and potential future waves of COVID-19 for gay men and other MSM at risk for HIV acquisition and transmission.
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Affiliation(s)
| | | | | | - Benjamin Ackerman
- Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Julia Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Fenway Institute, Boston, MA
| | | | | | - Glenn-Milo Santos
- Community Health Systems Department, University of California San Francisco, San Francisco, CA; and
- Center of Public Health Research, San Francisco Department of Public Health, San Francisco, CA
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29
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Hartmann M, Otticha S, Agot K, Minnis AM, Montgomery ET, Roberts ST. Tu'Washindi na PrEP: Working With Young Women and Service Providers to Design an Intervention for PrEP Uptake and Adherence in the Context of Gender-Based Violence. AIDS Educ Prev 2021; 33:103-119. [PMID: 33821679 PMCID: PMC8384060 DOI: 10.1521/aeap.2021.33.2.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 05/19/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition among adolescent girls and young women (AGYW). Existing evidence suggests that uptake and adherence are low among AGYW and that relationship factors such as gender-based violence (GBV) are important barriers. Through a community-based participatory research (CBPR) process, a youth advisory board (YAB), service providers (SP), and a study team developed the Tu'Washindi na PrEP intervention to support AGYW PrEP use in the context of GBV. The YAB also guided the formative research and interpretation of results. The authors pretested the intervention with SP, AGYW and their partners, and community change agents, and then developed guides for AGYW support clubs, community-based male sensitization sessions, and couples-based events that included formulation of story lines for dramatized PrEP negotiation and information dissemination skills. Stakeholder engagement led to an intervention responsive to AGYW's needs for PrEP support in the context of their relationships, which was evaluated through a 6-month pilot community randomized controlled trial.
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Affiliation(s)
- Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, California
| | | | - Kawango Agot
- Impact Research Development Organization, Kisumu, Kenya
| | - Alexandra M Minnis
- Women's Global Health Imperative, RTI International, Berkeley, California
| | | | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, California
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Faustino EVS, Raffini LJ, Hanson SJ, Cholette JM, Pinto MG, Li S, Kandil SB, Nellis ME, Shabanova V, Silva CT, Tala JA, McPartland T, Spinella PC. Age-Dependent Heterogeneity in the Efficacy of Prophylaxis With Enoxaparin Against Catheter-Associated Thrombosis in Critically Ill Children: A Post Hoc Analysis of a Bayesian Phase 2b Randomized Clinical Trial. Crit Care Med 2021; 49:e369-e380. [PMID: 33566465 PMCID: PMC7979442 DOI: 10.1097/ccm.0000000000004848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We explored the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against central venous catheter-associated deep venous thrombosis in critically ill children. DESIGN Post hoc analysis of a Bayesian phase 2b randomized clinical trial. SETTING Seven PICUs. PATIENTS Children less than 18 years old with newly inserted central venous catheter. INTERVENTIONS Enoxaparin started less than 24 hours after insertion of central venous catheter and adjusted to anti-Xa level of 0.2-0.5 international units/mL versus usual care. MEASUREMENTS AND MAIN RESULTS Of 51 children randomized, 24 were infants less than 1 year old. Risk ratios of central venous catheter-associated deep venous thrombosis with prophylaxis with enoxaparin were 0.98 (95% credible interval, 0.37-2.44) in infants and 0.24 (95% credible interval, 0.04-0.82) in older children greater than or equal to 1 year old. Infants and older children achieved anti-Xa level greater than or equal to 0.2 international units/mL at comparable times. While central venous catheter was in situ, endogenous thrombin potential, a measure of thrombin generation, was 223.21 nM.min (95% CI, 8.78-437.64 nM.min) lower in infants. Factor VIII activity, a driver of thrombin generation, was also lower in infants by 45.1% (95% CI, 15.7-74.4%). Median minimum platelet count while central venous catheter was in situ was higher in infants by 39 × 103/mm3 (interquartile range, 17-61 × 103/mm3). Central venous catheter:vein ratio was not statistically different. Prophylaxis with enoxaparin was less efficacious against central venous catheter-associated deep venous thrombosis at lower factor VIII activity and at higher platelet count. CONCLUSIONS The relatively lesser contribution of thrombin generation on central venous catheter-associated thrombus formation in critically ill infants potentially explains the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin.
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Affiliation(s)
| | - Leslie J Raffini
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Sheila J Hanson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Jill M Cholette
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY
| | - Matthew G Pinto
- Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Simon Li
- Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Sarah B Kandil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Marianne E Nellis
- Department of Pediatrics, NY Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | | | - Cicero T Silva
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT
| | - Joana A Tala
- Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, CT
| | - Tara McPartland
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, CT
| | - Philip C Spinella
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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31
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Cox J, Apelian H, Moodie EEM, Messier-Peet M, Hart TA, Grace D, Moore DM, Lachowsky NJ, Armstrong HL, Jollimore J, Skakoon-Sparling S, Rodrigues R, Tan DHS, Maheu-Giroux M, Noor SW, Lebouché B, Tremblay C, Olarewaju G, Lambert G. Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study. CMAJ Open 2021; 9:E529-E538. [PMID: 34021010 PMCID: PMC8177951 DOI: 10.9778/cmajo.20200198] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Our objective was to describe access to HIV pre-exposure prophylaxis (PrEP) and identify factors associated with not using PrEP among self-reported HIV-negative or HIV-unknown GBM. METHODS This was a cross-sectional analysis of the Engage study cohort. Between 2017 and 2019, sexually active GBM aged 16 years or more in Montréal, Toronto and Vancouver were recruited via respondent-driven sampling (RDS). Participation included testing for HIV and sexually transmitted and blood-borne infections, and completion of a questionnaire. We examined PrEP access using a health care services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those for whom PrEP was clinically recommended and who were aware of the intervention. RESULTS A total of 2449 GBM were recruited, of whom 2008 were HIV-negative or HIV-unknown; 1159 (511 in Montréal, 247 in Toronto and 401 in Vancouver) met clinical recommendations for PrEP. Of the 1159, 1100 were aware of PrEP (RDS-adjusted proportion: Montréal 84.6%, Toronto 94.2%, Vancouver 92.7%), 678 had felt the need for PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 39.2%, Toronto 56.1%, Vancouver 49.0%), 406 had tried to access PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 20.6%, Toronto 33.2%, Vancouver 29.6%) and 319 had used PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 14.5%, Toronto 21.6%, Vancouver 21.8%). Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider and lacking medication insurance. INTERPRETATION Although half of GBM met clinical recommendations for PrEP, less than a quarter of them reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health care system barriers is needed to scale up PrEP access among GBM in Canada.
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Affiliation(s)
- Joseph Cox
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que.
| | - Herak Apelian
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Marc Messier-Peet
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Trevor A Hart
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Daniel Grace
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - David M Moore
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Nathan J Lachowsky
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Heather L Armstrong
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Jody Jollimore
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Shayna Skakoon-Sparling
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Ricky Rodrigues
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Darrell H S Tan
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Syed W Noor
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Bertrand Lebouché
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Cecile Tremblay
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Gbolahan Olarewaju
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Gilles Lambert
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
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Haberer JE, Bukusi EA, Mugo NR, Pyra M, Kiptinness C, Oware K, Garrison LE, Thomas KK, Musinguzi N, Morrison S, Anderson PL, Ngure K, Baeten JM. Effect of SMS reminders on PrEP adherence in young Kenyan women (MPYA study): a randomised controlled trial. Lancet HIV 2021; 8:e130-e137. [PMID: 33662265 PMCID: PMC8289198 DOI: 10.1016/s2352-3018(20)30307-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 07/31/2020] [Revised: 10/24/2020] [Accepted: 11/05/2020] [Indexed: 04/18/2023]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV acquisition. However, adherence among young women (aged 18-24 years) has been challenging. SMS reminders have been shown to improve adherence to antiretroviral therapy in some contexts, including in combination with real-time adherence monitoring. We aimed to determine the effect of SMS reminders on PrEP adherence among young women in Kenya over a 2-year period. METHODS The monitoring PrEP among young adult women (MPYA) study was an open label randomised controlled trial involving young adult women at high risk of HIV in Thika and Kisumu, Kenya. Participants were recruited from colleges, vocational institutions, informal settlements, and community-based organisations supporting young women. Women had to be aged 18-24 years and at high risk of HIV acquisition (defined as a VOICE risk score of 5 or higher, or being in a serodiscordant relationship). Study staff randomly assigned participants (1:1) to receive either SMS reminders (SMS reminder group) or no reminders (no SMS reminder group). Study group assignment was known to trial staff but masked to investigators. Reminders were initially sent daily and participants could switch to as-needed reminders (ie, sent only if they missed opening the monitor as expected) after 1 month. Study visits occurred at 1 month, 3 months, and then quarterly (ie, every 3 months). The primary outcome was PrEP adherence over 24 months measured with a real-time electronic monitor and assessed by negative binomial models adjusted for the study site and quarter among participants who collected PrEP. This trial is registered with ClinicalTrials.gov, NCT02915367. FINDINGS Of 642 women initially approached, 348 eligible women were enrolled between Dec 21, 2016, and Feb 5, 2018. Participants were randomly assigned to either the SMS reminder group (n=173) or the no SMS reminder group (n=175). The median age was 21 years (IQR 19-22) and 228 (66%) of the 348 participants reported condomless sex in the month before baseline. 24 (14%) of the 173 participants assigned to receive daily SMS reminders later opted for as-needed reminders. 69 291 (97%) of 71 791 SMS reminders were sent as planned. Among participants collecting PrEP (thus potentially suggesting a desire for HIV protection), electronically monitored adherence averaged 26·8% over 24 months and was similar by study group (27·0% with SMS, 26·6% without SMS, adjusted incidence rate ratio 1·16 [95% CI 0·93-1·45], p=0·19). There were no serious adverse events related to trial participation; five social harms occurred in each study group, primarily related to PrEP use. INTERPRETATION SMS reminders were ineffective in promoting PrEP adherence among young Kenyan women. Given the overall low adherence in the trial, additional interventions are needed to support PrEP use in this population. FUNDING US National Institute of Mental Health.
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Affiliation(s)
- Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Nelly R Mugo
- Department of Global Health, University of Washington, Seattle, WA, USA; Center for Clinical Research, Kenya Medical Research Institute, Thika, Kenya
| | - Maria Pyra
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Kevin Oware
- Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lindsey E Garrison
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Susan Morrison
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Denver, CO, USA
| | - Kenneth Ngure
- Center for Clinical Research, Kenya Medical Research Institute, Thika, Kenya; Department of Community Heath, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Medicine and Department of Epidemiology, University of Washington, Seattle, WA, USA; Gilead Sciences, Redwood City, CA, USA
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Belludi A, McFall AM, Solomon SS, Celentano DD, Mehta SH, Srikrishnan AK, Kumar MS, Solomon S, Lucas GM. Awareness of and willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs and men who have sex with men in India: Results from a multi-city cross-sectional survey. PLoS One 2021; 16:e0247352. [PMID: 33630909 PMCID: PMC7906475 DOI: 10.1371/journal.pone.0247352] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Pre-exposure prophylaxis (PrEP) is effective in reducing HIV transmission among key populations. In India, where PrEP is not currently part of the national HIV program, little is known about PrEP awareness, willingness to use PrEP, and barriers to uptake among people who inject drugs (PWID) and men who have sex with men (MSM). Methods We used respondent-driven sampling to accrue PWID and MSM in 22 sites from August 2016 to May 2017. Participants were asked about awareness of PrEP, willingness to use PrEP (following a brief description) and reasons why they might not be willing to use PrEP. Participants were also queried on preferences for PrEP delivery modality (oral vs. injectable). Multi-level logistic regression models were used to determine participant correlates of willingness to use PrEP. Estimates were weighted for the sampling method. Results A total of 10,538 PWID and 8,621 MSM who self-reported being HIV-negative were included in the analysis. Only 6.1% (95% confidence interval [CI]: 5.9, 6.3) of PWID and 8.0% of MSM (95% CI: 7.7, 8.4) were aware of PrEP. However, willingness to use PrEP was substantially higher in both groups: 52.4% of PWID and 67.6% of MSM. Participants commonly cited a perceived low risk for acquiring HIV infection, being perceived by others as being HIV-positive, and side effects as reasons why they would be unwilling to use PrEP. Among PWID, sharing needles and hazardous alcohol use were associated with increased willingness to use PrEP. Among MSM, having a main male partner and injection drug use were associated with increased willingness to use PrEP. Preference for daily oral or monthly injectable PrEP was similar among MSM (39.6%% vs. 41.7%,), while PWID were more likely to prefer oral to injectable administration routes (56.3% vs. 31.1%). Conclusions As India plans to roll-out of PrEP in the public sector, our multi-city survey of PWID and MSM highlights the need for key population-focused education campaigns about PrEP and self-assessment of risk.
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Affiliation(s)
- Ashwin Belludi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Allison M. McFall
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sunil Suhas Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Y.R. Gaitonde Center for AIDS Research and Education, Chennai, Tamil Nadu, India
| | - David D. Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - A. K. Srikrishnan
- Y.R. Gaitonde Center for AIDS Research and Education, Chennai, Tamil Nadu, India
| | - M. Suresh Kumar
- Y.R. Gaitonde Center for AIDS Research and Education, Chennai, Tamil Nadu, India
| | - Suniti Solomon
- Y.R. Gaitonde Center for AIDS Research and Education, Chennai, Tamil Nadu, India
| | - Gregory M. Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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34
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Johnson DC, Nobles AL, Caputi TL, Liu M, Leas EC, Strathdee SA, Smith DM, Ayers JW. Monitoring HIV testing and pre-exposure prophylaxis information seeking by combining digital and traditional data. BMC Infect Dis 2021; 21:215. [PMID: 33632140 PMCID: PMC7908754 DOI: 10.1186/s12879-021-05907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/08/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Public health is increasingly turning to non-traditional digital data to inform HIV prevention and control strategies. We demonstrate a parsimonious method using both traditional survey and internet search histories to provide new insights into HIV testing and pre-exposure prophylaxis (PrEP) information seeking that can be easily extended to other settings. METHOD We modeled how US internet search volumes from 2019 for HIV testing and PrEP compared against expected search volumes for HIV testing and PrEP using state HIV prevalence and socioeconomic characteristics as predictors. States with search volumes outside the upper and lower bound confidence interval were labeled as either over or under performing. State performance was evaluated by (a) Centers for Disease Control and Prevention designation as a hotspot for new HIV diagnoses (b) expanding Medicaid coverage. RESULTS Ten states over-performed in models assessing information seeking for HIV testing, while eleven states under-performed. Thirteen states over-performed in models assessing internet searches for PrEP information, while thirteen states under-performed. States that expanded Medicaid coverage were more likely to over perform in PrEP models than states that did not expand Medicaid coverage. While states that were hotspots for new HIV diagnoses were more likely to over perform on HIV testing searches. CONCLUSION Our study derived a method of measuring HIV and PrEP information seeking that is comparable across states. Several states exhibited information seeking for PrEP and HIV testing that deviated from model assessments. Statewide search volume for PrEP information was affected by a state's decision to expand Medicaid coverage. Our research provides health officials with an innovative way to monitor statewide interest in PrEP and HIV testing using a metric for information-seeking that is comparable across states.
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Affiliation(s)
- Derek C Johnson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA.
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA.
| | - Alicia L Nobles
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
| | - Theodore L Caputi
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
- Department of Health Sciences, University of York, York, UK
| | | | - Eric C Leas
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, Division of Health Policy, University of California San Diego, La Jolla, California, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
| | - Davey M Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
| | - John W Ayers
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
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Delabre RM, Bernier A, Sánchez F, Vilotitch A, Chanos S, Cosmaro ML, Langanke H, Mey C, James C, Duken SB, Schlegel V, Stranz R, Jonas KJ, Spire B, Rojas Castro D. "Yes, I'm interested in taking PrEP!": PrEP interest among women respondents to the European community-based survey "Flash! PrEP in Europe". PLoS One 2021; 16:e0246037. [PMID: 33596225 PMCID: PMC7888674 DOI: 10.1371/journal.pone.0246037] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection, including women. However, data regarding PrEP interest among women is lacking, particularly in Europe. Factors associated with interest in using PrEP were assessed among women respondents to the Flash! PrEP in Europe (FPIE) survey. This community-based cross-sectional study, conducted in 12 European countries, aimed to assess PrEP knowledge and interest. “High objective risk” (HOR) was assessed using established risk criteria following EACS and CDC guidelines. Factors associated with interest in using PrEP were assessed in univariable and multivariable logistic regression models. Among 678 women, 12.5% (n = 85) were considered at HOR, 46.8% (n = 317) indicated prior PrEP knowledge and 18.0% (n = 122) reported interest in using PrEP. Among women at HOR, 40.0% (n = 34) were interested in PrEP. Factors significantly associated with PrEP interest in the final multivariable model were: younger age (18–29 years) (aOR 1.91[95CI: 1.07; 3.41]), bad self-perceived financial status (1.84[1.09; 3.11]), migrant status (south to north) (2.87[1.05; 7.89]), single or dating relationship status (1.93[1.23; 3.03]), sexual abuse history (1.86[1.17; 2.97]), “rather high”/ “high” self-perceived HIV risk (3.21[1.32; 7.81]), and HOR (2.49[1.42; 4.35]). These results show that women at HOR and those who perceived themselves to be at high risk are interested in using PrEP. There is a critical need for targeted information and improved access to PrEP to increase uptake of this HIV prevention tool to meet PrEP interest among women.
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Affiliation(s)
- Rosemary M. Delabre
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- * E-mail:
| | - Adeline Bernier
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
| | - Flor Sánchez
- Department of Social Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, Marseille, France
| | | | | | - Harriet Langanke
- GSSG–Gemeinnützige Stiftung Sexualität und Gesundheit, Cologne, Germany
| | | | - Cary James
- Terrence Higgins Trust, London, United Kingdom
| | | | | | | | - Kai J. Jonas
- Maastricht University, Maastricht, The Netherlands
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- AIDES, Pantin, France
| | - Daniela Rojas Castro
- Coalition PLUS, Community-Based Research Laboratory, Pantin, France
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
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36
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Holt M, MacGibbon J, Bear B, Lea T, Kolstee J, Crawford D, Murphy D, Power C, Ellard J, de Wit J. Trends in Belief That HIV Treatment Prevents Transmission Among Gay and Bisexual Men in Australia: Results of National Online Surveys 2013-2019. AIDS Educ Prev 2021; 33:62-72. [PMID: 33617321 DOI: 10.1521/aeap.2021.33.1.62] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013-2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | | | - Dean Murphy
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Cherie Power
- New South Wales Ministry of Health, Sydney, Australia
| | - Jeanne Ellard
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
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37
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Chow EPF, Hocking JS, Ong JJ, Phillips TR, Schmidt T, Buchanan A, Rodriguez E, Maddaford K, Fairley CK. Brief Report: Changes in PrEP Use, Sexual Practice, and Use of Face Mask During Sex Among MSM During the Second Wave of COVID-19 in Melbourne, Australia. J Acquir Immune Defic Syndr 2021; 86:153-156. [PMID: 33433122 PMCID: PMC7808277 DOI: 10.1097/qai.0000000000002575] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND A second wave of COVID-19 began in late June in Victoria, Australia. Stage 3 then Stage 4 restrictions were introduced in July-August. This study aimed to compare the use of pre-exposure prophylaxis (PrEP) and sexual practices among men who have sex with men taking PrEP between May-June (post-first lockdown) and July-August (second lockdown). METHODS This was an online survey conducted among men who have sex with men who had their PrEP managed at the Melbourne Sexual Health Centre, Australia. A short message service with a link to the survey was sent to 503 PrEP clients who provided consent to receive a short message service from Melbourne Sexual Health Centre in August 2020. RESULTS Of the 192 participants completed the survey, 153 (80%) did not change how they took PrEP. Of the 136 daily PrEP users, 111 (82%) continued to take daily PrEP, 3 (2%) switched to on-demand PrEP, and 22 (16%) stopped PrEP in July-August. Men generally reported that they had no partners or decreased sexual activities during second lockdown compared with post-first lockdown; the number of casual sex partners (43% decreased vs. 3% increased) and the number of kissing partners (36% decreased vs. 3% increased). Most men reported no chemsex (79%) or group sex (77%) in May-August. 10% (13/127) of men had ever worn face masks during sex in May-August. CONCLUSION During the second wave of COVID-19 in Victoria, most men did not change the way they used PrEP but the majority had no risks or reduced sexual practices while one in 10 men wore a face mask during sex.
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Affiliation(s)
- Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
- Central Clinical School, Monash University, Melbourne, Australia; and
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jane S. Hocking
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
- Central Clinical School, Monash University, Melbourne, Australia; and
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tiffany R. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
- Central Clinical School, Monash University, Melbourne, Australia; and
| | - Tina Schmidt
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
| | - Andrew Buchanan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
| | - Elena Rodriguez
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia;
- Central Clinical School, Monash University, Melbourne, Australia; and
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38
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Affiliation(s)
- Ella G Brown
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Kevin Deane
- Centre for Global Public Health, Queen Mary University of London, London, UK
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39
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Affiliation(s)
- John Joseph Reynolds-Wright
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
- NHS Lothian, Chalmers Centre, Edinburgh, UK
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40
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Hammoud MA, Grulich A, Holt M, Maher L, Murphy D, Jin F, Bavinton B, Haire B, Ellard J, Vaccher S, Saxton P, Bourne A, Degenhardt L, Storer D, Prestage G. Substantial Decline in Use of HIV Preexposure Prophylaxis Following Introduction of COVID-19 Physical Distancing Restrictions in Australia: Results From a Prospective Observational Study of Gay and Bisexual Men. J Acquir Immune Defic Syndr 2021; 86:22-30. [PMID: 33027151 PMCID: PMC7727320 DOI: 10.1097/qai.0000000000002514] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND In response to the novel coronavirus disease (COVID-19) pandemic, Australia introduced public health and physical distancing restrictions in late March 2020. We investigated the impact of these restrictions on HIV preexposure prophylaxis (PrEP) use among Australian gay and bisexual men (GBM). METHODS Participants in an ongoing online cohort study previously reported PrEP use from 2014 to 2019. In April 2020, 847 HIV-negative and untested participants completed questionnaires assessing changes in PrEP use as a result of COVID-19 public health measures. Binary logistic multiple regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to compare changes in PrEP use behaviors. RESULTS Among 847 men, mean age was 44.1 years (SD: 12.7). PrEP use rose from 4.9% in 2015 to 47.2% in 2020. Among those, 41.8% (n = 167) discontinued PrEP use during COVID-19 restrictions. Discontinuing PrEP during COVID-19 restrictions was independently associated with being less likely to have recently tested for HIV (aOR: 0.17; 95% CI: 0.09 to 0.34; P < 0.001) and less likely to report sex with casual partners (aOR: 0.28; 95% CI: 0.14 to 0.54; P < 0.001). CONCLUSIONS By April 2020, following the introduction of COVID-19 restrictions, GBM dramatically reduced PrEP use, coinciding with a reduction in sexual activity. Longer-term impacts of COVID-19 restrictions on sexual behaviors among GBM need to be monitored because they may foreshadow fluctuations in prevention coverage and risk of HIV infection. Our findings indicate a potential need for clear, targeted information about resumption of PrEP and on-demand optimal dosing regimens in response to ongoing changes in restrictions.
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Affiliation(s)
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, Australia
| | - Dean Murphy
- Kirby Institute, UNSW Sydney, Kensington, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Sydney, Kensington, Australia
| | | | | | - Jeanne Ellard
- Australian Federation of AIDS Organisations (AFAO), Newtown, Australia
| | | | - Peter Saxton
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; and
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Kensington, Australia
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41
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Pelaez D, Weicker NP, Glick J, Mesenburg JV, Wilson A, Kirkpatrick H, Clouse E, Sherman SG. The PEARL study: a prospective two-group pilot PrEP promotion intervention for cisgender female sex workers living in Baltimore, MD, U.S. AIDS Care 2021; 33:1-10. [PMID: 33627006 PMCID: PMC7983056 DOI: 10.1080/09540121.2021.1889954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
HIV remains elevated among female sex workers (FSW) globally, with a number of structural (e.g., poverty, access to care) factors driving these persistently high rates. Pre-exposure prophylaxis (PrEP), a user-controlled prevention method, is a promising means of empowering vulnerable populations to protect themselves and enhance agency. Yet there is a dearth of PrEP research and interventions targeting cisgender women in the United States, and even fewer aimed to reach FSW. We developed and implemented a multifaceted PrEP pilot intervention, the Promoting Empowerment And Risk Reduction (PEARL) study, to meet this gap. This paper describes the development process and nature of a community-informed intervention for tenofovir/emticitrabine (TDF/FTC) pre-exposure prophylaxis engagement among street-based cisgender FSW in Baltimore, Maryland, U.S. In the course of the study's implementation, structural, programmatic, and medical barriers have already posed significant barriers to full engagement. PEARL implemented a number of strategies in an effort to counter barriers and facilitate increased success of PrEP uptake and maintenance. The study will provide critical insights into the nature of intervention components that could help FSW to initiate PrEP and reduce PrEP care cascade gaps.
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Affiliation(s)
- D Pelaez
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N P Weicker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Glick
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J V Mesenburg
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Division of Population Health and Disease Prevention, Baltimore, MD, USA
| | - A Wilson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Kirkpatrick
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Clouse
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S G Sherman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Holloway IW, Krueger EA, Meyer IH, Lightfoot M, Frost DM, Hammack PL. Longitudinal trends in PrEP familiarity, attitudes, use and discontinuation among a national probability sample of gay and bisexual men, 2016-2018. PLoS One 2020; 15:e0244448. [PMID: 33382743 PMCID: PMC7775083 DOI: 10.1371/journal.pone.0244448] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
This study explored familiarity with, attitudes toward, uptake and discontinuation of PrEP (Pre-exposure prophylaxis) among a national probability sample of gay and bisexual men. PrEP is one of the most effective biomedical HIV prevention strategies; however, use among gay and bisexual men remains low within the United States. This study used a national probability sample of gay and bisexual men from three age cohorts of men (18-25, 34-41, and 52-59 years at wave 1) who completed three annual surveys between March 2016 and March 2018 (N at wave 1 = 624). Recruitment occurred through a Gallup dual-frame sampling procedure; results for this study came from eligible individuals who consented to be part of the self-administered online or mailed survey questionnaire. We used descriptive data with sampling weights to understand trends in PrEP familiarity, PrEP attitudes and PrEP use across all three time points. Next, PrEP uptake and discontinuation were assessed among men completing all three surveys and who remained eligible for PrEP at all three time points (N = 181). PrEP familiarity increased considerably between 2016 and 2018 among those eligible for PrEP (from 59.8% from wave 1 to 92.0% at wave 3). Favorable attitudes toward PrEP increased more modestly (from 68.3% at wave 1 to 72.7% at wave 3). While PrEP use increased by 90% between the two time points (from 4.1% in 2016 to 7.8% in 2018), this represented a small percentage of overall uptake among eligible participants across time (6.6%). Among respondents who reported PrEP use at wave 1 or wave 2, 33.3% subsequently discontinued PrEP use at a later wave. Findings indicate modest increases in PrEP use between 2016 and 2018 in a national probability sample of sexually-active gay and bisexual men. PrEP discontinuation was high and suggests the need for further research into gay and bisexual men's PrEP discontinuation and persistence.
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Affiliation(s)
- Ian W. Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, United States of America
- Gay Sexuality and Social Policy Initiative, UCLA Luskin School of Public Affairs, Los Angeles, California, United States of America
- * E-mail:
| | - Evan A. Krueger
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, United States of America
| | - Ilan H. Meyer
- Williams Institute, UCLA School of Law, Los Angeles, California, United States of America
| | - Marguerita Lightfoot
- Department of Medicine, University of California, San Francisco, California, United States of America
| | - David M. Frost
- Department of Social Science, University College, London, United Kingdom
| | - Phillip L. Hammack
- Department of Psychology, University of California, Santa Cruz, California, United States of America
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43
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Hall EW, Wang L, Huang X, Sullivan PS, Siegler AJ. Assessing the performance of international pre-exposure prophylaxis (PrEP) eligibility guidelines in a cohort of Chinese MSM, Beijing, China 2009 to 2016. J Int AIDS Soc 2020; 23:e25653. [PMID: 33345453 PMCID: PMC7750495 DOI: 10.1002/jia2.25653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/21/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION PrEP is a powerful HIV prevention tool, and locally relevant eligibility criteria are necessary to optimize the prevention impact of PrEP. We assessed performance of existing national and international PrEP eligibility criteria to predict future HIV seroconversion among MSM in Beijing, China. METHODS Participants were MSM aged ≥18 years who enrolled in a cohort study between July 2009 and March 2016. Participants completed HIV testing, syphilis testing, and a questionnaire on recent sexual health behaviours at each follow-up visit and were followed until HIV seroconversion or dropout. We assessed PrEP eligibility at the most recent follow-up visit prior to the final study visit. Participants were classified as indicated for PrEP (or not) based on criteria from guidelines from Europe, Korea, South Africa, Taiwan, the United Kingdom, United States and the World Health Organization. To compare guideline performance, we calculated sensitivity, specificity, Youden's Index (YI), Matthew's Correlation Coefficient (MCC), F1 scores and diagnostic odds ratios. For each guideline, performance measures were compared to random allocation of PrEP by randomly selecting a proportion of participants equal to the proportion indicated. RESULTS There were 287 (17∙3%) incident HIV seroconversions among 1663 MSM. The number of men indicated for PrEP from different guidelines ranged from 556 (33∙4%) to 1569 (94∙2%). Compared to random allocation, sensitivity of algorithms to predict seroconversion ranged from slightly worse (-4∙7%) to 30∙2% better than random. However, in absolute terms, none of the sensitivity values increased by more than 11% when compared to random allocation. For all guidelines, specificity was not meaningfully better than random allocation. No guidelines had high binary classification performance measures. CONCLUSIONS The performance of international indication guidelines in this sample was only slightly better than random allocation. Using such guidelines to screen out MSM self-identifying as interested in PrEP could lead to misallocation of resources and to good candidates for PrEP being denied access. For settings in which international guidelines perform poorly, alternative indication approaches should be considered.
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Affiliation(s)
- Eric W Hall
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | - Xiaojie Huang
- Center for Infectious DiseasesBeijing You’an HospitalCapital Medical UniversityBeijingP.R. China
| | - Patrick S Sullivan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Aaron J Siegler
- Department of Behavioral, Social and Health Education SciencesRollins School of Public HealthEmory UniversityAtlantaGAUSA
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McManus H, Grulich AE, Amin J, Selvey C, Vickers T, Bavinton B, Zablotska I, Vaccher S, Jin F, Holden J, Price K, Yeung B, Cabrera Quichua G, Ogilvie E, McNulty A, Smith D, Guy R. Comparison of Trends in Rates of Sexually Transmitted Infections Before vs After Initiation of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men. JAMA Netw Open 2020; 3:e2030806. [PMID: 33355675 PMCID: PMC7758809 DOI: 10.1001/jamanetworkopen.2020.30806] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE There have been concerns that HIV preexposure prophylaxis (PrEP) may be associated with increases in sexually transmitted infections (STIs) because of subsequent reductions in condom use and/or increases in sexual partners. OBJECTIVE To determine trends in STI test positivity among high-risk men who have sex with men (MSM) before and after the start of HIV PrEP. DESIGN, SETTING, AND PARTICIPANTS A before-after analysis was conducted using a subcohort of a single-group PrEP implementation study cohort in New South Wales, Australia (Expanded PreEP Implementation in Communities in New South Wales [EPIC-NSW]), from up to 1 year before enrollment if after January 1, 2015, and up to 2 years after enrollment and before December 31, 2018. STI testing data were extracted from a network of 54 sexual health clinics and 6 primary health care clinics Australia-wide, using software to deidentify, encrypt, and anonymously link participants between clinics. A cohort of MSM dispensed PrEP for the first time during the study, with 2 or more STI tests in the prior year and who tested during follow-up, were included from the EPIC-NSW cohort of HIV-negative participants with high-risk sexual behavior. Data analysis was performed from June to December 2019. EXPOSURES Participants were dispensed coformulated tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg) as HIV PrEP. MAIN OUTCOMES AND MEASURES The main outcome was STI, measured using test positivity, defined as the proportion of participants testing positive for an STI at least once per quarter of follow-up. Outcomes were calculated for Chlamydia trachomatis and Neisseria gonorrhoea by site of infection (anorectal, pharyngeal, urethral, or any) and for syphilis. RESULTS Of the EPIC-NSW cohort of 9709 MSM, 2404 were included in the before-after analysis. The mean (SD) age of the participants was 36 (10.4) years, and 1192 (50%) were Australia-born. STI positivity was 52% in the year after PrEP (23.3% per quarter; 95% CI, 22.5%-24.2% per quarter) with no significant trend (mean rate ratio [RR] increase of 1.01 per quarter [95% CI, 0.99-1.02]; P = .29), compared with 50% positivity in the year prior to PrEP (20.0% per quarter [95% CI, 19.04%-20.95% per quarter]; RR for overall STI positivity, 1.17 [95% CI, 1.10-1.24]; P < .001), with an increase in quarterly STI positivity (mean RR of 1.08 per quarter, or an 8% increase per quarter [95% CI, 1.05-1.11]; P < .001; RR, 0.93 [95% CI, 0.90-0.96]; P < .001). Findings were similar when stratified by specific STIs and anatomical site. CONCLUSIONS AND RELEVANCE STI rates were high but stable among high-risk MSM while taking PrEP, compared with a high but increasing trend in STI positivity before commencing PrEP. These findings suggest the importance of considering trends in STIs when describing how PrEP use may be associated with STI incidence.
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Affiliation(s)
- Hamish McManus
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Andrew E. Grulich
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Janaki Amin
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Department of Health Systems and Populations, Macquarie University, Sydney, New South Wales, Australia
| | - Christine Selvey
- Ministry of Health, New South Wales Government, St Leonards, New South Wales, Australia
| | - Tobias Vickers
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Benjamin Bavinton
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Iryna Zablotska
- Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
| | - Stephanie Vaccher
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Joanne Holden
- AIDS Council New South Wales, Sydney, New South Wales, Australia
| | - Karen Price
- AIDS Council New South Wales, Sydney, New South Wales, Australia
| | - Barbara Yeung
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | | | - Erin Ogilvie
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, New South Wales, Australia
| | - David Smith
- North Coast HIV/Sexual Health Services, Lismore, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
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Muwonge TR, Nsubuga R, Brown C, Nakyanzi A, Bagaya M, Bambia F, Katabira E, Kyambadde P, Baeten JM, Heffron R, Celum C, Mujugira A, Haberer JE. Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda. PLoS One 2020; 15:e0241399. [PMID: 33112907 PMCID: PMC7592843 DOI: 10.1371/journal.pone.0241399] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk). METHODS We administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP. RESULTS The survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as "antiretrovirals to be used before HIV exposure" increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories. CONCLUSIONS Initial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.
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Affiliation(s)
- Timothy R. Muwonge
- Infectious Diseases Institute Makerere University, Kampala, Uganda
- * E-mail: ,
| | - Rogers Nsubuga
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Charles Brown
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Agnes Nakyanzi
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Monica Bagaya
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Felix Bambia
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter Kyambadde
- Most At-Risk Populations Initiative, Kampala, Uganda
- STD/AIDS Control Program Ministry of Health, Kampala, Uganda
| | - Jared M. Baeten
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Renee Heffron
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Connie Celum
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Andrew Mujugira
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Jessica E. Haberer
- Department of General Internal Medicine, Massachusetts General Hospital Global Health, Boston, Massachusetts, United States of America
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46
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Westmoreland DA, D’Angelo A, Nash D, Grov C. Individual and Partner Characteristics Associated With Intentions to Use PrEP Among Partnered Men, Trans Men, and Trans Women in Sero-Concordant and -Discordant Relationships in the United States. AIDS Educ Prev 2020; 32:367-377. [PMID: 33112677 PMCID: PMC7597370 DOI: 10.1521/aeap.2020.32.5.367] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite proven effectiveness in reducing HIV transmission, pre-exposure prophylaxis (PrEP) use remains low among those who meet the recommended CDC guidance for PrEP use. Data are from a U.S. national cohort of men and trans persons who have sex with men (2017-2018). Logistic regression analyses were used to determine individual and partner factors associated with intentions to use PrEP among non-PrEP-using participants reporting a main partner (n = 1,671). Prior PrEP use among participants (14.2%) and their partners (7.7%) was low. Participants' prior PrEP use and main partner's HIV-positive status were both positively associated with intentions to use PrEP. HIV prevention interventions incorporating main partners may be effective in increasing PrEP use.
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Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
| | - Alexa D’Angelo
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denis Nash
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, New York, New York, USA
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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47
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Abstract
This cross-sectional study used data from the M-Cubed randomized clinical trial to assess the prevalence of pre-exposure prophylaxis (PrEP) medication sharing among HIV-negative men who have sex with men.
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Affiliation(s)
- Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kenneth Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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48
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Abstract
PrEP persistence, or PrEP use over time, has been shown to be short, with most PrEP users stopping within 6-12 months. Furthermore, those most vulnerable to HIV often use PrEP for shorter periods. This qualitative study explores patient, provider, and contextual factors that influence PrEP persistence. In interviews with 25 PrEP users and 18 PrEP providers in San Francisco's safety net clinics, we analyze the perceived benefits and difficulties of taking PrEP, including structural barriers. We identify different steps in receipt of PrEP care (clinic visits and lab tests, pharmacy interactions, and medication adherence), and describe barriers and facilitators for providers and patients at each step. Our findings suggest that drop-in visits, streamlined testing, standing orders for labs, and 90-day PrEP prescriptions are highly desirable for many PrEP users. Also important are the proactive provision of adherence support and counseling, and referrals for housing, substance use, and mental health services.
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Affiliation(s)
| | - Patrick M Kinley
- Disease Prevention and Control, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Matthew Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Ryan Whitacre
- Department of Anthropology and Sociology, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Hyman M Scott
- Division of HIV, ID, and Global Medicine, University of California, San Francisco, CA, USA
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Susan P Buchbinder
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
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49
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Shover CL, DeVost MA, Cunningham NJ, Beymer MR, Flores D, Flynn R, Gorbach PM, Lyman P, Amico KR, Bolan RK. Structural, Dosing, and Risk Change Factors Affecting Discontinuation of Pre-exposure Prophylaxis (PrEP) in a Large Urban Clinic. AIDS Educ Prev 2020; 32:271-S13. [PMID: 32897133 PMCID: PMC7886279 DOI: 10.1521/aeap.2020.32.4.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/11/2023]
Abstract
Understanding why clients stop taking pre-exposure prophylaxis (PrEP) is critical to improve PrEP delivery and ultimately reduce HIV incidence. We analyzed data from a programmatic evaluation conducted at the Los Angeles LGBT Center from February to May 2018. Of 180 respondents to the emailed survey, 91 had stopped taking PrEP and 11 never started. Among former PrEP users, most common reasons for stopping were entering a monogamous relationship (43%) and side effects (40%). Ten of 11 who never started PrEP reported access barriers (e.g., cost, insurance problems). A quarter of inactive clients re-engaged with PrEP services following the survey and 15% restarted PrEP by October 2018. Improving PrEP retention may require multifaceted interventions-e.g., tailored discussions about stopping and restarting PrEP safely as HIV risk changes, ensuring consistent access to affordable PrEP, and alternative dosing strategies. An emailed survey may be a simple, effective strategy to reengage some PrEP clients.
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Affiliation(s)
- Chelsea L Shover
- Los Angeles LGBT Center
- Stanford University, Stanford, California
| | | | | | | | | | | | | | | | - K Rivet Amico
- Los Angeles LGBT Center
- University of California Los Angeles, David Geffen School of Medicine
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50
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Flores DD, Meanley SP, Wood SM, Bauermeister JA. Family Characteristics in Sex Communication and Social Support: Implications for Emerging Adult Men Who Have Sex with Men's PrEP Engagement. Arch Sex Behav 2020; 49:2145-2153. [PMID: 32222853 PMCID: PMC7781437 DOI: 10.1007/s10508-020-01648-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 06/24/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 05/29/2023]
Abstract
While emerging adulthood (ages 18-25) is marked by increased independence from parents, parental support remains a strong correlate of positive sexual health outcomes for heterosexual youth. With the emergence of pre-exposure prophylaxis (PrEP), few studies have examined the potential for parent-child sex communication and PrEP adoption among emerging adult men who have sex with men (MSM). We aimed to describe the extent to which parents/family characteristics play supportive roles in emerging adult MSM's current PrEP use. PrEP-indicated participants (N = 222) were recruited via social media to complete an online survey. Multivariable logistic regression assessed associations between emerging adult MSM's current PrEP use and comfort with parent-child sex communication, family social support, family outness, and family prioritization, adjusted for sociodemographic variables. Thirty percent of participants reported current PrEP use. Only 20% reported moderate/high comfort with parent sex communication, 80% reported any family sexual identity disclosure, 70% reported moderate/high family social support, and 70% ranked family as a high/very high priority. Our multivariable model demonstrated an association between comfort with parent-child sex communication with current PrEP use only (AOR= 1.55, 95% CI 1.04-2.32). Our findings support that parents of emerging adult MSM possess a critical potential to reduce their sons' risk of HIV and promote PrEP uptake. Interventions that facilitate parents' efficacy to foster affirming, non-judgmental environments and discussions about their child's sexual behaviors, attractions/relationships, and health (e.g., PrEP) may be impactful in reducing the high HIV incidence rate that burdens emerging adult MSM.
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Affiliation(s)
- Dalmacio D Flores
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Suite 223L, Philadelphia, PA, 19104, USA.
| | - Steven P Meanley
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Suite 223L, Philadelphia, PA, 19104, USA
| | - Sarah M Wood
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jose A Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd., Suite 223L, Philadelphia, PA, 19104, USA
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