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Riddler SA, Kelly CW, Hoesley CJ, Ho KS, Piper JM, Edick S, Heard F, Doncel GF, Johnson S, Anderson PL, Brand RM, Kunjara Na Ayudhya RP, Bauermeister JA, Hillier SL, Hendrix CW. A Phase 1 Clinical Trial to Assess the Safety and Pharmacokinetics of a Tenofovir Alafenamide/Elvitegravir Insert Administered Rectally for HIV Prevention. J Infect Dis 2024:jiae211. [PMID: 38655842 DOI: 10.1093/infdis/jiae211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On-demand topical products could be an important tool for HIV prevention. We evaluated the safety, pharmacokinetics, and ex vivo pharmacodynamics of a tenofovir alafenamide/elvitegravir (TAF/EVG; 16 mg/20 mg) insert administered rectally. METHODS MTN-039 was a Phase 1, open-label, single-arm, 2-dose study. Blood, rectal fluid (RF), and rectal tissue (RT) were collected over 72 hours (hr) following rectal administration of one and two TAF/EVG inserts for each participant. ClinicalTrials.gov Identifier: NCT04047420. RESULTS TAF/EVG inserts were safe and well tolerated. EVG and tenofovir (TFV) were detected in blood plasma at low concentrations: median peak concentrations after 2 inserts were EVG 2.4 ng/mL and TFV 4.4 ng/mL. RT EVG peaked at 2-hr (median 2 inserts= 9 ng/mg) but declined to BLQ in the majority of samples at 24-hr, whereas TFV-DP remained high >2,000 fmol/million cells for 72-hr with 2 inserts. Compared to baseline, median cumulative log10 HIV p24 antigen of ex vivo rectal tissue HIV infection was reduced at each timepoint for both 1 and 2 inserts (p<0.065 and p<0.039, respectively). DISCUSSION Rectal administration of TAF/EVG inserts achieved high rectal tissue concentrations of EVG and TFV-DP with low systemic drug exposure and demonstrable ex vivo inhibition of HIV infection for 72 hours.
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Affiliation(s)
- Sharon A Riddler
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Clifton W Kelly
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, WA
| | - Craig J Hoesley
- Departments of Medicine and Medical Education, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Ken S Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Jeanna M Piper
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892 USA
| | - Stacey Edick
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Faye Heard
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | | | | | - Peter L Anderson
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 USA
| | - Rhonda M Brand
- Department of Medicine, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, PA 15213 USA
| | | | - José A Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104 USA
| | - Sharon L Hillier
- Department of Obstetrics and Gynecology, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, PA 15213 USA
| | - Craig W Hendrix
- Department of Medicine (Clinical Pharmacology), Johns Hopkins University, Baltimore, MD 21287 USA
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Schieber E, Cottrell L, Deveaux L, Li X, Taylor M, Adderley R, Marshall S, Forbes N, Wang B. Teachers' Perceptions of the Impact of the COVID-19 Pandemic and Their Implementation of an Evidence-based HIV Prevention Program in the Bahamas. AIDS Behav 2024:10.1007/s10461-024-04345-8. [PMID: 38642212 DOI: 10.1007/s10461-024-04345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021-2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained "very important" during times of crisis. Greater self-efficacy and supports increased implementation fidelity.
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Affiliation(s)
- Elizabeth Schieber
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, 959 Hartman Run Road. Morgantown, WV, Morgantown, 26506, USA.
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Marcellus Taylor
- Government and Public Policy Institute, University of The Bahamas, Oakes Field Campus University Drive, Nassau, Bahamas
| | - Richard Adderley
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Sharon Marshall
- Department of Pediatrics, Wayne State University School of Medicine, 400 Mack Avenue, Detroit, MI, 48201, USA
| | - Nikkiah Forbes
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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3
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Mpirirwe R, Mujugira A, Walusaga H, Ayebare F, Musanje K, Ndugga P, Muhumuza C, Nangendo J, Semitala FC, Kyambadde P, Kalyango J, Kiragga A, Karamagi C, Kamya MR, Armstrong-Hough M, Katahoire AR. Perspectives of female sex workers on HIV pre-exposure prophylaxis delivery in Uganda: A qualitative study. Res Sq 2024:rs.3.rs-4115528. [PMID: 38562811 PMCID: PMC10984088 DOI: 10.21203/rs.3.rs-4115528/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background HIV pre-exposure prophylaxis (PrEP) is underutilized by cisgender female sex workers (FSW) despite its proven effectiveness. This study aimed to understand the experiences of FSW with PrEP services in Uganda to inform HIV programming for this key population. Methods We conducted qualitative interviews with 19 FSW between June and July 2022 at the Most at Risk Populations Initiative clinic, Mulago Hospital, Kampala, to explore experiences with accessing PrEP Indepth interviews explored: (1) descriptions of where and how PrEP was obtained; (2) perspectives on current approaches for accessing PrEP; and (3) individual encounters with PrEP services. Data were analyzed through inductive thematic analysis. Results Three key themes emerged for FSW perspectives on PrEP service delivery. FSW highlighted the positive impact of a welcoming clinic environment, which motivated FSW to initiate PrEP and fostered a sense of connectedness within their community. They also reported feeling accepted, secure, and free from prejudice when accessing PrEP through facility-based services. The second explores the obstacles faced by FSW, such as lengthy wait times at clinics, inadequate provider support, and lack of sensitivity training which hindered their access to PrEP The third sheds light on how HIV-related stigma negatively impacted the delivery of community-based PrEP for FSW. While community-based distribution offered convenience and helped mitigate stigma, clinic-based care provided greater anonymity and was perceived as offering higher-quality care. Overall, FSWs emphasized the critical role of friendly healthcare providers, social support, and non-stigmatizing environments in promoting successful utilization of PrEP. Conclusion The study findings offer insights that can support HIV programs in optimizing PrEP delivery for FSW. Establishing easily accessible drug pick-up locations, prioritizing privacy, addressing and improving health workers' attitudes, and providing regular reminders could enhance PrEP access for FSW and decrease HIV acquisition.
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Wells KJ, Gordon JR, Carrizosa CM, Mozo EH, Lucido NC, Cobian Aguilar RA, Brady JP, Rojas SA, Ramers CB, Nogg KA, Fahey KML, Jones IJ, Rivera DB, Blashill AJ. Interpersonal and Community-Level Influences Across the PrEP Cascade Among Young Adult Latinx Men who Have Sex with Men Living in a US-Mexico Border Region: A Qualitative Study. AIDS Behav 2024; 28:759-773. [PMID: 37773474 PMCID: PMC10922111 DOI: 10.1007/s10461-023-04185-y] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
Latinx men who have sex with men (MSM) are an at-risk population for new HIV diagnoses. Pre-exposure prophylaxis (PrEP) is a suite of biomedical approaches to prevent HIV infection. Latinx MSM are less likely to take PrEP compared to non-Latinx White MSM. This qualitative study identified interpersonal- and community-level barriers and facilitators of PrEP among young adult Latinx MSM. Using stratified purposeful sampling, 27 Latinx men, ages 19-29 years and living in a US-Mexico border region, completed self-report demographic surveys and participated in semi-structured in-depth interviews assessing barriers and facilitators to PrEP. Directed content analysis was used to identify both a priori and emerging themes. Most participants reported that other people, including peers, friends, partners, and health care providers were both supportive and discouraging of PrEP use. Participants' intersectional identities as members of both Latinx and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) communities both hindered and facilitated PrEP use.
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Affiliation(s)
- Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA.
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA.
| | - Janna R Gordon
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA
| | | | | | - Nicholas C Lucido
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - Rosa A Cobian Aguilar
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA
| | - John P Brady
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA
| | - Sarah A Rojas
- Laura Rodriguez Research Institute-Family Health Centers of San Diego, San Diego, CA, 92102, USA
| | - Christian B Ramers
- Laura Rodriguez Research Institute-Family Health Centers of San Diego, San Diego, CA, 92102, USA
| | - Kelsey A Nogg
- San Diego State University Research Foundation, San Diego, CA, 92120, USA
| | - Kalina M L Fahey
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - Isaiah J Jones
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - David B Rivera
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA
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Perez-Urbano I, Dilraj A, Pitsi A, Hlongwane N, Abdelatif N, Dietrich J, Ahmed K. Strategies to Close the PrEP Uptake Gap Among Transgender People and Men Who Have Sex with Men in Tshwane, South Africa: Perspectives from the Community. AIDS Behav 2024:10.1007/s10461-024-04300-7. [PMID: 38427124 DOI: 10.1007/s10461-024-04300-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
HIV Pre-exposure Prophylaxis (PrEP) uptake among transgender (TG) people and gay men and other men who have sex with men (MSM) remains low, despite South Africa being the first African country to approve PrEP. This mixed-methods study used a two-phase explanatory sequential design: (1) quantitative analysis of cross-sectional surveys followed by (2) qualitative in-depth interviews. This study explored facilitators and barriers to PrEP uptake to identify strategies to increase utilization in these key populations. We conducted 202 cross-sectional surveys and 20 in-depth interviews between July 2021 and March 2022 in Soshanguve, Tshwane, Gauteng. Quantitative data were analyzed using univariate logistic regression; thematic analysis was performed for qualitative data. Findings show high willingness to use PrEP but low PrEP uptake. We outline strategies to facilitate PrEP use: (1) demystify daily PrEP by deploying community-engaged PrEP education campaigns; (2) capitalize on existing peer networks; and (3) expand accessible and culturally responsive PrEP service delivery models. We provide feasible recommendations to close the PrEP uptake gap in these key populations in South Africa.
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Affiliation(s)
- India Perez-Urbano
- University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA.
| | | | - Annah Pitsi
- Setshaba Research Centre, Tshwane, Soshanguve, South Africa
| | | | - Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), Wits Health Consortium, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa
| | - Khatija Ahmed
- Setshaba Research Centre, Tshwane, Soshanguve, South Africa
- Department of Medical Microbiology, University of Pretoria, Tshwane, South Africa
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Nardell MF, Govathson C, Mngadi-Ncube S, Ngcobo N, Letswalo D, Lurie M, Miot J, Long L, Katz IT, Pascoe S. Migrant men and HIV care engagement in Johannesburg, South Africa. BMC Public Health 2024; 24:435. [PMID: 38347453 PMCID: PMC10860300 DOI: 10.1186/s12889-024-17833-2] [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: 09/28/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND South Africa (SA) has one of the highest rates of migration on the continent, largely comprised of men seeking labor opportunities in urban centers. Migrant men are at risk for challenges engaging in HIV care. However, rates of HIV and patterns of healthcare engagement among migrant men in urban Johannesburg are poorly understood. METHODS We analyzed data from 150 adult men (≥ 18 years) recruited in 10/2020-11/2020 at one of five sites in Johannesburg, Gauteng Province, SA where migrants typically gather for work, shelter, transit, or leisure: a factory, building materials store, homeless shelter, taxi rank, and public park. Participants were surveyed to assess migration factors (e.g., birth location, residency status), self-reported HIV status, and use and knowledge of HIV and general health services. Proportions were calculated with descriptive statistics. Associations between migration factors and health outcomes were examined with Fisher exact tests and logistic regression models. Internal migrants, who travel within the country, were defined as South African men born outside Gauteng Province. International migrants were defined as men born outside SA. RESULTS Two fifths (60/150, 40%) of participants were internal migrants and one fifth (33/150, 22%) were international migrants. More internal migrants reported living with HIV than non-migrants (20% vs 6%, p = 0.042), though in a multi-variate analysis controlling for age, being an internal migrant was not a significant predictor of self-reported HIV positive status. Over 90% all participants had undergone an HIV test in their lifetime. Less than 20% of all participants had heard of pre-exposure prophylaxis (PrEP), with only 12% international migrants having familiarity with PrEP. Over twice as many individuals without permanent residency or citizenship reported "never visiting a health facility," as compared to citizens/permanent residents (28.6% vs. 10.6%, p = 0.073). CONCLUSIONS Our study revealed a high proportion of migrants within our community-based sample of men and demonstrated a need for HIV and other healthcare services that effectively reach migrants in Johannesburg. Future research is warranted to further disaggregate this heterogenous population by different dimensions of mobility and to understand how to design HIV programs in ways that will address migrants' challenges.
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Affiliation(s)
- Maria Francesca Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Caroline Govathson
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithabile Mngadi-Ncube
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkosinathi Ngcobo
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Letswalo
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Lurie
- Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jacqui Miot
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Ingrid Theresa Katz
- Harvard Medical School, Boston, MA, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office (HE2RO), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Carter G, Tavares T. PrEP prescription in indiana 2017-2022: Implications for clinical practice. Res Nurs Health 2024; 47:49-59. [PMID: 37963774 DOI: 10.1002/nur.22354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Abstract
The Ending the HIV Epidemic initiative is poised to eradicate HIV through increasing screening and linkage to care. Despite this, the rate of HIV testing remains inadequate, and effective preventive measures like pre-exposure prophylaxis (PrEP) are not adequately prescribed. A retrospective chart review was conducted to include 2017 through July 2022 from a large nonprofit health care system in the Midwest. Inclusion criteria included an HIV-negative diagnosis between 2017 and July 2022. Additional information includes gender, age, race/ethnicity, the primary payment method, the facility where screening occurred, history of PrEP prescription, and the provider who documented sexual health screening. Most patients were female (73%, n = 3366), followed by 27% (n = 1242) who identified as male. The majority identified as white (52.4%, n = 2415), and patients who identified as Black represented 45.3% (n = 2087) of the sample. Of the participants in the sample, n = 3030 (65.8%) did not have a documented sexual health assessment at the time of HIV screening. Black patients were 0.40 times less likely to report a PrEP prescription than their white counterparts. Patients screened by the provider and identified with infectious disease via a sexual mode of transmission demonstrated three times increased odds of being prescribed PrEP. This research highlights the importance of updating medical records systems to capture salient sexual health factors. Ongoing professional development should be made readily available so providers can conduct comprehensive sexual health assessments.
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Affiliation(s)
- Gregory Carter
- Indiana University School of Nursing, Bloomington, Indiana, USA
- The Kinsey Institute, Bloomington, Indiana, USA
- Rural Center for AIDS and STD Prevention, Indiana, USA
| | - Taran Tavares
- Indiana University School of Nursing, Bloomington, Indiana, USA
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Hershow RB, Worthington N, Adams M, McDonald R, Wilson S, McBee S, Balleydier S, Curran KG. A Qualitative Analysis of Barriers to Accessing HIV Prevention Services During an HIV Outbreak among Persons who Inject Drugs in West Virginia. AIDS Behav 2024; 28:669-681. [PMID: 38165598 PMCID: PMC10922593 DOI: 10.1007/s10461-023-04254-2] [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: 12/12/2023] [Indexed: 01/04/2024]
Abstract
In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework. Participants identified numerous political, physical, social, and economic community-level barriers that influenced access to HIV prevention services among PWID. Political factors included low community support for syringe services programs (SSPs); physical factors included low SSP coverage, low coverage of HIV testing outreach events, low HIV preexposure prophylaxis availability, and homelessness; social factors included stigma and discrimination; economic factors included community beliefs that SSPs negatively affect economic investments and limited resources for HIV screening in clinical settings. Individual-level barriers included co-occurring acute medical conditions and mental illness. Community-level interventions, such as low-barrier one-stop shop models, are needed to increase access to sterile syringes through comprehensive harm reduction services.
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Affiliation(s)
- Rebecca B Hershow
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Nancy Worthington
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Adams
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert McDonald
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne Wilson
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shannon McBee
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shawn Balleydier
- West Virginia Department of Health and Human Resources, West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Kathryn G Curran
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rotsaert A, Vanhamel J, Vanbaelen T, Vuylsteke B, van der Loeff MS, Hensen B, Kielmann K, Callens S, Reyniers T. HIV Pre-exposure Prophylaxis (PrEP) Care in Belgium: A mixed-methods Study on PrEP Users' Experiences and Service Delivery Preferences. AIDS Behav 2024; 28:393-407. [PMID: 38038778 DOI: 10.1007/s10461-023-04232-8] [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: 11/21/2023] [Indexed: 12/02/2023]
Abstract
In Belgium, HIV pre-exposure prophylaxis (PrEP) services are mainly provided through specialised HIV clinics. To optimise PrEP uptake and retention in care, we require insights into users' perspectives on PrEP care. We aimed to elicit experiences with, and preferences for, PrEP service delivery among PrEP users in Belgium, including willingness to involve their family physician (FP) in PrEP care. We adopted a sequential mixed-methods design. We used a web-based longitudinal study among 326 PrEP users that consisted of two questionnaires at six-month intervals, and complemented this with 21 semi-structured interviews (September 2020-January 2022). We conducted descriptive analyses and logistic regression to examine factors associated with willingness to involve their FP in PrEP care. Interviews were analysed using thematic analysis. Survey respondents reported high satisfaction with care received in HIV clinics [median score 9 (IQR 8-10), 10='very satisfied']. Interviews revealed the importance of regular HIV/STI screening, and the expertise and stigma-free environment of HIV clinics. Yet, they also contextualised service delivery barriers reported in the questionnaire, including the burden of cost and challenges integrating PrEP visits into their private and professional lives. Although 63.8% (n = 208/326) of baseline respondents preferred attending an HIV clinic for PrEP follow-up, 51.9% (n = 108/208) of participants in the follow-up questionnaire reported to be willing to have their FP involved in PrEP care. Participants reporting trust in FPs' PrEP and sexual health expertise, or who didn't feel judged by their FP, were more likely to be willing to involve them in PrEP care. Therefore, we recommend a differentiated PrEP service delivery approach, including involving FPs, to make PrEP care more client-centred.
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Affiliation(s)
- Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium.
| | - Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity (AII), Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam, the Netherlands
| | - Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Karina Kielmann
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
| | - Steven Callens
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, B-2000, Belgium
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Gautam K, Paudel K, Ahmed A, Dhakal M, Wickersham JA, Poudel KC, Pagoto S, Acharya B, Deuba K, Valente PK, Shrestha R. High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal. J Community Health 2024:10.1007/s10900-024-01324-x. [PMID: 38281283 DOI: 10.1007/s10900-024-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/30/2024]
Abstract
Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.
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Affiliation(s)
- Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Kiran Paudel
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
- Nepal Health Frontiers, Tokha-5, Kathmandu, 44600, Nepal
| | - Ali Ahmed
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Manisha Dhakal
- Blue Diamond Society, Dhumbarahi Marg, Kathmandu, 44600, Nepal
| | - Jeffrey A Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, 06510, USA
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Institute for Global Health, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Bibhav Acharya
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, School of Medicine, 675 18th Street, San Francisco, CA, 94107, USA
- Possible, a non-profit organization, Bhim Plaza, Kathmandu, Nepal
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pablo K Valente
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA.
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, 06510, USA.
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Boering P, Seeley J, Buule J, Kamacooko O, King R. A Comparison of Self-reported Condomless Sex and Yc-DNA Biomarker Data from Young Women Engaged in High Risk Sexual Activity in Kampala, Uganda. AIDS Behav 2024; 28:320-331. [PMID: 37751111 PMCID: PMC10803388 DOI: 10.1007/s10461-023-04177-y] [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: 09/11/2023] [Indexed: 09/27/2023]
Abstract
Reporting of condom-use can limit researchers' understanding of high-risk sexual behaviours. We compared self-reported condom-use with the Yc-DNA biomarker data and investigated potential factors influencing participation in, and reporting of, sexual behaviours. Self-reported data were collected using Audio Computer Assisted Self Interviews (ACASI) and samples for Yc-DNA biomarker were collected using self-administered and health worker-collected vaginal swabs from 644 women (aged 15-24 years) who were not living with HIV. Yc-DNA results and interview data were compared using McNemar-Bowker Analysis and Cohen's Kappa. Test statistics for Yc-DNA biomarker were calculated. Log Binomial models for Yc-DNA and self-reported results were conducted to assess for association. We found strong evidence (p < 0.001) for a difference between Yc-DNA and self-reported results. 13.7% of participants reported consistent condom-use with all partners, regardless of HIV status. Self-reported condom-use was discordant in 50.0% (n = 206) of cases, when compared to Yc-DNA results. Positive Yc-DNA results were found to be associated with older age (RR 1.36; 95%CI 1.04, 1.76 p = 0.023). Self-reported condom-use with partners with unknown HIV status was associated with higher education (RR 0.76; 95%CI 0.58,0.99 p = 0.043). Sensitivity analysis did not determine difference between methods for controlling for missing data. We found significant under-reporting of condomless sex in the self-reported data when compared to Yc-DNA results.
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Affiliation(s)
- Pippa Boering
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK.
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
| | - Joshua Buule
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Rachel King
- University of California, San Francisco, CA, USA
- INSERM, 60 Rue de Navacelles, 34090, Montpellier, France
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12
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El-Krab R, Brousseau N, Kalichman SC. Medical mistrust as a barrier to HIV prevention and care. J Behav Med 2023; 46:897-911. [PMID: 37698802 DOI: 10.1007/s10865-023-00417-7] [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] [Received: 10/22/2022] [Accepted: 05/03/2023] [Indexed: 09/13/2023]
Abstract
Medical mistrust is fueled by conspiracy theories and histories of healthcare systems abuse and is a known determinant of health outcomes in minority populations. Plagued by multiple and pervasive conspiracy theories, HIV/AIDS has proven to be particularly hampered by medical mistrust. The current paper systematically reviews the literature on medical mistrust among people at risk for or living with HIV infection. The bulk of evidence from 17 studies supports medical mistrust as a barrier to HIV testing, engagement in prevention and care services, treatment uptake and adherence, and clinical outcomes. While findings mostly indicate that medical mistrust is a barrier to HIV prevention and care, some studies report null results and others suggest that medical mistrust may actually improve some HIV-related outcomes. Additionally, most of the reviewed literature was cross-sectional. Thus longitudinal, theory-driven research is needed to reconcile inconsistent findings and determine long term outcomes of medical mistrust. Interventions may then be developed to reduce the negative consequences associated with medical mistrust.
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Affiliation(s)
- Renee El-Krab
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States.
| | - Natalie Brousseau
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, United States
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy (InCHIP), University of Connecticut, Storrs, CT, United States
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13
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Burns CM, Endres K, Derrick C, Cooper A, Fabel P, Okeke NL, Ahuja D, Corneli A, McKellar MS. A survey of South Carolina pharmacists' readiness to prescribe human immunodeficiency virus pre-exposure prophylaxis. J Am Coll Clin Pharm 2023; 6:329-338. [PMID: 37251085 PMCID: PMC10210504 DOI: 10.1002/jac5.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Introduction HIV pre-exposure prophylaxis (PrEP) is largely underutilized in the Southern United States. Given their community presence, pharmacists are well positioned to provide PrEP within rural, Southern regions. However, pharmacists' readiness to prescribe PrEP in these communities remains unknown. Objective To determine the perceived feasibility and acceptability of prescribing PrEP by pharmacists in South Carolina (SC). Methods We distributed a 43-question online descriptive survey through the University of SC Kennedy Pharmacy Innovation Center's listerv of licensed SC pharmacists. We assessed pharmacists' comfort, knowledge, and readiness to provide PrEP. Results A total of 150 pharmacists responded to the survey. The majority were White (73%, n=110), female (62%, n=93), and non-Hispanic (83%, n=125). Pharmacists practiced in retail (25%, n=37), hospital (22%, n=33), independent (17%, n=25), community (13%, n=19), specialty (6%, n=9), and academic settings (3%, n=4); 11% (n=17) practiced in rural locales. Pharmacists viewed PrEP as both effective (97%, n=122/125) and beneficial (74% n=97/131) for their clients. Many pharmacists reported being ready (60% n=79/130) and willing (86% n=111/129) to prescribe PrEP, although over half (62% n=73/118) cited lack of PrEP knowledge as a barrier. Pharmacists described pharmacies as an appropriate location to prescribe PrEP (72% n=97/134). Conclusions Most SC pharmacists surveyed considered PrEP to be effective and beneficial for individuals who frequent their pharmacy and are willing to prescribe this therapy if statewide statutes allow. Many felt that pharmacies are an appropriate location to prescribe PrEP but lack a complete understanding of required protocols to manage these patients. Further investigation into facilitators and barriers of pharmacy-driven PrEP are needed to enhance utilization within communities.
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Affiliation(s)
- Charles M. Burns
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kyle Endres
- Center for Social and Behavioral Research, University of Northern Iowa, Cedar Falls, Iowa, United States of America
| | - Caroline Derrick
- School of Medicine, University of South Carolina, Columbia, South Carolina, United States of America
- Division of Infectious Diseases, University of South Carolina, Prisma Health-Midlands, Columbia, South Carolina, United States of America
| | - Alexandra Cooper
- Duke Initiative on Survey Methodology, Duke University, Durham, North Carolina, United States of America
| | - Patricia Fabel
- Kennedy Pharmacy Innovation Center, University of South Carolina, Columbia, South Carolina, United States of America
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Divya Ahuja
- Division of Infectious Diseases, University of South Carolina, Prisma Health-Midlands, Columbia, South Carolina, United States of America
| | - Amy Corneli
- Department of Population Health Sciences, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Mehri S. McKellar
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
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14
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Chagoma N, Kanyenda T, Pindiwe B, Nyika H, Nyazema L, Stover J, Resar D, Shoko N, Jenkins S, Katanda Y, Xaba S, Mugurungi O. Applying mathematical modelling to estimate the impact of COVID-19-related VMMC service disruptions on new HIV infections in Zimbabwe. BMC Infect Dis 2023; 23:113. [PMID: 36823550 PMCID: PMC9948776 DOI: 10.1186/s12879-023-08081-7] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has overwhelmed health systems with knock on effects on diagnosis, treatment, and care. To mitigate the impact, the government of Zimbabwe enforced a strict lockdown beginning 30 March 2020 which ran intermittently until early 2021. In this period, the Ministry of Health and Childcare strategically prioritized delivery of services leading to partial and full suspension of services considered non-essential, including HIV prevention. As a result, Voluntary Medical Male Circumcision (VMMC) services were disrupted leading to an 80% decline in circumcisions conducted in 2020. Given the efficacy of VMMC, we quantified the potential effects of VMMC service disruption on new HIV infections in Zimbabwe. METHODS We applied the GOALS model to evaluate the impact of COVID-19-related disruptions on reducing new HIV infections over 30-years. GOALS is an HIV simulation model that estimates number of new HIV infections based on sexual behaviours of population groups. The model is parameterized based on national surveys and HIV program data. We hypothesized three coverage scenarios by 2030: scenario I - pre-COVID trajectory: 80% VMMC coverage; Scenario II - marginal COVID-19 impact: 60% VMMC coverage, and scenario III - severe COVID-19 impact: 45% VMMC coverage. VMMC coverage between 2020 and 2030 was linearly interpolated to attain the estimated coverage and then held constant from 2030 to 2050, and discounted outcomes at 3%. RESULTS Compared to the baseline scenario I, in scenario II, we estimated that the disruption of VMMC services would generate an average of 200 (176-224) additional new infections per year and 7,200 new HIV infections over the next 30 years. For scenario III, we estimated an average of 413 (389-437) additional new HIV infections per year and 15,000 new HIV infections over the next 30 years. The disruption of VMMC services could generate additional future HIV treatment costs ranging from $27 million to $55 million dollars across scenarios II and III, respectively. CONCLUSION COVID-19 disruptions destabilized delivery of VMMC services which could contribute to an additional 7,200 new infections over the next 30 years. Unless mitigated, these disruptions could derail the national goals of reducing new infections by 2030.
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Affiliation(s)
- Newton Chagoma
- grid.452345.10000 0004 4660 2031Clinton Health Access Initiative, Boston, USA
| | - Tiwonge Kanyenda
- grid.452345.10000 0004 4660 2031Clinton Health Access Initiative, Boston, USA
| | | | - Howard Nyika
- grid.415818.1Ministry of Health and Child Care, Harare, Zimbabwe
| | - Lawrence Nyazema
- grid.415818.1Ministry of Health and Child Care, Harare, Zimbabwe
| | - John Stover
- grid.475068.80000 0004 8349 9627Avenir Health, Glastonbury, USA
| | - Danielle Resar
- grid.452345.10000 0004 4660 2031Clinton Health Access Initiative, Boston, USA
| | - Natsai Shoko
- grid.452345.10000 0004 4660 2031Clinton Health Access Initiative, Boston, USA
| | - Sarah Jenkins
- grid.452345.10000 0004 4660 2031Clinton Health Access Initiative, Boston, USA
| | | | | | - Owen Mugurungi
- grid.415818.1Ministry of Health and Child Care, Harare, Zimbabwe
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15
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Comer C, Fernández R. Health Departments and PrEP: A Missed Opportunity for Public Health. J Law Med Ethics 2022; 50:64-68. [PMID: 35902080 PMCID: PMC9341197 DOI: 10.1017/jme.2022.39] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The paper identifies common barriers and challenges to Pre-Exposure Prophylaxis (PrEP) uptake and offers considerations for state and local public health departments to address barriers and retool infrastructure to increase access to PrEP to new users. Authors identify synergistic opportunities with federal agencies and funders to advance PrEP-related HIV prevention efforts, that prioritize strategies and investments to provide PrEP to people who could benefit from the intervention but are unaware of PrEP or struggle to access it. Barriers discussed and examined include financing strategies to reduce financial burden of PrEP medication, expanding PrEP access and outreach beyond clinical settings, and increasing the network and reach of the provider community to serve people we oppress through policy choices and discourses of racial and socioeconomic inferiority.
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16
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Rowland BHP, Palfai TP, Simons JS, Maisto SA. Working memory moderates the relation between implicit alcohol associations and heavy episodic drinking in moderate-to-heavy drinking men who have sex with men. Addict Behav 2021; 123:107053. [PMID: 34416533 PMCID: PMC8498971 DOI: 10.1016/j.addbeh.2021.107053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Heavy episodic drinking poses a risk for HIV-infection, particularly among men who have sex with men (MSM). Previous research suggests implicit associations may play a role in heavy episodic drinking and that various executive functions (EF) may moderate the relation between implicit associations and heavy episodic drinking. This study investigated the role of two EF - working memory (maintaining and updating information) and response inhibition (inhibiting prepotent responses) - as moderators of the relation between implicit alcohol approach associations and heavy episodic drinking among moderate-to-heavy drinking MSM. METHODS Two-hundred and fifty-one participants completed measures of implicit alcohol associations (the implicit alcohol approach association test - IAT), working memory, and response inhibition, as well as a self-report questionnaire assessing heavy episodic drinking. Regression analyses were conducted to examine whether the association between the IAT and heavy episodic drinking was moderated by working memory and response inhibition. RESULTS Results showed that working memory moderated the relation between the alcohol IAT and heavy episodic drinking such that IAT alcohol approach scores were positively associated with heavy episodic drinking among those low in working memory but not those high in working memory. Response inhibition did not moderate the association between IAT scores and heavy episodic drinking. CONCLUSIONS Results suggest that the relation between implicit alcohol approach associations and heavy episodic drinking is stronger among moderate-to-heavy drinking MSM with lower working memory capacity compared to those with higher working memory capacity, and these individuals may particularly benefit from alcohol intervention approaches that target automatic alcohol responses.
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Affiliation(s)
- Bonnie H P Rowland
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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17
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Liu Z, Tang X, Liu Y, Zhang L, Yang Y, Zheng Y, Liu W, Jike C, Mai H, Fan H, Yu G, Han M, Gao GF. HIV Prevention and Health Poverty Alleviation - Liangshan Prefecture, Sichuan Province, China, 2017-2020. China CDC Wkly 2021; 3:1031-1035. [PMID: 34888120 PMCID: PMC8633550 DOI: 10.46234/ccdcw2021.250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zhongfu Liu
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Xuefeng Tang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yufen Liu
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - Linglin Zhang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yihui Yang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yongli Zheng
- Chengdu Public Health Clinical Center, Chengdu, Sichuan, China
| | - Weixin Liu
- Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Chunnong Jike
- Liangshan Prefecture Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Hong Mai
- The First People's Hospital of Liangshan Prefecture, Xichang, Sichuan, China
| | - Heying Fan
- Liangshan Prefecture Maternal & Child Health and Family Planning Service Center, Xichang, Sichuan, China
| | - Gang Yu
- Liangshan Prefecture Center for Disease Control and Prevention, Xichang, Sichuan, China
| | - Mengjie Han
- National Center for AIDS/STD Control and Prevention, China CDC, Beijing, China
| | - George F Gao
- Chinese Center for Disease Control and Prevention, Beijing, China
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18
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Johnson RJ. A Note From the Field In Search of Roland Wayne, Jr. (Not His Real Name): Comment on Social Connectivity. J Public Health Int 2021; 3:18-21. [PMID: 34046639 PMCID: PMC8153548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This brief report article is a retrospective, descriptive, first-person account of following-up on a difficult-to-find client of an HIV/AIDS community-based pre-post intervention and disease prevention Research and Demonstration project in Houston, TX. Through the story about the personal journey of searching for the client, the author experiences an epiphany, especially in light of current events. Specifically, as opposed to social distancing and disconnection, public health disease prevention probably would be better served through leveraging the powerful and positive natural human features of social connectivity and closeness.
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Affiliation(s)
- Ralph J Johnson
- Dept. of Myeloma, UT-MDACC, Unit 429, 1515 Holcombe BlVd., Houston, TX, 77071, USA
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19
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Akinola M, Wirtz AL, Chaudhry A, Cooney E, Reisner SL. Perceived acceptability and feasibility of HIV self-testing and app-based data collection for HIV prevention research with transgender women in the United States. AIDS Care 2021; 33:1079-1087. [PMID: 33487032 DOI: 10.1080/09540121.2021.1874269] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the United States, transgender women are disproportionately burdened by HIV infection. Research aimed at curbing the HIV epidemic for this population may benefit from innovative technology to engage participants in research. Adult transgender women (n = 41) from six cities in the southern and eastern United States participated in seven online focus groups between August 2017 and January 2018. Analyses focused on perceived acceptability of novel technologies for research purposes, particularly HIV self-testing (HIVST) and remote data collection through a mobile app. While participants noted a number of benefits to HIVST and remote study participation, including increased participant engagement and sentiments of agency, they also expressed concerns that may impact HIVST and remote participation including housing instability, inconsistent access to technology, and confidentiality. Study findings provide insight into gaps that must be addressed when using technology-enhanced methods to support HIV testing and research participation among transgender women in the US. Substantial effort is required on the part of investigators to ensure equitable access across subgroups and, thus, minimize bias to avoid reproducing health disparities in research.
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Affiliation(s)
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aeysha Chaudhry
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Erin Cooney
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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- The Fenway Institute, Fenway Health, Boston, MA, USA
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20
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Abstract
BACKGROUND Many countries have been trying to eliminate Mother-to-Child transmission of the Human Immunodeficiency Virus (HIV) and achieve the 90-90-90 target goals. The targets mean that 90% of People Living with HIV (PLWHIV) know their HIV status, 90% of those who are infected receive Antiretroviral treatment (ART), and 90% of those achieve viral suppression. Despite some progress, the goals have not been met in the Philippines, Myanmar, and Cambodia, countries with relatively high or growing HIV prevalence. This study identifies the sociodemographic determinants of testing among women in these countries so that better health education and stigma reduction strategies can be developed. METHODS Descriptive and multivariable analyses were conducted using Demographic and Health Survey data conducted in the Philippines (2017), Myanmar (2015/2016), and Cambodia (2014). The outcome variable was having ever been tested for HIV. Independent variables included knowledge and attitudes about HIV and social determinants of health. RESULTS A significant difference in testing rates among women was observed (the Philippines: 5%, Myanmar: 19%, Cambodia: 42%). In Myanmar and Cambodia, women who had more HIV knowledge and less stigma towards PLWHIV were more likely to get tested for HIV than those who did not. Marital status, education, wealth were strong predictors for HIV testing among women. Younger women aged 15-19 and those who live in the rural areas were less likely to get HIV tested than older and those living in urban areas. Employed women were less likely to seek an HIV test than the unemployed in Myanmar and Cambodia, whereas, in the Philippines, the opposite relationship was found. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Women with less education and those less familiar with HIV should be targeted for HIV testing interventions. Stigma reduction and different testing strategies could facilitate early screening leading to improved HIV testing among women.
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Affiliation(s)
- Wah W Myint
- Department of Health Promotion & Community Health Sciences, Texas A&M University School of Public Health, College Station, TX, USA
| | - David J Washburn
- Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, USA
| | - Brian Colwell
- Department of Health Promotion & Community Health Sciences, Texas A&M University School of Public Health, College Station, TX, USA
| | - Jay E Maddock
- Department of Environmental & Occupational Health, Texas A&M University School of Public Health, College Station, TX, USA
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21
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Anderson KR, Palfai TP, Maisto SA, Simons JS. Drinking motives mediate the associations between urgency and hazardous/harmful alcohol use among moderate-to-heavy drinking men who have sex with men (MSM). Addict Behav 2020; 110:106520. [PMID: 32622024 PMCID: PMC8565053 DOI: 10.1016/j.addbeh.2020.106520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/14/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 01/25/2023]
Abstract
Urgency, the tendency to act rashly under extreme emotions, has been associated with higher rates of hazardous/harmful drinking. Moreover, previous work suggests that the association between urgency and hazardous/harmful drinking may be mediated by drinking motives. The current study sought to replicate and extend this research to men who have sex with men (MSM), a population that has shown increased alcohol-related health risk behavior. METHODS Two-hundred-and-fifty-six moderate-to-heavy drinking MSM completed questionnaires assessing urgency, drinking motives, and hazardous/harmful drinking. Regression models were conducted to examine the direct effect of Urgency on heavy episodic drinking and alcohol-related consequences and its indirect effects on these outcomes through drinking motives. RESULTS Urgency was significantly associated with heavy episodic drinking and alcohol-related consequences. Bootstrapping procedures indicated significant indirect effects through coping and enhancement motives for both outcomes and also conformity for consequences. CONCLUSIONS These results indicate urgency may be an important risk factor for hazardous/harmful drinking among adult MSM that may operate in part through its effects on coping and enhancement motives.
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Affiliation(s)
- Kyle R Anderson
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
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Conroy ER, Knox BL, Henderson SL. Assessing Medical Neglect in HIV-Exposed or Infected Children. J Child Adolesc Trauma 2020; 13:317-325. [PMID: 33088389 PMCID: PMC7561658 DOI: 10.1007/s40653-019-00274-0] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Human Immunodeficiency Virus (HIV) causes a chronic illness requiring lifelong medical care to prevent opportunistic infections and death. It is important to identify medical neglect in children that are perinatally exposed to or living with human immunodeficiency virus and to take steps to prevent it. Diagnosis of medical neglect must be considered in the context of the caregivers' understanding of the risks of harm, and the logistical, cultural and social factors that may influence their actions or non-actions. When medical neglect as failure of treatment or prevention of infection is suspected, medical providers should work collaboratively with caregivers to assess and address barriers to adherence and to provide resources and support. Medical neglect may be diagnosed if repeated preventive efforts fail.
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Affiliation(s)
- Ellen R. Conroy
- Medical School of the University of Wisconsin School of Medicine and Public Health, Madison, WI USA
- Present Address: Pediatric Residency Program, Cohen Children’s Medical Center of New York, Northwell Health, New Hyde Park, NY USA
| | - Barbara L. Knox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-4108 USA
| | - Sheryl L. Henderson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792-4108 USA
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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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Taggart T, Milburn NG, Nyhan K, Ritchwood TD. Utilizing a Life Course Approach to Examine HIV Risk for Black Adolescent Girls and Young Adult Women in the United States: A Systematic Review of Recent Literature. Ethn Dis 2020; 30:277-286. [PMID: 32346273 DOI: 10.18865/ed.30.2.277] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Black female youth have been disproportionately burdened by the HIV epidemic. Emerging literature suggests that individual and social-structural factors may uniquely increase HIV risk within this population during key developmental periods, namely adolescence (ages 10-17 years) and emerging adulthood (ages 18-25 years). Few studies, however, have compared drivers of risk within and between these key developmental periods. Therefore, we conducted a systematic review of recent literature to characterize and identify important gaps in our understanding of the individual, psychosocial, and social-structural determinants of HIV risk among Black adolescent girls and emerging adult women. Design Using a replicable strategy, we searched electronic databases for articles and abstracts published between October 1, 2017 and September 30, 2019 in which the primary focus was on HIV prevention among Black adolescent girls and emerging adults in the United States. Results In total, 21 studies met the inclusion criteria. Most of the studies on Black adolescent girls assessed family functioning, parental monitoring, and parent-adolescent communication as determinants of HIV-related behaviors. However, equivalent studies were lacking for Black emerging adult women. Moreover, few studies assessed neighborhood characteristics, social networks, or other community-level factors as determinants of HIV-related behaviors, which are known drivers of HIV disparities. Conclusions Our findings highlighted several gaps in the literature, including failure to recognize the ethnic and cultural differences among Black women that may contribute to behavioral differences within this population and insufficient acknowledgment of the role of HIV protective factors (eg, resilience and community assets). Implications and future directions are discussed.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Washington, DC; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Kate Nyhan
- Yale School of Public Health; Harvey Cushing/John Hay Whitney Medical Library, Department of Environmental Health Sciences, Yale University, New Haven, CT
| | - Tiarney D Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
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Ebor MT, Jackson AP. HIV Prevention Programming for Older African American Women: The Impact of a Faith-Based and Behavioral Science Partnership on Depressive Symptoms. Ethn Dis 2020; 30:287-294. [PMID: 32346274 PMCID: PMC7186045 DOI: 10.18865/ed.30.2.287] [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] [Indexed: 11/18/2022] Open
Abstract
Objective The current study sought to test the effect of an HIV prevention intervention on depressive symptoms in a sample of older African American women. Design Setting and Participants A pretest-posttest randomized control group design was conducted in a mega-church in Los Angeles with a sample of 62 older African American women, aged ≥50 years, 29 of whom were randomly assigned to the experimental condition and 33 to the comparison/control condition. Measures A measure of psychological wellbeing (CES-D) was utilized to test the effect of the four-session group intervention vs the one-session informational group intervention on change in depressive symptoms from pretest to posttest. Demographic characteristics included: measures of age in years; relationship and employment statuses (coded 1 for yes, 0 for no); and educational attainment. Results Participation in the study was associated with a significant improvement in the women's psychological wellbeing from baseline to time 2; ie, decreased depressive symptoms. This change was greater for women in the four-session experimental group than for those in the one-session comparison group, due in part to a marginally significant interaction between time and experimental conditions. Conclusions This study demonstrates the utility of faith-based/behavioral-scientist partnerships in HIV programming. Findings contribute to the evidence on interventions that might reduce depressive symptoms and HIV risk among older African American women.
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Affiliation(s)
- Megan T. Ebor
- Center for Culture, Trauma, and Mental Health Disparities, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Aurora P. Jackson
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA
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26
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Clark JL, Perez-Brumer AG, Reisner SL, Salazar X, McLean S, Huerta L, Silva-Santisteban A, Moriarty KM, Mimiaga MJ, Sanchez J, Mayer KH, Lama JR. Social Network Organization, Structure, and Patterns of Influence Within a Community of Transgender Women in Lima, Peru: Implications for Biomedical HIV Prevention. AIDS Behav 2020; 24:233-245. [PMID: 30989553 PMCID: PMC6801001 DOI: 10.1007/s10461-019-02506-8] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Understanding social network structures can contribute to the introduction of new HIV prevention strategies with socially marginalized populations like transgender women (TW). We conducted 20 semi-structured interviews and four focus groups (n = 32) with TW from selected social networks in Lima, Peru between May and July, 2015. Participants described layers of social influence from diverse actors in their social networks. The majority identified a close relative as their primary social support, with whom they confided secrets but avoided issues of transgender identity, sexuality, and sex work. Participants described close circles of TW friends with whom they shared information about gender identity, body modification, and sexual partners, but avoided issues like HIV. Community leadership included political leaders (who advocated for transgender rights) as well as social leaders (who introduced TW to hormone therapy, body modification, and commercial sex). Detailed analysis of TW social networks can contribute to implementation and acceptability of new HIV prevention technologies.
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Affiliation(s)
- J L Clark
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA.
| | - A G Perez-Brumer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - S L Reisner
- Department of Pediatrics, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - X Salazar
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S McLean
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - L Huerta
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - A Silva-Santisteban
- Instituto de Estudios de Sexualidad y Derechos Humanos, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - K M Moriarty
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Leconte Avenue, CHS 37-121, Los Angeles, CA, 90095, USA
- Brown University Alpert School of Medicine, Providence, RI, USA
| | - M J Mimiaga
- Center for Health Equity Research, Brown University, Providence, RI, USA
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert School of Medicine, Providence, RI, USA
| | - J Sanchez
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- CITBM, Universidad Nacional Mayor San Marcos, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
| | - K H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - J R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
- Department of Global Health, University of Washington School of Medicine, Seattle, WA, USA
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Armstrong-Mensah E, Ruiz K, Fofana A, Hawley V. Perinatal HIV Transmission Prevention: Challenges among Women Living with HIV in sub-Saharan Africa. Int J MCH AIDS 2020; 9:354-359. [PMID: 32832201 PMCID: PMC7433295 DOI: 10.21106/ijma.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing.
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Affiliation(s)
| | - Krystal Ruiz
- Georgia State University, School of Public Health, Atlanta, Georgia 30303
| | - Aminata Fofana
- Georgia State University, School of Public Health, Atlanta, Georgia 30303
| | - Victoria Hawley
- Georgia State University, School of Public Health, Atlanta, Georgia 30303
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28
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Ogunbajo A, Leblanc NM, Kushwaha S, Boakye F, Hanson S, Smith MDR, Nelson LE. Knowledge and Acceptability of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Ghana. AIDS Care 2019; 32:330-336. [PMID: 31597455 DOI: 10.1080/09540121.2019.1675858] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Ghana, men who have sex with men (MSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a biomedical intervention that reduces the risk of HIV infection but is not currently available in Ghana. This paper explores knowledge and acceptability of HIV PrEP among Ghanaian MSM. Qualitative content analysis was conducted on 22 focus group discussions (N = 137) conducted between March and June 2012 in Accra, Kumasi, and Manya Krobo. Overall, participants reported low knowledge of PrEP. However, once information about PrEP was provided, there was high acceptability. The primary reason for acceptability was that PrEP provided an extra level of protection against HIV. Acceptability of PrEP was conditioned on it having minimal side effects, being affordable and efficient in preventing HIV infection. No acceptability of PrEP was attributed to limited knowledge of side effects and perceived lack of effectiveness. The reasons provided to utilize PrEP and condoms were that condoms protect against other STIs, and sexual partner factors. This is the first known study to explore PrEP knowledge and acceptability among Ghanaian MSM. It is important that key stakeholders preemptively address potential barriers to PrEP acceptability, uptake, and adherence, especially among MSM, once PrEP becomes available in Ghana.
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Affiliation(s)
- Adedotun Ogunbajo
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA
| | | | - Sameer Kushwaha
- University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | | | - Samuel Hanson
- Centre for Popular Education and Human Rights, Accra, Ghana
| | | | - LaRon E Nelson
- University of Rochester, School of Nursing, Rochester, NY, USA.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Hosek S, Castillo M, Hotton A, Balthazar C, Gwiazdowski B, Laboy R, Davis K, Lemos D, Harper GW, Bell M. Comparison of Two Distinct House Ball Communities Involved in an HIV Prevention Study: Baseline Data from the POSSE Project. J HIV AIDS Soc Serv 2019; 18:399-416. [PMID: 33013233 PMCID: PMC7531774 DOI: 10.1080/15381501.2019.1673868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 06/11/2023]
Abstract
For many Black/African American gay, bisexual, and other young men who have sex with men (B-GBMSM), the House/Ball Community (HBC) offers a social network where they can be free to express diverse sexual and gender identities, but HIV prevalence and stigma are high. The POSSE project is an effectiveness-implementation trial of a popular opinion leader intervention designed to address HIV prevention in the Chicago and Philadelphia HBCs. In June 2016 baseline behavioral data were collected along with HIV, gonorrhea and Chlamydia testing. Eligible participants were sexually-active YMSM or transgender women (TGW), between the ages of 15-24, who self-identified as Black. One-third participants (32.5%) met or exceeded the clinical cut-off for depressive symptoms. Approximately 18% of the participants across both cities reported that they were HIV-positive. Overall, the baseline data establishes the need for HIV and STI prevention interventions across both cities, as well as interventions to address other co-occurring epidemics.
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Affiliation(s)
- Sybil Hosek
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, IL USA
| | - Marne Castillo
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Anna Hotton
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL USA
| | | | - Bevin Gwiazdowski
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Richard Laboy
- Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Kortez Davis
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, IL USA
| | | | - Gary W. Harper
- School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Margo Bell
- Division of Adolescent Medicine, John Stroger Hospital of Cook County, Chicago, IL USA
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Wirden M, De Oliveira F, Bouvier-Alias M, Lambert-Niclot S, Chaix ML, Raymond S, Si-Mohammed A, Alloui C, André-Garnier E, Bellecave P, Malve B, Mirand A, Pallier C, Poveda JD, Rabenja T, Schneider V, Signori-Schmuck A, Stefic K, Calvez V, Descamps D, Plantier JC, Marcelin AG, Visseaux B. New HIV-1 circulating recombinant form 94: from phylogenetic detection of a large transmission cluster to prevention in the age of geosocial-networking apps in France, 2013 to 2017. Euro Surveill 2019; 24:1800658. [PMID: 31576801 PMCID: PMC6774227 DOI: 10.2807/1560-7917.es.2019.24.39.1800658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundEnding the HIV pandemic must involve new tools to rapidly identify and control local outbreaks and prevent the emergence of recombinant strains with epidemiological advantages.AimThis observational study aimed to investigate in France a cluster of HIV-1 cases related to a new circulating recombinant form (CRF). The confirmation this CRF's novelty as well as measures to control its spread are presented.MethodsPhylogenetic analyses of HIV sequences routinely generated for drug resistance genotyping before 2018 in French laboratories were employed to detect the transmission chain. The CRF involved was characterised by almost full-length viral sequencing for six cases. Cases' clinical data were reviewed. Where possible, epidemiological information was collected with a questionnaire.ResultsThe transmission cluster comprised 49 cases, mostly diagnosed in 2016-2017 (n = 37). All were infected with a new CRF, CRF94_cpx. The molecular proximity of this CRF to X4 strains and the high median viraemia, exceeding 5.0 log10 copies/mL, at diagnosis, even in chronic infection, raise concerns of enhanced virulence. Overall, 41 cases were diagnosed in the Ile-de-France region and 45 were men who have sex with men. Among 24 cases with available information, 20 reported finding partners through a geosocial networking app. Prevention activities in the area and population affected were undertaken.ConclusionWe advocate the systematic use of routinely generated HIV molecular data by a dedicated reactive network, to improve and accelerate targeted prevention interventions. Geosocial networking apps can play a role in the spread of outbreaks, but could also deliver local targeted preventive alerts.
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Affiliation(s)
- Marc Wirden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Fabienne De Oliveira
- Normandie Université, UNIROUEN, EA2656 GRAM, CHU de Rouen, Laboratoire de virologie associé au CNR VIH, Rouen, France
| | | | | | - Marie-Laure Chaix
- AP-HP, Hôpital Saint-Louis, Laboratoire de virologie, INSERM U944, Paris, France
| | | | | | - Chakib Alloui
- Laboratoire de virologie, Hôpital Avicenne, Bobigny, France
| | | | | | - Brice Malve
- Laboratoire de virologie CHU de Nancy, Nancy, France
| | - Audrey Mirand
- Laboratoire de virologie CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Coralie Pallier
- Laboratoire de virologie, Hôpital P. Brousse, Villejuif, France
| | | | - Theresa Rabenja
- Laboratoire du Grand Hôpital de l’Est Francilien, Jossigny, France
| | | | | | - Karl Stefic
- Laboratoire de virologie CHU de Tours, Tours, France
| | - Vincent Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Diane Descamps
- Laboratoire de virologie, AP-HP, Hopital Bichat Claude Bernard, Univ Paris-Diderot, INSERM, IAME, CNR VIH, Paris, France
| | - Jean-Christophe Plantier
- Normandie Université, UNIROUEN, EA2656 GRAM, CHU de Rouen, Laboratoire de virologie associé au CNR VIH, Rouen, France
| | - Anne-Genevieve Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Laboratoire de virologie, Paris, France
| | - Benoit Visseaux
- Laboratoire de virologie, AP-HP, Hopital Bichat Claude Bernard, Univ Paris-Diderot, INSERM, IAME, CNR VIH, Paris, France
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Starks TJ, Millar BM, Doyle KM, Bertone P, Ohadi J, Parsons JT. Motivational interviewing with couples: A theoretical framework for clinical practice illustrated in substance use and HIV prevention intervention with gay male couples. Psychol Sex Orientat Gend Divers 2018; 5:490-502. [PMID: 30581887 PMCID: PMC6300150 DOI: 10.1037/sgd0000297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidemiological data indicate the need to address substance use and sexual HIV transmission risk among gay and bisexual men in relationships. While brief Motivational Interviewing (MI) delivered to the individual has shown efficacy in reducing sexual HIV risk with casual partners and substance use, the application of MI with couples has received less attention. Most studies of MI with couples have conceptualized the "spouse" or partner as an adjunct participant in the treatment of an identified client. We propose a theoretical framework for conducting MI with a couple, which approaches the couple as the identified client, and may be adopted when either one or both partners engage in the target behavior. We then discuss similarities between MI-processes conceptualized with our proposed framework and those that are salient in existing couples therapies. We utilize case examples from brief MI sessions targeting substance use and sexual HIV risk in gay male couples to illustrate three phenomena unique to the implementation of MI with couples: 1) interpersonal ambivalence; 2) the role of dyadic functioning in tolerating and resolving interpersonal ambivalence; and 3) joint goal formation as a prerequisite to the planning phase of MI. Connecting these phenomena with the transformation of motivation and accommodation processes outlined in Couples Interdependence Theory, this paper suggests that brief MI may be a promising modality for substance use and HIV risk reduction interventions with couples generally and gay couples specifically.
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Affiliation(s)
- Tyrel J. Starks
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY 10034, USA
| | - Brett M. Millar
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Kendell M. Doyle
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Paula Bertone
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Jonathan Ohadi
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Jeffrey T. Parsons
- Center for HIV/AIDS Educational Studies and Training (CHEST), 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave, New York, NY 10065, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, 365 5th Ave, New York, NY 10034, USA
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Chang HH, Kim SW, Jung H, Lee SA, Park HK, Kim S, Lee JM, Choi JY. Awareness and Acceptance of HIV Pre-exposure Prophylaxis among Medical Personnel and Men Who Have Sex with Men in Korea. J Korean Med Sci 2018; 33:e91. [PMID: 29542300 PMCID: PMC5852420 DOI: 10.3346/jkms.2018.33.e91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We aimed to investigate the awareness of human immunodeficiency virus (HIV) infection among high-risk individuals, including men who have sex with men (MSM) and medical personnel (MP) in Korea through a cross-sectional survey, identify possible obstacles hindering their access to pre-exposure prophylaxis (PrEP). METHODS In 2016, the first questionnaire survey was sent to randomly selected MSM and MP. To compare the changes in attitudes and knowledge of MSM, a second questionnaire survey was conducted in August 2017. RESULTS More than half of MSM (61.3% in 2016, 88.6% in 2017) were aware of PrEP. However, MP who offered PrEP had less knowledge regarding PrEP (23.4%). The background knowledge and experience with PrEP among MSM and MP in this survey was low (3.4% in 2016 and 5.7% in 2017, 1.9% in MP). The major obstacles that MSM reported were lack of insurance coverage (29% in 2016 and 32% in 2017), concern regarding adverse effects of PrEP (19% and 21%), and risk of exposing HIV-positive status to other people (15% and 18%). Among MP, lack of knowledge regarding the efficacy of PrEP was the most common obstacle (30%), followed by lack of insurance coverage (22%), and concern regarding adverse effects (20%). CONCLUSION Our study showed that PrEP is required among MSM in Korea; however, most MP were not aware of PrEP. Lack of insurance coverage and knowledge regarding PrEP were major hindrances in the access to PrEP; therefore, further studies on how to make PrEP information more accessible are needed to help prevent HIV infection.
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Affiliation(s)
- Hyun Ha Chang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
| | - Hyejin Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sang Ah Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Han Ki Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Sujeong Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Myung Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Anderson S, Ghys PD, Ombam R, Hallett TB. Frontloading HIV financing maximizes the achievable impact of HIV prevention. J Int AIDS Soc 2018; 21:e25087. [PMID: 29498234 PMCID: PMC5832948 DOI: 10.1002/jia2.25087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/30/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Due to the nature of funding, national planners and international donors typically balance budgets over short time periods when designing HIV programmes (˜5-year funding cycles). We aim to explicitly quantify the cost of short-term funding arrangements on the success of future HIV prevention programmes. METHODS Using mathematical models of HIV transmission in Kenya, we compare the impact of optimized combination prevention strategies under different constraints on investment over time. Each scenario has the same total budget for the 30-year intervention period but the pattern of spending over time is allowed to vary. We look at the impact of programmes with decreasing, increasing or constant spending across 5-year funding cycles for a 30-year period. Interventions are optimized within each funding cycle such that strategies take a short-term view of the epidemic. We compare these with two strategies with no spending pattern constraints: one with static intervention choices and another flexible strategy with interventions changed in year ten. RESULTS AND DISCUSSION For the same total 30-year budget, greatest impact is achieved if larger initial prevention spending is offset by later treatment savings which leads to accumulating benefits in reduced infections. The impact under funding cycle constraints is determined by the extent to which greater initial spending is permitted. Short-term funding constraints and funds held back to later years may reduce impact by up to 18% relative to the flexible long-term strategy. CONCLUSIONS Ensuring that funding arrangements are in place to support long-term prevention strategies will make spending most impactful. Greater prevention spending now will bring considerable returns through reductions in new infections, greater population health and reductions in the burden on health services in the future.
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Affiliation(s)
- Sarah‐Jane Anderson
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
| | | | | | - Timothy B Hallett
- Department of Infectious Disease EpidemiologyImperial College LondonLondonUK
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Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, Partners, Providers and Costs: Potential Barriers to PrEP Uptake among US Women. ACTA ACUST UNITED AC 2017; 8. [PMID: 29201531 PMCID: PMC5708581 DOI: 10.4172/2155-6113.1000730] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results The women expressed concerns about social and structural barriers to PrEP use. They were afraid that stigma related to using “HIV medicines” could affect PrEP use as well. They are worried that family and friends may question their reasons for taking anti-retrovirals and suspect that they were HIV-positive. They expected hostile reactions from male partners, including accusations of infidelity and introducing mistrust in their relationships. Communicating with health care providers about sexual matters in general and their need for PrEP in particular were identified as further barriers. Women reported that providers rarely ask about risk behaviors related to HIV acquisition; that short visits hinder establishing a trusting relationship to discuss sensitive matters. They were concerned that disclosure of risk behaviors may result in judgmental responses and harsh treatment from providers. Lastly, women were concerned that PrEP costs, including insurance coverage and copays, would keep PrEP out of their reach. While cognizant of the potential barriers, women were unwavering in their determination to find ways to circumvent challenges to PrEP access. Conclusion Social and structural barriers may impede women's access to PrEP despite their own reported interest. Continued efforts to reduce HIV stigma, improve patient-provider relationships and ensure affordability of PrEP may increase the likelihood that women will use this important prevention modality.
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Duby Z, Mensch B, Hartmann M, Montgomery E, Mahaka I, Bekker LG, van der Straten A. Achieving the optimal vaginal state: using vaginal products and study gels in Uganda, Zimbabwe, and South Africa. Int J Sex Health 2017; 29:247-257. [PMID: 30519370 PMCID: PMC6276804 DOI: 10.1080/19317611.2017.1297754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Preferences and practices related to the vaginal condition have implications for the use of vaginal HIV prevention products. We used qualitative methods to explore narratives relating to the vaginal state amongst women in South Africa, Uganda and Zimbabwe who had previously participated in a biomedical HIV prevention trial. We investigated women's behaviours related to optimising the vaginal state, experiences and perceptions of the gel's effect on the vaginal state and on penile-vaginal intercourse, women's narratives on male partner perceptions, and how preferences relating to the vaginal state may have interfered with gel use.
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Affiliation(s)
- Zoe Duby
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | | | - Miriam Hartmann
- Women’s Global Health Imperative, RTI International, San Francisco, CA, USA
| | | | - Imelda Mahaka
- UZ-UCSF Collaborative Research Programme, Harare, Zimbabwe
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, South Africa
| | - Ariane van der Straten
- Women’s Global Health Imperative, RTI International, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
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Abstract
INTRODUCTION Updated guidelines from the WHO recommend antiretroviral treatment for adults with HIV at any CD4 count and daily oral pre-exposure prophylaxis (PrEP) for people at substantial risk of HIV infection. However, implementation challenges may hinder the ability of programmes to translate these recommendations into successful practice. This demonstration project is the first to integrate PrEP and immediate treatment (ITx) for female sex workers (FSWs) in South Africa to answer operational research questions. METHODS AND ANALYSIS This is a prospective cohort study where the main outcome is retention at 12 months. The study population is recruited into two arms across two urban sites: (1) PrEP for HIV-negative FSWs (n=400) and (2) ITx for HIV-positive FSWs with CD4 greater than national guidelines (n=300). We investigate process and other health indicators, uptake and use of PrEP and ITx through qualitative research, and evaluate cost-effectiveness analysis combined with estimates of impact through epidemiological modelling. ETHICS AND DISSEMINATION The Treatment And Prevention for female Sex workers in South Africa (TAPS) Project was designed as an implementation study before emtricitabine/tenofovir disoproxil fumarate was licenced as an indication for PrEP in South Africa. Therefore, clinical trial requirements for ethical and South African Medicines Control Council approvals were followed. Results will be disseminated to participants, local health officials and other stakeholders, as well as in peer-reviewed journals and at conferences.
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Affiliation(s)
- Gabriela B Gomez
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
- Department of Global Health and Amsterdam, Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robyn Eakle
- Wits Reproductive Health and HIV Institute, London School of Hygiene and Tropical Medicine, London, UK
| | - Judie Mbogua
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | | | | | - Helen Rees
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
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Bond KT, Gunn AJ. Perceived Advantages and Disadvantages of Using Pre-Exposure Prophylaxis (PrEP) among Sexually Active Black Women: An Exploratory Study. ACTA ACUST UNITED AC 2016; 3:1-24. [PMID: 28725660 DOI: 10.1353/bsr.2016.0019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Knowledge of pre-exposure prophylaxis (PrEP) continues to remain scarce among Black women who are disproportionally affected by HIV in the United States. A thematic analysis of open-ended questions from a sample of Black women (n=119) who completed a mix-methods, online, e-health study was conducted to examine the perceived advantages and disadvantages of using PrEP. Being a female controlled method, empowerment, option for women with risky sex partners, and serodiscordant couples were advantages described. Disadvantages of PrEP were identified as the complexity of the choice, encouragement of sex with risky partners, increased burden, promotion of unprotected sex, and newness of the drug.
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Affiliation(s)
- Keosha T Bond
- Center for Drug Use and HIV Research, NYU School of Nursing
| | - Alana J Gunn
- Department of Social Work, SUNY Binghamton University
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Kessler J, Ruggles K, Patel A, Nucifora K, Li L, Roberts MS, Bryant K, Braithwaite RS. Targeting an alcohol intervention cost-effectively to persons living with HIV/AIDS in East Africa. Alcohol Clin Exp Res 2015; 39:2179-88. [PMID: 26463727 PMCID: PMC5651989 DOI: 10.1111/acer.12890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 05/22/2015] [Accepted: 08/26/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the current report, we ask if targeting a cognitive behavioral therapy (CBT)-based intervention aimed at reducing hazardous alcohol consumption to HIV-infected persons in East Africa would have a favorable value at costs that are feasible for scale-up. METHODS Using a computer simulation to inform HIV prevention decisions in East Africa, we compared 4 different strategies for targeting a CBT intervention-(i) all HIV-infected persons attending clinic; (ii) only those patients in the pre-antiretroviral therapy (ART) stages of care; (iii) only those patients receiving ART; and (iv) only those patients with detectable viral loads (VLs) regardless of disease stage. We define targeting as screening for hazardous alcohol consumption (e.g., using the Alcohol Use Disorders Identification Test and offering the CBT intervention to those who screen positive). We compared these targeting strategies to a null strategy (no intervention) or a hypothetical scenario where an alcohol intervention was delivered to all adults regardless of HIV status. RESULTS An intervention targeted to HIV-infected patients could prevent 18,000 new infections, add 46,000 quality-adjusted life years (QALYs), and yield an incremental cost-effectiveness ratio of $600/QALY compared to the null scenario. Narrowing the prioritized population to only HIV-infected patients in pre-ART phases of care results in 15,000 infections averted, the addition of 21,000 QALYs and would be cost-saving, while prioritizing based on an unsuppressed HIV-1 VL test results in 8,300 new infections averted, adds 6,000 additional QALYs, and would be cost-saving as well. CONCLUSIONS Our results suggest that targeting a cognitive-based treatment aimed at reducing hazardous alcohol consumption to subgroups of HIV-infected patients provides favorable value in comparison with other beneficial strategies for HIV prevention and control in this region. It may even be cost-saving under certain circumstances.
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Affiliation(s)
- Jason Kessler
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Kelly Ruggles
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Anik Patel
- Department of Population Health, NYU School of Medicine, New York, New York
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Nucifora
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Lifeng Li
- Department of Population Health, NYU School of Medicine, New York, New York
| | - Mark S Roberts
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Abstract
OBJECTIVE Most HIV-positive men who have sex with men (MSM) ages 50 and older feel a responsibility to protect their sex partners from HIV transmission risk. For some, this is enacted through HIV disclosure, for others, this is realized through reduced risk behaviors. METHODS To examine this, we analyzed interviews of 23 HIV-positive MSM ages 50 and older. RESULTS We identified several contextual, relational, and psychosocial factors that served as either barriers or facilitators to HIV disclosure. CONCLUSIONS Our findings suggest HIV status disclosure is multifaceted and continues to impact sexual communication in the lives of MSM as they enter middle age.
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Affiliation(s)
- Perry N Halkitis
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, Professor of Applied Psychology, Public Health, and Medicine, New York University, Global Institute of Public Health, 41 East 11th Street, #716, New York, NY 10003 212 998 5373
| | - Molly J Kingdon
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Staci Barton
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Jessica Eddy
- The Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS), The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
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Doblecki-Lewis S, Cohen S, Liu A. Clinical Treatment Options Infectious Diseases: Update on PrEP Implementation, Adherence, and Advances in Delivery. Curr Treat Options Infect Dis 2015; 7:101-12. [PMID: 25931990 DOI: 10.1007/s40506-015-0046-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective and evidence-based HIV-prevention option and is recommended for individuals with substantial risk for HIV infection [1]. Randomized controlled trials have demonstrated that daily oral PrEP dramatically reduces the risk of HIV infection when it is taken as directed. Concerns regarding widespread emergence of antiretroviral resistance attributable to PrEP and behavioral disinhibition have to date not been observed in clinical trials and open-label demonstration projects. PrEP has great potential as part of an HIV risk reduction strategy and barriers to wider implementation including community education, prescriber availability, and elimination of financial barriers should be aggressively pursued. Adherence is critical to PrEP efficacy and has varied across study populations; developing and refining ways of measuring and supporting adherence is essential to the success of PrEP. Evaluation of long-acting medications and alternative formulations for PrEP is underway and may lead to the wider implementation and impact of PrEP.
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Joppa MC, Rizzo CJ, Brown LK, Hadley W, Dattadeen JA, Donenberg G, DiClemente R. Internalizing Symptoms and Safe Sex Intentions among Adolescents in Mental Health Treatment: Personal Factors as Mediators. Child Youth Serv Rev 2014; 46:177-185. [PMID: 25284921 PMCID: PMC4180408 DOI: 10.1016/j.childyouth.2014.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.
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Affiliation(s)
- Meredith C. Joppa
- Department of Psychology, Rowan University. 201 Mullica Hill Road, Glassboro, NJ 08028
| | - Christie J. Rizzo
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry K. Brown
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Wendy Hadley
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Jodi-Ann Dattadeen
- Bradley Hasbro Children’s Research Center/Rhode Island Hospital and The Warren Alpert Medical School of Brown University. One Hoppin Street, Suite 204, Providence, RI 02903
| | - Geri Donenberg
- Department of Psychiatry, University of Illinois at Chicago. Institute for Juvenile Research, Chicago, IL
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Savel C, Mierzwa S, Gorbach P, Lally M, Zimet G, Meyer K, Souidi S, Interventions A. Web-based, mobile-device friendly, self-report survey system incorporating avatars and gaming console techniques. Online J Public Health Inform 2014; 6:e191. [PMID: 25422726 PMCID: PMC4235324 DOI: 10.5210/ojphi.v6i2.5347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We describe building an avatar-based self-report data collection tool to be used for a specific HIV prevention research project that is evaluating the feasibility and acceptability of this novel approach to collect self-reported data among youth. We discuss the gathering of requirements, the process of building a prototype of the envisioned system, and the lessons learned during the development of the solution. Specific knowledge is shared regarding technical experience with software development technologies and possible avenues for changes that could be considered if such a self-report survey system is used again. Examples of other gaming and avatar technology systems are included to provide further background.
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Affiliation(s)
- Craig Savel
- Information Technology, Population Council, New York, NY
| | - Stan Mierzwa
- Information Technology, Population Council, New York, NY
| | - Pamina Gorbach
- Department of Epidemiology, University of California, Los Angeles (UCLA), CA
| | - Michelle Lally
- Alpert Medical School of Brown University and Lifespan Hospital System, Providence, RI
| | | | - Kristin Meyer
- Department of Epidemiology, University of California, Los Angeles (UCLA), CA
| | - Samir Souidi
- Information Technology, Population Council, New York, NY
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Braithwaite RS, Nucifora KA, Kessler J, Toohey C, Mentor SM, Uhler LM, Roberts MS, Bryant K. Impact of interventions targeting unhealthy alcohol use in Kenya on HIV transmission and AIDS-related deaths. Alcohol Clin Exp Res 2014; 38:1059-67. [PMID: 24428236 PMCID: PMC4017636 DOI: 10.1111/acer.12332] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/31/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND HIV remains a major cause of preventable morbidity and mortality in Kenya. The effects of behaviors that accompany unhealthy alcohol consumption are a pervasive risk factor for HIV transmission and progression. Our objective was to estimate the portion of HIV infections attributable to unhealthy alcohol use and to evaluate the impact of hypothetical interventions directed at unhealthy alcohol use on HIV infections and deaths. METHODS We estimated outcomes over a time horizon of 20 years using a computer simulation of the Kenyan population. This computer simulation integrates a compartmental model of HIV transmission with a mechanistic model of HIV progression that was previously validated in sub-Saharan Africa. Integration of the transmission and progression models allows simultaneous consideration of alcohol's effects on HIV transmission and progression (e.g., lowering antiretroviral adherence may increase transmission risk by elevating viral load, and may simultaneously increase progression by increasing the likelihood of AIDS). The simulation considers important aspects of heterogeneous sexual mixing patterns, including assortativeness of partners by age and activity level, age-discordant relationships, and high activity subgroups. Outcomes included number of new HIV infections, number of AIDS deaths, and infectivity (number of new infections per infected person per year). RESULTS Our model estimated that the effects of behaviors accompanying unhealthy alcohol consumption are responsible for 13.0% of new HIV infections in Kenya. An alcohol intervention with effectiveness similar to that observed in a published randomized controlled trial of a cognitive-behavioral therapy-based intervention in Kenya (45% reduction in unhealthy alcohol consumption) could prevent nearly half of these infections, reducing their number by 69,858 and reducing AIDS deaths by 17,824 over 20 years. Estimates were sensitive to assumptions with respect to the magnitude of alcohol's underlying effects on condom use, antiretroviral therapy adherence, and sexually transmitted infection prevalence. CONCLUSIONS A substantial number of new HIV infections in Kenya are attributable to unhealthy alcohol use. An alcohol intervention with the effectiveness observed in a published randomized controlled trial has the potential to reduce infections over 20 years by nearly 5% and avert nearly 18,000 deaths related to HIV.
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Affiliation(s)
- R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, New York
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Catalani C, Philbrick W, Fraser H, Mechael P, Israelski DM. mHealth for HIV Treatment & Prevention: A Systematic Review of the Literature. Open AIDS J 2013; 7:17-41. [PMID: 24133558 PMCID: PMC3795408 DOI: 10.2174/1874613620130812003] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/13/2013] [Accepted: 07/19/2013] [Indexed: 11/22/2022] Open
Abstract
This systematic review assesses the published literature to describe the landscape of mobile health technology (mHealth) for HIV/AIDS and the evidence supporting the use of these tools to address the HIV prevention, care, and treatment cascade. The speed of innovation, broad range of initiatives and tools, and heterogeneity in reporting have made it difficult to uncover and synthesize knowledge on how mHealth tools might be effective in addressing the HIV pandemic. To do address this gap, a team of reviewers collected literature on the use of mobile technology for HIV/AIDS among health, engineering, and social science literature databases and analyzed a final set of 62 articles. Articles were systematically coded, assessed for scientific rigor, and sorted for HIV programmatic relevance. The review revealed evidence that mHealth tools support HIV programmatic priorities, including: linkage to care, retention in care, and adherence to antiretroviral treatment. In terms of technical features, mHealth tools facilitate alerts and reminders, data collection, direct voice communication, educational messaging, information on demand, and more. Studies were mostly descriptive with a growing number of quasi-experimental and experimental designs. There was a lack of evidence around the use of mHealth tools to address the needs of key populations, including pregnant mothers, sex workers, users of injection drugs, and men who have sex with men. The science and practice of mHealth for HIV are evolving rapidly, but still in their early stages. Small-scale efforts, pilot projects, and preliminary descriptive studies are advancing and there is a promising trend toward implementing mHealth innovation that is feasible and acceptable within low-resource settings, positive program outcomes, operational improvements, and rigorous study design
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Kagimu M, Guwatudde D, Rwabukwali C, Kaye S, Walakira Y, Ainomugisha D. Religiosity for HIV prevention in Uganda: a case study among Muslim youth in Wakiso district. Afr Health Sci 2012; 12:282-290. [PMID: 23382741 PMCID: PMC3557679] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Evidence for the association between religiosity and HIV infections is limited. Sujda, the hyper-pigmented spot on the forehead due to repeated prostration during prayers and fasting to worship, involving abstaining from food, drink and sex during daytime in Ramadhan and other specified days, are measures of religiosity among Muslims OBJECTIVES To assess the association between religiosity and HIV infections. METHODS This was an unmatched case-control study with 29 HIV positive cases and 116 HIV negative controls, from 1224 Muslims, 15-24 years. RESULTS Respondents without Sujda had more HIV infections (odds ratio 2.90, 95% CI 1.07-7.86, p=0.029). Those with Sujda were more likely to abstain from sex (odds ratio 1.69, 95% CI 1.31-2.20, p<0.001) and be faithful in marriage (odds ratio 1.69, 95% CI 1.11-2.57, p=0.012). Respondents without Sujda were more likely to have ever taken alcohol before sex (odds ratio 5.00, 95% CI 1.39-17.95, p=0.006) and to have ever used narcotics (odds ratio 2.12, 95% CI, 1.11-4.05, p=0.019). Respondents who fasted less, had more HIV infections (odds ratio 2.46, 95% CI 1.07-5.67, p=0.028). CONCLUSION Sujda and fasting were associated with lower HIV infections. Imams should use this information to intensify the Islamic approach to HIV prevention.
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Affiliation(s)
- M Kagimu
- Islamic Medical Association of Uganda, Uganda.
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