Promising Directions: A Systematic Review of Psychosocial and Behavioral Interventions with Cultural Incorporation for Advanced and Metastatic Cancer

BACKGROUND

Improving quality of life (QOL) in advanced and metastatic cancer is a priority with increasing survivorship. This systematic review synthesizes psychosocial and behavioral interventions incorporating culture with the goal of examining their benefit for understudied and medically underserved populations with advanced and metastatic cancer.

METHOD

Reports were systematically screened for (1) a focus on advanced and metastatic cancer survivors, (2) psychosocial or behavioral intervention intended to improve QOL, (3) evidence of incorporating the culture(s) of understudied/underserved populations, and (4) availability in English. Bias was evaluated using the JBI Critical Appraisal Checklist and the Methodological index for non-randomized studies. Qualitative synthesis and quantitative meta-analyses were completed.

RESULTS

Eighty-six reports containing 5981 participants' data were examined. Qualitative synthesis of 23 studies identified four overarching themes relevant for incorporating culture in interventions. Meta-analysis of 19 RCTs and 4 quasi-experimental studies containing considerable heterogeneity indicated greater improvements in QOL (g = 0.84), eudaimonic well-being (g = 0.53), distress (g = -0.49), and anxiety (g = -0.37) for main intervention conditions compared to controls. Meta-analysis of 10 single-arm trials containing minimal to moderate heterogeneity found benefit for anxiety (g = -0.54), physical symptoms (g = -0.39), and depression (g = -0.38).

CONCLUSION

Psychosocial and behavioral interventions with cultural incorporation appear beneficial for improving QOL-related outcomes in advanced and metastatic cancer. Studies incorporating culture in psychosocial or behavioral interventions offer noteworthy insight and suggestions for future efforts such as attending to deep cultural structure.

Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida

Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.

Disparities of HIV risk and PrEP use among transgender women of color in South Florida

BACKGROUND

The majority of the transgender female population in South Florida are Latina and Black, and are at greatest risk for acquiring HIV, yet there is limited research focused on South Florida transgender women of color. The study objective was to describe the disparities among racial/ethnic minority transgender women regarding HIV screening, pre exposure prophylaxis (PrEP) knowledge and PrEP utilization.

METHODS

Sixty transgender women, recruited from South Florida community-based organizations, completed a questionnaire on HIV prevention and PrEP awareness and use. Univariate statistics were generated to describe sexual risk behavior, PrEP awareness and use, and HIV screening by race/ethnicity.

RESULTS

Of the 60 participants, 50.0% were Latina, 35.0% African American/non-Hispanic Black (AA/NHB), 11.7% white and 3.3% other race/ethnicity. 75.0% reported being screened for HIV in the last 12 months, 15.3% of the participants reported living with HIV (PLWH), while 18.6% reported an unknown status. Compared to Latinas, AA/NHB demonstrated more risk (≥2 sexual partners: 76.2% vs 53.3%; transactional sex: 47.6% vs. 26.7%; unprotected receptive anal sex: 42.9% v. 26.7%), and more engagement in routine care (81.0% vs. 76.7%) at least once a year. PrEP knowledge was 76.7% among Latinas, 71.4% among whites, 47.6% among Blacks, and 50.0% among other race/ethnicity. 65.0% of participants knew about PrEP. Of the 8.2% with current or previous PrEP use, none were AA/NHB.

CONCLUSION

Findings suggest that education and public health campaigns in South Florida that promote HIV prevention should focus on increasing awareness and utilization of PrEP among racial/ethnic minority transgender, particularly among AA/NHB transgender women who are most at risk and had the lowest knowledge and use of PrEP.