170 results on '"Jessica M Sales"'
Search Results
2. Applying an Evidence-Based Community Organizing Approach to Strengthen HIV Prevention for Cisgender Women in US South: Protocol for a Mixed Methods Study
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Anandi N Sheth, Dazon Dixon Diallo, Celeste Ellison, Deja L Er, Adaora Ntukogu, Kelli A Komro, and Jessica M Sales
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundMost new HIV diagnoses among cisgender women in the United States occur in the South. HIV pre-exposure prophylaxis (PrEP), a cornerstone of the federal Ending the HIV Epidemic (EHE) initiative, remains underused by cisgender women who may benefit. Awareness and access to PrEP remain low among cisgender women. Moreover, improving PrEP reach among cisgender women requires effectively engaging communities in the development of appropriate and acceptable patient-centered PrEP care approaches to support uptake. In a community-clinic-academic collaboration, this protocol applies an evidence-based community organizing approach (COA) to increase PrEP awareness and reach among cisgender women in Atlanta. ObjectiveThe aim of this study is to use and evaluate a COA for engaging community members across 4 Atlanta counties with high-priority EHE designation, to increase PrEP awareness, interest, and connection to PrEP care among cisgender women. MethodsThe COA, consisting of 6 stages, will systematically develop the skills of community members to become leaders and advocates for HIV prevention inclusive of PrEP for cisgender women in their communities. We will use the evidence-based COA to develop and implement a PrEP-specific action plan to create broader community change by raising awareness and interest in PrEP, reducing stigma associated with HIV or PrEP, and connecting women to sexual health clinics providing PrEP services. In the first 4 stages, to prepare for and develop action plans, we will gather data from one-on-one interviews with up to 100 individuals across Atlanta to capture attitudes, motivations, and influences related to women’s sexual health with a focus on HIV prevention and PrEP. Informed by the community interviews, we will revise a sexual health curriculum inclusive of PrEP and community-centered engagement. We will then recruit and train community action team members to develop action plans to implement the curriculum during community-located events. In the last 2 stages, we will implement and evaluate COA’s effect on PrEP awareness, interest, HIV or PrEP stigma, and connection to PrEP care among cisgender women community members. ResultsThis project was funded by the National Institutes of Health and approved by the Emory University institutional review board in July 2021. Data collection began in December 2021 and is ongoing. COA stage 1 of the study is complete with 70 participants enrolled. Community events commenced in November 2023, and data collection will be completed by November 2025. Stage 1 qualitative data analysis is complete with results to be published in 2024. Full study results are anticipated to be reported in 2026. ConclusionsThrough a community-clinic-academic collaboration, this protocol proposes to mount a coordinated approach across diverse Atlanta counties to strengthen HIV prevention for cisgender women and to create a sustainable systems approach to move new sexual health innovations more quickly to cisgender women. International Registered Report Identifier (IRRID)DERR1-10.2196/56293
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- 2024
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3. Clinic-level complexities prevent effective engagement of people living with HIV who are out-of-care.
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Srija Dutta, Brendan H Pulsifer, Kaylin V Dance, Eric P Leue, Melissa Beaupierre, Kennedi Lowman, Jessica M Sales, Melanie Strahm, Jeri Sumitani, Jonathan A Colasanti, and Ameeta S Kalokhe
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Medicine ,Science - Abstract
Approximately half of people living with HIV (PLWH) in the United States are not retained in HIV care. Although numerous studies have identified individual-level barriers to care (i.e., substance abuse, mental health, housing, transportation challenges), less is known about institutional-level barriers. We aimed to identify clinic-level barriers to HIV care and strategies to address them to better engage PLWH who have been out of care (PLWH-OOC). As part of a larger qualitative study in a Ryan White-funded HIV Clinic in Atlanta, which aimed to understand the acceptance and feasibility of community-based HIV care models to better reach PLWH-OOC, we explored barriers and facilitators of HIV care engagement. From October 2022-March 2023, 18 in-depth-interviews were conducted with HIV-care providers, administrators, social workers, and members of a Community Advisory Board (CAB) comprised of PLWH-OOC. Transcripts were coded by trained team members using a consensus approach. Several clinic-level barriers emerged: 1) the large burden placed on patients to provide proof of eligibility to receive Ryan White Program services, 2) inflexibility of provider clinic schedules, 3) inadequate processes to identify patients at risk of disengaging from care, 4) poorly-resourced hospital-to-clinic transitions, 5) inadequate systems to address primary care needs outside of HIV care, and 6) HIV stigma among medical professionals. Strategies to address these barriers included: 1) colocation of HIV and non-HIV services, 2) community-based care options that do not require patients to navigate complex transportation systems, 3) hospital and community-based peer navigation services, 4) dedicated staffing to identify and support PLWH-OOC, and 5) enhanced systems support to help patients collect the high burden of documentation required to receive subsidized HIV care. Several systems-level HIV care barriers exist and intersect with individual and community-level barriers to disproportionately affect HIV care engagement among PLWH-OOC. Findings suggest several strategies that should be considered to reach the remaining 50% of PLWH who remain out-of-care.
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- 2024
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4. Impacts of GlobalConsent, a Web-Based Social Norms Edutainment Program, on Sexually Violent Behavior and Bystander Behavior Among University Men in Vietnam: Randomized Controlled Trial
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Kathryn M Yount, Yuk Fai Cheong, Irina Bergenfeld, Quach Thu Trang, Jessica M Sales, Yiman Li, and Tran Hung Minh
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Public aspects of medicine ,RA1-1270 - Abstract
BackgroundSexual violence against women is prevalent worldwide. Prevention programs that treat men as allies and integrate a bystander framework are emerging in lower income settings, but evidence of their effectiveness is conflicting. ObjectiveThis study aimed to test the impact of GlobalConsent on sexually violent behavior and prosocial bystander behavior among university men in Vietnam. MethodsWe used a double-blind, parallel intervention versus control group design with 1:1 randomization at 2 universities. A total of 793 consenting heterosexual or bisexual men aged 18-24 years who matriculated in September 2019 were enrolled and assigned randomly to GlobalConsent or an attention-control adolescent health education (AHEAD) program. GlobalConsent is an adapted, theory-based, 6-module web-based intervention with diverse behavior change techniques and a locally produced serial drama. AHEAD is a customized, 6-module attention-control program on adolescent health. Both the programs were delivered to computers and smartphones over 12 weeks. Self-reported sexually violent behaviors toward women in the prior 6 months and prosocial bystander behaviors in the prior year were measured at 0, 6, and 12 months. ResultsMore than 92.7% (735/793) of men in both study arms completed at least 1 program module, and >90.2% (715/793) of men completed all 6 modules. At baseline, a notable percentage of men reported any sexually violent behavior (GlobalConsent: 123/396, 31.1%; AHEAD: 103/397, 25.9%) in the prior 6 months. Among men receiving GlobalConsent, the odds of reporting a high level (at least 2 acts) of sexually violent behavior at the endline were 1.3 times the odds at baseline. Among men receiving AHEAD, the corresponding odds ratio was higher at 2.7. The odds of reporting any bystander behavior at endline were 0.7 times the odds at baseline for GlobalConsent, and the corresponding odds ratio for AHEAD was lower at 0.5. ConclusionsCompared with a health attention-control condition, GlobalConsent has sustained favorable impacts on sexually violent behavior and prosocial bystander behavior among matriculating university men in Vietnam, who would otherwise face increasing risks of sexually violent behavior. GlobalConsent shows promise for national scale-up and regional adaptations. Trial RegistrationClinicalTrials.gov NCT04147455; https://clinicaltrials.gov/ct2/show/NCT04147455 International Registered Report Identifier (IRRID)RR2-10.1186/s12889-020-09454-2
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- 2023
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5. Using clinical cascades to measure health facilities’ obstetric emergency readiness: testing the cascade model using cross-sectional facility data in East Africa
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Peter Waiswa, Dilys Walker, John N Cranmer, Jessica M Sales, Bridget Whaley, Elizabeth Butrick, and Anthony Wanyoro
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Medicine - Abstract
Objectives Globally, hundreds of women die daily from preventable pregnancy-related causes, with the greatest burden in sub-Saharan Africa. Five key emergencies—bleeding, infections, high blood pressure, delivery complications and unsafe abortions—account for nearly 75% of these obstetric deaths. Skilled clinicians with strategic supplies could prevent most deaths. In this study, we (1) measured facility readiness to manage common obstetric emergencies using the clinical cascades and signal function tracers; (2) compared these readiness estimates by facility characteristics; and (3) measured cascading drop-offs in resources.Design A facility-based cross-sectional analysis of resources for common obstetric emergencies.Setting Data were collected in 2016 from 23 hospitals (10 designated comprehensive emergency obstetric care (CEmOC) facilities) in Migori County, western Kenya, and Busoga Region, eastern Uganda, in the Preterm Birth Initiative study in East Africa. Baseline data were used to estimate a facility’s readiness to manage common obstetric emergencies using signal function tracers and the clinical cascade model. We compared emergency readiness using the proportion of facilities with tracers (signal functions) and the proportion with resources for identifying and treating the emergency (cascade stages 1 and 2).Results The signal functions overestimated practical emergency readiness by 23 percentage points across five emergencies. Only 42% of CEmOC-designated facilities could perform basic emergency obstetric care. Across the three stages of care (identify, treat and monitor-modify) for five emergencies, there was a 28% pooled mean drop-off in readiness. Across emergencies, the largest drop-off occurred in the treatment stage. Patterns of drop-off remained largely consistent across facility characteristics.Conclusions Accurate measurement of obstetric emergency readiness is a prerequisite for strengthening facilities’ capacity to manage common emergencies. The cascades offer stepwise, emergency-specific readiness estimates designed to guide targeted maternal survival policies and programmes.Trial registration number NCT03112018.
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- 2022
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6. Low provider and staff self-care in a large safety-net HIV clinic in the Southern United States: Implications for the adoption of trauma-informed care
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Jessica M Sales, Kaitlin Piper, Clara Riddick, Betelihem Getachew, Jonathan Colasanti, and Ameeta Kalokhe
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Medicine (General) ,R5-920 - Abstract
Objective: This mixed-methods needs assessment study examined self-care practices among providers, staff, and administrators at an HIV clinic and identified barriers and facilitators to strengthening self-care services in this setting. Methods: Surveys (n = 31) and qualitative interviews (n = 23) were conducted with staff, providers, and administrators at a large, safety-net HIV clinic. Results: Surveys indicated an overall absence of formal self-care services including resources to manage stress, opportunities to debrief, and formal mechanisms to voice concerns. Based on interviews with staff and providers, deficiencies in self-care services included support for dealing with complex patients, formal mechanisms for feedback, and time for self-care. Administrators recognized the need for more support, acknowledged that opportunities for employees to voice concerns were lacking, and felt that implementing multi-disciplinary team meetings could improve morale and reduce stress and burnout. Conclusion: This assessment revealed a need to enhance self-care in safety-net HIV services. Adoption of trauma-informed care, which includes activities to strengthen self-care, could reduce workplace burnout.
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- 2019
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7. The protective role of secure attachment in the relationship between experiences of childhood abuse, emotion dysregulation and coping, and behavioral and mental health problems among emerging adult Black women: A moderated mediation analysis
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Nicole K. Gause, Jessica M. Sales, Jennifer L. Brown, William E. Pelham, Yu Liu, and Stephen G. West
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Adult ,Young Adult ,Mediation Analysis ,Mental Health ,Adolescent ,Adaptation, Psychological ,Emotions ,Humans ,Female ,Child Abuse ,Child - Abstract
To determine the extent to which secure attachment moderates the effects of previous child abuse history on the intermediate variables (putative mediators) of emotion dysregulation and coping, which, in turn, influence adult behavioral health and mental health problems. Black women (
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- 2023
8. Navigating Changing Norms Around Sex in Dating Relationships: A Qualitative Study of Young People in Vietnam
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Jessica M. Sales, Tran Hung Minh, Ilyssa Tamler, Irina Bergenfeld, Kathryn M. Yount, and Quach Thu Trang
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Cultural Studies ,Gender Studies ,Agency (sociology) ,Premarital sex ,Normative ,Context (language use) ,Cognitive reframing ,Thematic analysis ,Psychology ,Sexual coercion ,Developmental psychology ,Qualitative research - Abstract
Social and economic changes in Vietnam since the economic restructuring of the 1980s have caused a shift in norms about premarital sex. While expectations of female chastity remain, sex before marriage is becoming more common among young people. As the formative phase of a parent randomized controlled trial, the present study examined the normative context of sex in dating relationships from the perspectives of young women and men in Vietnam. Men (n = 12) and women (n = 9) studying at two universities in Hanoi participated in semi-structured interviews that explored perspectives on sexual relationships and sexual coercion among their peers. Thematic analysis synthesized participant narratives into broader themes. Our findings confirmed that, as social norms evolve in Vietnam, young women must navigate shifting, and often contradictory, expectations about sex and dating relationships. Women and men expressed the belief that competing sexual expectations often can limit young women’s sexual agency and contribute to the normalization of sexual coercion in dating relationships. However, some women were embracing greater sexual freedom and reframing norms in ways that reflected their sexual agency. Efforts are needed to address these conflicting expectations, to deepen young men’s understanding of this conflict, and to prevent sexual coercion in young adulthood.
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- 2021
9. Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training
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Aditi Ramakrishnan, Jessica M Sales, Micah McCumber, Leah Powell, and Anandi N Sheth
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Infectious Diseases ,Oncology - Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective human immunodeficiency virus (HIV) prevention intervention, but its access and use are suboptimal, especially for women. Healthcare providers provision of PrEP is a key component of the Ending the HIV Epidemic initiative. Although training gaps are an identified barrier, evidence is lacking regarding how to tailor trainings for successful implementation. Title X family planning clinics deliver safety net care for women and are potential PrEP delivery sites. To inform provider training, we assessed PrEP knowledge, attitudes, and self-efficacy in the steps of PrEP care among Title X providers in the Southern United States. Methods We used data from providers in clinics that did not currently provide PrEP from a web-based survey administered to Title X clinic staff in 18 Southern states from February to June 2018. We developed generalized linear mixed models to evaluate associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in PrEP care, guided by the Consolidated Framework for Implementation Research. Results Among 351 providers from 193 clinics, 194 (55%) were nonprescribing and 157 (45%) were prescribing providers. Provider ability to prescribe medications was significantly associated PrEP knowledge, attitudes, and self-efficacy. Self-efficacy was lowest in the PrEP initiation step of PrEP care and was positively associated with PrEP attitudes, PrEP knowledge, and contraception self-efficacy. Conclusions Our findings suggest that PrEP training gaps for family planning providers may be bridged by addressing unfavorable PrEP attitudes, integrating PrEP and contraception training, tailoring training by prescribing ability, and focusing on the initiation steps of PrEP care.
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- 2022
10. Horizons and Group Motivational Enhancement Therapy: HIV Prevention for Alcohol-Using Young Black Women, a Randomized Experiment
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Jessica M. Sales, Ariadna Capasso, Ralph J. DiClemente, James W. Hardin, Gina M. Wingood, Sarah W. Feldstein Ewing, Erin L. P. Bradley, Stephen G. West, Tiffaney L. Renfro, Teaniese L. Davis, Jennifer L. Brown, Angela D. Bryan, Yu Liu, Janet E. Rosenbaum, and Eve Rose
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Georgia ,Epidemiology ,Sexual Behavior ,media_common.quotation_subject ,Gonorrhea ,Sexually Transmitted Diseases ,Psychological intervention ,HIV Infections ,law.invention ,Condoms ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Condom ,law ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Poisson regression ,media_common ,Chlamydia ,business.industry ,Random assignment ,Public Health, Environmental and Occupational Health ,Motivational enhancement therapy ,Abstinence ,medicine.disease ,Black or African American ,Alcoholism ,symbols ,Female ,business ,Demography - Abstract
Introduction Black women are at disproportionately greater risk for HIV and sexually transmitted infections than women of other ethnic/racial backgrounds. Alcohol use may further elevate the risk of HIV/sexually transmitted infection acquisition and transmission. Study Design A random-assignment parallel-group comparative treatment efficacy trial was conducted with random assignment to 1 of 3 conditions. Setting/participants The sample comprised 560 Black or African American women aged 18–24 years who reported recent unprotected vaginal or anal sex and recent alcohol use. Participants were recruited from community settings in Atlanta, Georgia, from January 2012 to February 2014. Intervention A Group Motivational Enhancement Therapy module was designed to complement a Centers for Disease Control and Prevention–designated evidence-based intervention (Horizons) to reduce sexual risk behaviors, alcohol use, and sexually transmitted infections, with 3 comparison groups: (1) Horizons + Group Motivational Enhancement Therapy intervention, (2) Horizons + General Health Promotion intervention, and (3) enhanced standard of care. Main outcome measures Outcome measures included safe sex (abstinence or 100% condom use); condom nonuse; proportion of condom use during sexual episodes; incident chlamydia, gonorrhea, and trichomonas infections; and problematic alcohol use measured by Alcohol Use Disorders Identification Test score. Treatment effects were estimated using an intention-to-treat protocol‒generalized estimating equations with logistic regression for binomial outcomes and Poisson regression for count outcomes. Analyses were conducted between October 2018 and October 2019. Results Participants assigned to Horizons + Group Motivational Enhancement Therapy had greater odds of safe sex (AOR=1.45, 95% CI=1.04, 2.02, p=0.03), greater proportion of condom use (AOR=1.68, 95% CI=1.18, 2.41, p=0.004), and lower odds of condom nonuse (AOR=0.57, 95% CI=0.38, 0.83, p=0.004). Both interventions had lower odds of problematic alcohol use (Horizons: AOR=0.57, 95% CI=0.39, 0.85, p=0.006; Horizons + Group Motivational Enhancement Therapy: AOR=0.61, 95% CI=0.41, 0.90, p=0.01). Conclusions Complementing an evidence-based HIV prevention intervention with Group Motivational Enhancement Therapy may increase safer sexual behaviors and concomitantly reduce alcohol use among young Black women who consume alcohol. Trial registration This study is registered at www.clinicaltrials.gov NCT01553682.
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- 2021
11. Outness, Discrimination, and Depressive Symptoms Among Bi + Women: The Roles of Partner Gender and Sexual Identity
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Candace Girod, Kathryn M. Yount, Casey D. Xavier Hall, Jessica M. Sales, and Brian A. Feinstein
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Cultural Studies ,050103 clinical psychology ,Sexual identity ,030505 public health ,Demographics ,05 social sciences ,Human sexuality ,Health outcomes ,Mental health ,Article ,Biphobia ,Gender Studies ,03 medical and health sciences ,0501 psychology and cognitive sciences ,Lesbian ,0305 other medical science ,Psychology ,Depressive symptoms ,Clinical psychology - Abstract
Bisexual and other non-monosexual (bi+) women are at higher risk than monosexual women for mental health problems. While being in a relationship is typically associated with better health outcomes, research suggests an inverse association for bisexual women. Despite emerging evidence of differences in bisexual women's experiences based on the gender of their partner, few studies have considered partner sexual identity. To address this gap, the current study examined influences of partner gender and sexual identity on outness, discrimination, and depressive symptoms in a cross-sectional study of 608 bi+ cisgender women. Adjusting for other demographics, being in a relationship with a bisexual cisgender woman, a lesbian cisgender woman, or a bisexual cisgender man was positively associated with outness and discrimination compared to being in a relationship with a heterosexual cisgender man. Findings highlight the importance of accounting for partner gender and sexual identity in order to understand bi+ women's experiences.
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- 2021
12. Implementation and evaluation of a large-scale postpartum family planning program in Rwanda: study protocol for a clinic-randomized controlled trial
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Kristin M. Wall, Rosine Ingabire, Amelia Mazzei, Claudine Umuhoza, Rachel Parker, Amanda Tichacek, Azhar Nizam, Jessica M. Sales, Lisa B. Haddad, Phaedra Corso, Susan Allen, Julien Nyombayire, and Etienne Karita
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Male ,Postpartum Period ,Infant, Newborn ,Rwanda ,Medicine (miscellaneous) ,Ambulatory Care Facilities ,Contraception ,Pregnancy ,Family Planning Services ,Humans ,Female ,Pharmacology (medical) ,Program Evaluation ,Randomized Controlled Trials as Topic - Abstract
Background Though the Rwandan Ministry of Health (MOH) prioritizes the scale-up of postpartum family planning (PPFP) programs, uptake and sustainability of PPFP services in Rwanda are low. Furthermore, highly effective long-acting reversible contraceptive method use (LARC), key in effective PPFP programs, is specifically low in Rwanda. We previously pilot tested a supply-demand intervention which significantly increased the use of postpartum LARC (PPLARC) in Rwandan government clinics. In this protocol, we use an implementation science framework to test whether our intervention is adaptable to large-scale implementation, cost-effective, and sustainable. Methods In a type 2 effectiveness-implementation hybrid study, we will evaluate the impact of our PPFP intervention on postpartum LARC (PPLARC) uptake in a clinic-randomized trial in 12 high-volume health facilities in Kigali, Rwanda. We will evaluate this hybrid study using the RE-AIM framework. The independent effectiveness of each PPFP demand creation strategy on PPLARC uptake among antenatal clinic attendees who later deliver in a study facility will be estimated. To assess sustainability, we will assess the intervention adoption, implementation, and maintenance. Finally, we will evaluate intervention cost-effectiveness and develop a national costed implementation plan. Discussion Adaptability and sustainability within government facilities are critical aspects of our proposal, and the MOH and other local stakeholders will be engaged from the outset. We expect to deliver PPFP counseling to over 21,000 women/couples during the project period. We hypothesize that the intervention will significantly increase the number of stakeholders engaged, PPFP providers and promoters trained, couples/clients receiving information about PPFP, and PPLARC uptake comparing intervention versus standard of care. We expect PPFP client satisfaction will be high. Finally, we also hypothesize that the intervention will be cost-saving relative to the standard of care. This intervention could dramatically reduce unintended pregnancy and abortion, as well as improve maternal and newborn health. Our PPFP implementation model is designed to be replicable and expandable to other countries in the region which similarly have a high unmet need for PPFP. Trial registration ClinicalTrials.gov NCT05056545. Registered on 31 March 2022.
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- 2022
13. Theoretical mediators of GlobalConsent: An adapted web-based sexual violence prevention program for university men in Vietnam
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Kathryn M. Yount, Irina Bergenfeld, Katherine M. Anderson, Quach Thu Trang, Jessica M. Sales, Yuk Fai Cheong, and Tran Hung Minh
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Male ,Internet ,Health (social science) ,History and Philosophy of Science ,Universities ,Vietnam ,Sex Offenses ,Humans ,Female ,Students - Abstract
Sexual violence remains a global problem that disproportionately affects women. Though sexual violence interventions exist, few have been implemented in low- or middle-income countries, and none in Vietnam for young men. We adapted a sexual violence prevention intervention (RealConsent) developed for college men in the U.S. and conducted a randomized controlled trial of the adapted intervention (GlobalConsent) with college men in Vietnam. We assessed the effects of GlobalConsent on sexually violent behavior and prosocial bystander behavior, directly and through theoretically targeted mediators. The study design entailed a double-blind, parallel intervention-control-group design in two universities. Consenting heterosexual or bisexual men 18-24 years starting university in September 2019 (n = 793) completed a baseline survey and were assigned with 1:1 randomization to GlobalConsent or attention control. Both programs were web-based and lasted 12 weeks. Path analysis was performed to study the mediating effects of cognition/knowledge, beliefs/attitudes, affect, and efficacy/intention variables measured at six months on sexually violent behavior and prosocial bystander behavior measured at 12 months. In parallel multiple-mediator models, initiating GlobalConsent lowered the odds of sexually violent behavior mainly indirectly, via knowledge of sexual violence legality and harm and victim empathy and increased the odds of prosocial bystander behavior directly and indirectly, through knowledge of sexual violence legality and harm and bystander capacities. The efficacious direct and indirect effects of GlobalConsent support the cross-cultural applicability of its underlying theory of change and findings from mediation analyses of its sister program RealConsent, suggesting GlobalConsent's national scalability and adaptability across Southeast Asia.
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- 2022
14. Preventing sexual violence in college men: a randomized-controlled trial of GlobalConsent
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Kathryn M. Yount, Irina Bergenfeld, Tran Hung Minh, Yuk Fai Cheong, Quach Thu Trang, and Jessica M. Sales
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Male ,Adolescent ,Universities ,Sexual Behavior ,Campus sexual assault ,Poison control ,030209 endocrinology & metabolism ,Suicide prevention ,03 medical and health sciences ,Social norms approach ,Young Adult ,Study Protocol ,0302 clinical medicine ,Bystander behavior ,Injury prevention ,Social Norms ,Medicine ,Humans ,030212 general & internal medicine ,Health Education ,Sexual violence ,Randomized Controlled Trials as Topic ,Educational entertainment (edutainment) ,Social norms theory ,business.industry ,lcsh:Public aspects of medicine ,Sex Offenses ,Public Health, Environmental and Occupational Health ,Men ,lcsh:RA1-1270 ,Behavioral change communication ,Focus group ,United States ,Bystander self-efficacy ,Prosocial behavior ,Attitude ,Vietnam ,Research Design ,Female ,business ,Psychological Theory ,Social cognitive theory ,Internet-Based Intervention ,Clinical psychology - Abstract
Background Sexual violence—any sexual act committed against a person without freely given consent—disproportionately affects women. Women’s first experiences of sexual violence often occur in adolescence. In Asia and the Pacific, 14% of sexually experienced adolescent girls report forced sexual debut. Early prevention with men that integrates a bystander framework is one way to address attitudes and behavior while reducing potential resistance to participation. Methods This paper describes a study protocol to adapt RealConsent for use in Vietnam and to test the impact of the adapted program—GlobalConsent—on cognitive/attitudinal/affective mediators, and in turn, on sexual violence perpetration and prosocial bystander behavior. RealConsent is a six-session, web-based educational entertainment program designed to prevent sexual violence perpetration and to enhance prosocial bystander behavior in young men. The program has reduced the incidence of sexual violence among men attending an urban, public university in the Southeastern United States. We used formative qualitative research and the Centers for Disease Control and Prevention’s Map of the Adaptation Process to adapt RealConsent. We conducted semi-structured interviews with college men (n = 12) and women (n = 9) to understand the social context of sexual violence. We conducted focus group discussions with university men and stakeholders (n = 14) to elicit feedback on the original program. From these data, we created scripts in storyboard format of the adapted program. We worked closely with a small group of university men to elicit feedback on the storyboards and to refine them for acceptability and production. We are testing the final program—GlobalConsent—in a randomized controlled trial in heterosexual or bisexual freshmen men 18–24 years attending two universities in Hanoi. We are testing the impact of GlobalConsent (n = 400 planned), relative to a health-education attention control condition we developed (n = 400 planned), on cognitive/attitudinal/affective mediators, prosocial bystander behavior, and sexual violence perpetration. Discussion This project is the first to test the impact of an adapted, theoretically grounded, web-based educational entertainment program to prevent sexual violence perpetration and to promote prosocial bystander behavior among young men in a middle-income country. If effective, GlobalConsent will have exceptional potential to prevent men’s sexual violence against women globally. Trial registration U.S. National Library of Medicine Clinicaltrials.govNCT04147455 on November 1, 2019 (Version 1). Retrospectively registered. Protocol amendments will be submitted to clinicaltrials.gov.
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- 2020
15. Perceived neighborhood violence and crime, emotion regulation, and PTSD symptoms among justice-involved, urban African-American adolescent girls
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Jessica M. Sales, Ralph J. DiClemente, Shufang Sun, and Natasha Crooks
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Adolescent ,Urban Population ,020205 medical informatics ,Social Psychology ,Population ,Psychological intervention ,Poison control ,Context (language use) ,Dysfunctional family ,02 engineering and technology ,Suicide prevention ,Article ,Stress Disorders, Post-Traumatic ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,mental disorders ,Injury prevention ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,Longitudinal Studies ,030212 general & internal medicine ,education ,Uncategorized ,Exposure to Violence ,education.field_of_study ,Human factors and ergonomics ,Southeastern United States ,Emotional Regulation ,Black or African American ,Clinical Psychology ,Juvenile Delinquency ,Female ,Crime ,Psychology ,Clinical psychology - Abstract
Objective African-American adolescent girls in urban areas are overrepresented in the juvenile justice system, and they are also disproportionately impacted by neighborhood violence and crime (NVC), which has been shown to positively associate with posttraumatic stress disorder (PTSD) symptoms. Guided by an ecological (individual X context) perspective, the present study aimed to examine the main and interactive effects of perceived NVC and emotion regulation (ER) strategies in a sample of justice-involved, urban African-American adolescent girls (n = 85) following their release from detention centers. Method We investigated this research question longitudinally. Multiple linear regression models were conducted. PTSD symptoms at 3 months after release was used as the outcome variable, predicted by ER strategies, perceived NVC, and their interactions before release, controlling for PTSD symptoms and a brief screening of trauma events assessed beforen release. Simple slope analysis was used to probe significant interaction terms. Results The main effects of perceived NVC and dysfunctional ER were significant. A significant interaction effect was found between perceived NVC and internal dysfunction ER at baseline to predict PTSD symptoms at 3 months after release. High levels of internal dysfunctional ER intensified the positive association of baseline perceived NVC and PTSD symptoms. Conclusions Justice-involved African-American adolescent girls who report high NVC and use dysfunctional ER strategies are particularly vulnerable to the development of PTSD symptoms. Interventions with this population may benefit from targeting dysfunctional ER strategies to mitigate or prevent neighborhood violence related PTSD symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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- 2020
16. Barriers and facilitators to implementation of trauma support services at a large HIV treatment center in the Southern United States
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Kaitlin N. Piper, Betelihem Getachew, Eugene W. Farber, Clara Riddick, Julia Schiff, Ameeta S. Kalokhe, and Jessica M. Sales
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Adult ,Male ,Stress Disorders, Traumatic ,medicine.medical_specialty ,Health (social science) ,Social Psychology ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Article ,Health Services Accessibility ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Trauma management ,Surveys and Questionnaires ,medicine ,Humans ,Center (algebra and category theory) ,030212 general & internal medicine ,Hiv treatment ,Qualitative Research ,Support services ,030505 public health ,High prevalence ,Primary Health Care ,Delivery of Health Care, Integrated ,business.industry ,Public Health, Environmental and Occupational Health ,Social Support ,Middle Aged ,medicine.disease ,United States ,Family medicine ,Female ,0305 other medical science ,business ,Delivery of Health Care - Abstract
The high prevalence of trauma among people living with HIV underscore the need for tailored, integrated trauma management (“trauma-informed care” or TIC) to improve retention, adherence to care, and overall well-being. Although TIC has been identified as a priority area for HIV care, uptake has been limited. To investigate barriers and facilitators to integrating trauma support services within HIV primary care, surveys (n=94) and interviews (n=44) were administered to providers, staff, and patients at a large HIV treatment center. Results highlighted the availability of several trauma services, including psychotherapy and support groups, but also revealed the absence of provider training on how to respond to patient trauma needs. Identified gaps in TIC services included written safety and crisis prevention plans, patient education on traumatic stressors, and opportunities for creative expression. Providers and staff supported implementation of trauma support services and employee trainings, but expressed a number of concerns including resource and skill deficiencies. Patient-reported barriers to TIC services included lack of awareness of services and difficulties navigating the healthcare system. This assessment revealed support and methods for strengthening integration of trauma support services within HIV primary care, which future TIC implementation efforts should address.
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- 2020
17. Substance use prevention services in juvenile justice and behavioral health: results from a national survey
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Hannah K. Knudsen, John P. Bartkowski, Rodney R. Funk, Ellen H. Steele, Katherine S. Elkington, Jessica M. Sales, Christy K. Scott, and Larkin S. McReynolds
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medicine.medical_specialty ,lcsh:Social pathology. Social and public welfare. Criminology ,Community supervision ,Staffing ,030508 substance abuse ,Logistic regression ,lcsh:HV1-9960 ,03 medical and health sciences ,0302 clinical medicine ,Agency (sociology) ,medicine ,030212 general & internal medicine ,Justice (ethics) ,Social policy ,Response rate (survey) ,Service (business) ,National survey ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Substance use prevention ,Juvenile justice ,lcsh:RA1-1270 ,Community behavioral health providers ,Family medicine ,Juvenile probation ,0305 other medical science ,Psychology ,Law ,Research Article - Abstract
Background This study examined the national availability of substance use prevention (SUP) within juvenile justice (JJ) and their primary behavioral health (BH) providers, and the relationships between the availability of SUP and agency-level measures of organizational structure, staffing, and youth characteristics. A three-stage national probability sampling process was used to select participants for a national survey that included, among other facets of community supervision (CS) and BH practices, questions on agency characteristics, youth characteristics, whether the agency/provider directly provided SUP services, and whether the agency/provider directly provided substance use and/or mental health treatment. This paper focuses on SUP services along with agency/provider and youth characteristics related to providing SUP. Results The response rate for both CS agencies (n = 195) and BH providers (n = 271) was 96%. Complex samples logistic regression initially examined univariate associations of each variable and identified candidates for a final multivariate model. Overall, only one-third of CS and BH providers reported offering SUP services, with BH providers being significantly more likely than CS agencies to provide SUP services. In addition, likelihood of SUP was significantly lower among agencies where the substance use distribution of the caseload was below the median. Controlling for master’s level staff and the substance use distribution, CS agencies were about 67% less likely to offer SUP when compared to BH providers. Conclusions Given the high rates of substance use among justice-involved youth and that substance use is an established risk for several negative behaviors, outcomes, and health conditions, these findings suggest that evidence-based prevention services should likely be expanded in justice settings, and perhaps included as part of CS programs, even when youth do not initially present with SU service needs.
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- 2020
18. Measuring Sexual Communication in Adolescent Dating Relationships in Vietnam: Development and Validation of the Sexual Communications Scales for Attitudes, Self-Efficacy, and Behavior
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Irina Bergenfeld, Jessica M. Sales, Tran Hung Minh, and Kathryn M. Yount
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Communication - Abstract
Sexual communication improves relationship quality and the sexual and reproductive health of both partners. Much of the research on sexual communication among adolescents has been conducted in settings of the Global North and focuses narrowly on sexual health and condom use. Building on prior measures of sexual communication, we developed a set of three scales to measure sexual communication attitudes, self-efficacy, and behavior in adolescent dating relationships and administered the measures to 793 first-year male undergraduates 18–24 years in Hanoi, Vietnam. We used factor analysis to explore and confirm factor structure and assess invariance across relationship history and over time, suggesting a seven-item, two-factor attitudes scale and five-item, unidimensional scales for efficacy and behavior. Participants reported positive attitudes toward sexual communication, with low-to-moderate self-efficacy and behavior. All scales showed good convergent and discriminant validity. These related measures may be useful for identifying individual attitudes, self-efficacy, and behavior relevant to sexual violence prevention programming for adolescents.
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- 2022
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19. Measuring campus sexual assault and culture: A systematic review of campus climate surveys
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Michael Windle, Kathryn M. Yount, Jessica M. Sales, Regine Haardörfer, Rebecca Woofter, and Kathleen H. Krause
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medicine.medical_specialty ,Health (social science) ,Social Psychology ,Injury control ,Human factors and ergonomics ,Poison control ,Suicide prevention ,Occupational safety and health ,Injury prevention ,medicine ,Sex offense ,Psychiatry ,Psychology ,Applied Psychology ,Sexual assault - Published
- 2019
20. Preexposure prophylaxis care continuum among transgender women at a patient-centered preexposure prophylaxis program in Atlanta, Georgia
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Akanksha Vaidya, Grant H Roth, Ana Paula Duarte, Anandi N. Sheth, Valeria D Cantos, Meredith Lora, Bradley L Smith, Ziduo Zheng, Jessica M. Sales, Amalia Aldredge, Suprateek Kundu, and Judah K Gruen
- Subjects
medicine.medical_specialty ,Georgia ,biology ,Anti-HIV Agents ,business.industry ,Immunology ,MEDLINE ,HIV Infections ,Continuity of Patient Care ,biology.organism_classification ,Transgender Persons ,Care Continuum ,Transgender women ,Atlanta ,Infectious Diseases ,Patient-Centered Care ,Family medicine ,medicine ,Humans ,Immunology and Allergy ,Female ,Pre-Exposure Prophylaxis ,business ,Patient centered - Published
- 2021
21. Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV
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Tiffaney L. Renfro, Adrienne Crusey, Anthony E. Hitch, Natalia Revzina, Jennifer L. Brown, Ariadna Capasso, Ralph J. DiClemente, E. V. Boeva, Iakovos Anastasakis, Vadim Rassokhin, and Jessica M. Sales
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Gerontology ,Immunology ,Psychological intervention ,Human immunodeficiency virus (HIV) ,HIV Infections ,Dermatology ,medicine.disease_cause ,Russia ,Intervention (counseling) ,Medicine ,Humans ,computerized intervention ,Hiv treatment ,Adaptation (computer science) ,business.industry ,Coinfection ,Computers ,Brief Report ,Russian women ,Intervention approach ,HIV ,virus diseases ,Hepatitis C ,Alcohol reduction intervention ,Diseases of the genitourinary system. Urology ,Infectious Diseases ,multi-component intervention ,HCV ,Female ,RC870-923 ,business ,Alcohol reduction - Abstract
Background: There is elevated prevalence of problem drinking among Russian women living with HIV and HCV co-infection. This paper describes the development and cultural adaptation of a multi-component alcohol reduction intervention incorporating a brief, computer-delivered module for Russian women living with HIV and HCV co-infection. Methods: The format and content of the intervention were adapted to be linguistic-, cultural-, and gender-appropriate using the ADAPT-ITT framework. A computer-delivered module and brief clinician-delivered individual and telephone sessions were developed. Results: We describe the theoretical foundations of the intervention, the cultural adaptation of the intervention, and overview the content of the intervention’s multiple components. Discussion: Interventions to reduce alcohol use that can be integrated within Russian HIV treatment centers are urgently needed. If efficacious, the culturally-adapted intervention offers the promise of a cost-effective, easily disseminated intervention approach for Russian women living with HIV/HCV co-infection engaging in problematic alcohol use.
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- 2021
22. Developmental Changes in Sexual Risk and Substance Use Among African American Females: an Integrated Data Analysis Approach Using Time-varying Effect Models
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Jessica M. Sales, Ralph J. DiClemente, Jennifer L. Brown, Michael Windle, Andrea Swartzendruber, and Regine Haardörfer
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Adult ,Data Analysis ,medicine.medical_specialty ,Georgia ,Adolescent ,Substance-Related Disorders ,Sexual Behavior ,Gonorrhea ,Sexually Transmitted Diseases ,Psychological intervention ,Observation ,Article ,Interviews as Topic ,Young Adult ,03 medical and health sciences ,Risk-Taking ,Intervention (counseling) ,medicine ,Humans ,0501 psychology and cognitive sciences ,Qualitative Research ,030505 public health ,Chlamydia ,business.industry ,Public health ,05 social sciences ,Public Health, Environmental and Occupational Health ,Fixed effects model ,medicine.disease ,Black or African American ,Health psychology ,Female ,Self Report ,Substance use ,0305 other medical science ,business ,050104 developmental & child psychology ,Demography - Abstract
INTRODUCTION: The aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). METHODS: Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1,974 individuals, aged 14–25 years for behavioral outcomes and 16–25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. RESULTS: Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16–17 years and thereafter generally declined. STI acquisition was highest at age 16 years. CONCLUSIONS: This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.
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- 2019
23. Age-related associations between substance use and sexual risk behavior among high-risk young African American women in the South
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Andrea Swartzendruber, Jessica M. Sales, Michael Windle, Jennifer L. Brown, and Regine Haardörfer
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Adolescent ,Alcohol Drinking ,Sexual Behavior ,Medicine (miscellaneous) ,Underage Drinking ,Toxicology ,Article ,Cigarette Smoking ,Condoms ,Young Adult ,Risk-Taking ,Age related ,Humans ,Medicine ,Young adult ,Sexual risk ,African american ,business.industry ,Age Factors ,Fixed effects model ,Southeastern United States ,Black or African American ,Psychiatry and Mental health ,Clinical Psychology ,Sexual Partners ,Integrative data analysis ,Female ,Marijuana Use ,Substance use ,Prevention trials ,business ,Demography - Abstract
Background We assessed age-related associations between substance use and sexual risk behavior using data from three HIV prevention trials that enrolled young African American women. Methods We used integrative data analysis to pool data from 1862 individuals aged 16–25 years. We used time-varying effect models to examine associations between substance use (alcoholic drinks per month, recent marijuana use, cigarettes smoked per day) and sexual risk behaviors (monthly frequency of vaginal sex, multiple sex partners, condomless sex), adjusting for the fixed effect of trial. Results In models that included all three substances, cigarette smoking was not associated with any outcome. Alcohol quantity was associated with greater frequency of sex at all ages, an increased likelihood of having multiple sex partners from about age 17–24 years, and an increased likelihood of condomless sex after about age 18.5 years. Associations between alcohol quantity and sex frequency were relatively stable; associations with having multiple sex partners and condomless sex increased beginning at about age 22 years. Marijuana use was associated with greater sex frequency at approximate ages 16.5–24 years and an increased likelihood of having multiple sex partners at ages 18–24 years. Associations with sex frequency were relatively stable; associations with having multiple sex partners increased from about age 18 and peaked at about age 23 years. Conclusions We observed developmentally-dependent relationships between both alcohol and marijuana and sexual risk behavior. The findings underscore the need to address substance-related sexual risk among young African American women and may inform optimal timing of intervention.
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- 2019
24. Integrating program-tailored universal trauma screening into HIV care: an evidence-based participatory approach
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Clara Riddick, Betelihem Getachew, Carlos del Rio, Julia Schiff, Ameeta S. Kalokhe, Kaitlin N. Piper, and Jessica M. Sales
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Adult ,Male ,Community-Based Participatory Research ,medicine.medical_specialty ,Health (social science) ,Evidence-based practice ,Social Psychology ,Emotional safety ,Human immunodeficiency virus (HIV) ,Intimate Partner Violence ,HIV Infections ,Violence ,medicine.disease_cause ,Article ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,Qualitative Research ,Staff perceptions ,030505 public health ,Delivery of Health Care, Integrated ,business.industry ,Qualitative interviews ,Parallel design ,Public Health, Environmental and Occupational Health ,Professional-Patient Relations ,Participatory approach ,Negative HIV ,Mental Health ,Family medicine ,Female ,0305 other medical science ,business - Abstract
Trauma is prevalent among HIV-infected populations and associated with negative HIV care outcomes. While several agencies have called for integrating trauma-informed care into HIV services, uptake has been limited and effective methods have not been delineated. To develop comprehensive trauma screening strategies tailored to a large, urban HIV care center, we aimed to first understand provider and staff perceptions of the center's current level of trauma screening and barriers and facilitators to universal screening uptake. We used a mixed-methods convergent parallel design: quantitative assessments with 31 providers and staff and in-depth interviews with 19 providers and staff. Quantitative assessments highlighted center strengths (i.e. assessing effects of trauma, explaining care plans to patients, providing opportunities for questions) and gaps (i.e. asking about head injuries, emotional safety). Qualitative interviews suggested center screening practices were highly-variable and limited, identified gaps in interdepartmental communication regarding results of trauma screening that led to repeated screenings and potential patient re-traumatization, screening barriers (i.e. limited time, competing clinical priorities) and facilitators (i.e. provider-driven, standardized, non-disruptive screening with clear cut-points and follow-up steps). This study provides tangible strategies for the center to begin integrating universal trauma screening, many of which could be adapted by other U.S. HIV clinics.
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- 2019
25. The Process of Becoming a Sexual Black Woman: A Grounded Theory Study
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Audrey Tluczek, Jessica M. Sales, Barbara King, and Natasha Crooks
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Adult ,Risk ,Sociology and Political Science ,media_common.quotation_subject ,Sexually Transmitted Diseases ,Psychology of self ,Psychological intervention ,HIV Infections ,Human sexuality ,Stereotype ,Article ,Grounded theory ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Women ,Sexual Maturation ,Girl ,Uncategorized ,media_common ,Stereotyping ,030219 obstetrics & reproductive medicine ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Middle Aged ,Black or African American ,Sexualization ,Grounded Theory ,Life course approach ,Female ,0305 other medical science ,business ,Sexuality ,Clinical psychology - Abstract
Black females in the United States disproportionately suffer from STDs, including HIV. Understanding the sociocultural conditions that affect their risk is essential to developing effective and culturally relevant prevention programs. Methods: In 2016-2017 in Madison, Wisconsin, 20 black females aged 19-62 completed interviews that explored the sociocultural conditions associated with sexual development and STD/HIV risk. Interviews were guided by grounded theory; open, axial and selective coding and constant comparative analysis were used to identify developmental phases and relevant sociocultural conditions. Results: Three phases of becoming a sexual black woman were identified: Girl, when participants reported beginning to understand their sexuality; Grown, marking a transition to adulthood, when participants began to feel more self-sufficient yet still grappled with their emerging sexuality; and Woman, when participants developed a strong sense of self and took ownership of their bodies. Two sociocultural conditions affected progression through these phases: stereotype messaging and protection (both self-protection and protecting others). Negative life events (e.g., sexual trauma) and early sexualization reportedly affected sexual development, and STD experience influenced self-perceptions of sexuality and sexual behavior, often leading to self-protective behaviors. Older participants reported strategies to protect young black females from negative sexual experiences. Conclusion: Interventions at multiple levels of the social ecology throughout the life course may help reduce STD/HIV risk among black women in the United States. Future research should include examination of the experiences of black females younger than 18 and evaluation of the protective strategies employed by older black females.
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- 2019
26. Application of the Consolidated Framework for Implementation Research to Facilitate Delivery of Trauma-Informed HIV Care
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Ameeta S. Kalokhe, Kaitlin N. Piper, Lauren L Brown, Ilyssa Tamler, and Jessica M. Sales
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Epidemiology ,Population ,Human immunodeficiency virus (HIV) ,Original Report: Implementation Science ,HIV Infections ,Primary care ,medicine.disease_cause ,03 medical and health sciences ,Nursing ,Acquired immunodeficiency syndrome (AIDS) ,medicine ,Humans ,education ,Qualitative Research ,education.field_of_study ,030505 public health ,High prevalence ,Primary Health Care ,General Medicine ,medicine.disease ,Primary care clinic ,United States ,Identification (information) ,Implementation research ,0305 other medical science ,Psychology - Abstract
Background: The high prevalence of trauma and its negative impact on health among people living with HIV underscore the need for adopting trauma-informed care (TIC), an evidence-based approach to address trauma and its physical and mental sequelae. However, virtually nothing is known about factors internal and external to the clinical environment that might influence adoption of TIC in HIV primary care clinics. Methods: We conducted a pre-implementation assessment consisting of in-depth interviews with 23 providers, staff, and administrators at a large urban HIV care center serving an un-/under-insured population in the southern United States. We used the Consolidated Framework for Implementation Research (CFIR) to guide qualitative coding to ascertain factors related to TIC adoption. Results: Inner setting factors perceived as impacting TIC adoption within HIV primary care included relative priority, compatibility, available resources, access to knowledge and information (ie, training), and networks and communications. Relevant outer setting factors included patient needs/resources and cosmopolitanism (ie, connections to external organizations). Overall, the HIV care center exhibited high priority and compatibility for TIC adoption but displayed a need for system strengthening with regard to available resources, training, communications, cosmopolitanism, and patient needs/ resources. Conclusions: Through identification of CFIR inner and outer setting factors that might influence adoption of TIC within an HIV primary care clinic, our findings begin to fill key knowledge gaps in understanding barriers and facilitators for adopting TIC in HIV primary care settings and highlight implementation strategies that could be employed to support successful TIC implementation. Ethn Dis. 2021;31(1):109-118; doi:10.18865/ed.31.1.109
- Published
- 2021
27. Pre-exposure Prophylaxis Implementation in Family Planning Services Across the Southern United States: Findings from a Survey Among Staff, Providers and Administrators Working in Title X-Funded Clinics
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Evan Kwiatkowski, Teresa Filipowicz, Lisa B. Haddad, Jessica M. Sales, Matthew A. Psioda, Maria Sanchez, Sophia A. Hussen, Cam Escoffery, Anandi N. Sheth, and Micah McCumber
- Subjects
medicine.medical_specialty ,Medical staff ,Social Psychology ,Anti-HIV Agents ,HIV Infections ,Sex Education ,Ambulatory Care Facilities ,Article ,03 medical and health sciences ,Pre-exposure prophylaxis ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Reproductive health ,030505 public health ,business.industry ,Title X ,Public health ,Public Health, Environmental and Occupational Health ,United States ,Health psychology ,Infectious Diseases ,Family planning ,Family medicine ,Family Planning Services ,Female ,Pre-Exposure Prophylaxis ,Implementation research ,0305 other medical science ,Psychology ,business - Abstract
To improve women's access to pre-exposure prophylaxis (PrEP) in family planning (FP) clinics, we examined readiness to provide PrEP, and barriers and facilitators at the clinic level to integrate PrEP services into Title X-funded FP clinics across the Southern US. Title X-funded FP clinics across DHHS regions III (Mid-Atlantic), IV (Southeast), and VI (Southwest), comprising the Southern US. From February to June, 2018, we conducted a web-based, geographically targeted survey of medical staff, providers and administrators of Title X-funded FP clinics in DHHS regions III (Mid-Atlantic), IV (Southeast), and VI (Southwest). Survey items were developed using the Consolidated Framework for Implementation Research to assess constructs relevant to PrEP implementation. One-fifth of 283 unique Title X clinics across the South provided PrEP. Readiness for PrEP implementation was positively associated with a climate supportive of HIV prevention, leadership engagement, and availability of resources, and negatively associated with providers holding negative attitudes about PrEP's suitability for FP. The Title X FP network is a vital source of sexual health care for millions of individuals across the US. Clinic-level barriers to providing PrEP must be addressed to expand onsite PrEP delivery in Title X FP clinics in the Southern US.
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- 2020
28. Using clinical cascades to measure health facilities’ obstetric emergency readiness: testing the cascade model using cross-sectional facility data in East Africa
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Bridget Whaley, Elizabeth Butrick, Jessica M Sales, Anthony Wanyoro, Peter Waiswa, Dilys Walker, and John N Cranmer
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Pediatric ,maternal medicine ,obstetrics ,Other Medical and Health Sciences ,international health services ,Clinical Sciences ,Infant, Newborn ,Infant ,General Medicine ,Health Services ,Newborn ,Kenya ,quality in health care ,Good Health and Well Being ,Cross-Sectional Studies ,Clinical Research ,Pregnancy ,Infant Mortality ,Public Health and Health Services ,Humans ,Premature Birth ,Female ,Uganda ,Health Facilities ,Infection - Abstract
ObjectivesGlobally, hundreds of women die daily from preventable pregnancy-related causes, with the greatest burden in sub-Saharan Africa. Five key emergencies—bleeding, infections, high blood pressure, delivery complications and unsafe abortions—account for nearly 75% of these obstetric deaths. Skilled clinicians with strategic supplies could prevent most deaths. In this study, we (1) measured facility readiness to manage common obstetric emergencies using the clinical cascades and signal function tracers; (2) compared these readiness estimates by facility characteristics; and (3) measured cascading drop-offs in resources.DesignA facility-based cross-sectional analysis of resources for common obstetric emergencies.SettingData were collected in 2016 from 23 hospitals (10 designated comprehensive emergency obstetric care (CEmOC) facilities) in Migori County, western Kenya, and Busoga Region, eastern Uganda, in the Preterm Birth Initiative study in East Africa. Baseline data were used to estimate a facility’s readiness to manage common obstetric emergencies using signal function tracers and the clinical cascade model. We compared emergency readiness using the proportion of facilities with tracers (signal functions) and the proportion with resources for identifying and treating the emergency (cascade stages 1 and 2).ResultsThe signal functions overestimated practical emergency readiness by 23 percentage points across five emergencies. Only 42% of CEmOC-designated facilities could perform basic emergency obstetric care. Across the three stages of care (identify, treat and monitor-modify) for five emergencies, there was a 28% pooled mean drop-off in readiness. Across emergencies, the largest drop-off occurred in the treatment stage. Patterns of drop-off remained largely consistent across facility characteristics.ConclusionsAccurate measurement of obstetric emergency readiness is a prerequisite for strengthening facilities’ capacity to manage common emergencies. The cascades offer stepwise, emergency-specific readiness estimates designed to guide targeted maternal survival policies and programmes.Trial registration numberNCT03112018.
- Published
- 2022
29. Youth-Centered Clinics: The Voices of Adolescent Sesotho-Speaking Girls From Mangaung, South Africa
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Lochner Marais, Jennifer L. Brown, Carla Sharp, Jessica M. Sales, Molefi Lenka, Kolisa Rani, and Jan Cloete
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General Arts and Humanities ,General Social Sciences - Abstract
Youth-centered health services have become a global practice and South Africa is no exception. This paper describes a project conducted in Mangaung in 2018 using cultural consensus modeling. We conducted 25 interviews and used a combination of hermeneutics, phenomenology theory, and thematic analysis. Our research found that girls in our sample have confidentiality concerns associated with the stigma of attending a clinic and cannot talk openly about sex and HIV. Themes related to negative experiences included the lack of confidentiality, the stigma of HIV, the lack of professional neutrality, failure to understand adolescents, poor service, systemic problems (long queues), and administrative problems. Positive themes included believing that clinics could help prevent pregnancy, provide information, create a safe space, and help with moral support. Moreover, some interviewees reported that services were good and that they provided products and support that were not available from home. However, many said they had to attend public clinics because they could not afford private alternatives. Some said the clinics offered a safe space and staff have positive attitudes. In the absence of discussions about sex at home, the clinics ultimately perform an important function, but systemic problems remain. More can be done by schools and households to reduce the stigma associated with sex and HIV.
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- 2022
30. A Review of HIV Pre-exposure Prophylaxis Streamlining Strategies
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Aaron J Siegler, Douglas S. Krakower, Kevin Steehler, and Jessica M. Sales
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0301 basic medicine ,Male ,Telemedicine ,Anti-HIV Agents ,Psychological intervention ,HIV Infections ,The Science of Prevention (JD Stekler and JM Baeten, Section Editors) ,03 medical and health sciences ,Pre-exposure prophylaxis ,Sexual and Gender Minorities ,0302 clinical medicine ,Nursing ,Virology ,Medicine ,Humans ,Patient Navigation ,030212 general & internal medicine ,Medical prescription ,Homosexuality, Male ,mHealth ,Chronic care ,Text Messaging ,Modalities ,business.industry ,Chronic care model ,030112 virology ,PrEP ,Clinical trial ,Self-Help Groups ,Infectious Diseases ,Pre-Exposure Prophylaxis ,business - Abstract
Purpose of Review Standard care for HIV pre-exposure prophylaxis (PrEP) in the USA creates substantial burdens for patients, clinicians, and the healthcare system; to optimize uptake, there is a need for innovative strategies to streamline its provision. Recent Findings Our review, structured by the expanded chronic care model, identified eleven promising strategies to streamline PrEP care. Approaches ranged widely in mechanism of action. Using text messages to support care was the only strategy with clinical trial evidence supporting its use. Other modalities such as patient navigation, telemedicine PrEP models, alternate dosing availability, same-day prescription, and provider training have promising pilot or associational data and seem likely to lower barriers to entering into or remaining in care. Many of the strategies have established success in related domains such as HIV care, meriting consideration in evaluating their use for PrEP. Summary Making PrEP care less burdensome will be an important part of bringing it to scale. Text message interventions have proven efficacy and merit broad adoption. Encouraging preliminary evidence for other strategies indicates the importance of building a stronger evidence base to clarify the effect of each strategy. Ongoing development of an evidence base should not delay the use of these promising strategies; instead, it calls for careful consideration for how each program may best match its environment to facilitate PrEP prescribing and use.
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- 2020
31. Exploring the Heterogeneity of Factors that may Influence Implementation of PrEP in Family Planning Clinics: A Latent Profile Analysis
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Cam Escoffery, Kaitlin N. Piper, Jessica M. Sales, Regine Haardörfer, and Anandi N. Sheth
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Medicine (General) ,medicine.medical_specialty ,Context (language use) ,Consolidated Framework for Implementation Research ,Health administration ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,medicine ,030212 general & internal medicine ,Family planning ,Health policy ,030503 health policy & services ,Public health ,Title X ,Research ,Health services research ,Latent profile analysis ,PrEP ,Family medicine ,Implementation science ,HIV/AIDS ,Implementation research ,0305 other medical science ,Psychology - Abstract
Background Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, PrEP has not been widely integrated into family planning services, especially in the Southern US, and data suggest there may be significant implementation challenges in this setting. Because Title X clinics vary greatly in provider-, organizational-, and systems-level characteristics, there is likely variation in capacity to implement PrEP across clinics. Methods We conducted a survey from February to June 2018 among providers and administrators of non-PrEP-providing Title X-funded clinics across 18 southern states. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR) to assess constructs relevant to PrEP implementation. To explore the heterogeneity of CFIR-related implementation determinants and identify distinct sub-groups of Title X clinics, a latent profile analysis was conducted using nine CFIR constructs: complexity, relative advantage, cost, attitudes, implementation climate, compatibility, leadership engagement, available resources, and cosmopolitanism. We then conducted a multi-level analysis (accounting for nesting of participants within clinics) to test whether group membership was associated with readiness for implementation of PrEP, controlling for key sociodemographic characteristics. Results Four hundred and fourteen healthcare providers/administrators from 227 non-PrEP-providing Title X clinics participated in the study. We identified six sub-groups of clinics that each had distinct patterns of PrEP implementation determinants. Clinic sub-groups included “Highest Capacity for Implementation”, “Favorable Conditions for Implementation”, “Mixed Implementation Context”, “Neutral Implementation Context”, “Incompatible Setting for Implementation”, and “Resource-Strained Setting”. Group membership was related to numerous provider-level (i.e., ability to prescribe medication) and clinic-level (i.e., provision of primary care) characteristics. In comparison to the “Neutral” group (which held neutral perceptions across the implementation determinants), the “Highest Capacity” and “Favorable Conditions” groups had significantly higher levels of implementation readiness, and the “Resource-Strained” group had a significantly lower level of implementation readiness. Conclusions Latent profile analyses can help researchers understand how implementation readiness varies across healthcare settings, promoting tailoring of implementation strategies to unique contexts.
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- 2020
32. Influences on Women's Care Seeking at Planned Parenthood Health Centers in Two Southern States
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Michael R. Kramer, Anna Newton-Levinson, Andrea Swartzendruber, Roger W. Rochat, Sarah C. Blake, Jessica M. Sales, and Megan Higdon
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medicine.medical_specialty ,Health (social science) ,Care seeking ,Context (language use) ,Ambulatory Care Facilities ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Contraceptive Agents ,Maternity and Midwifery ,Health care ,medicine ,Humans ,Confidentiality ,030219 obstetrics & reproductive medicine ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,Obstetrics and Gynecology ,Patient Acceptance of Health Care ,United States ,Family planning ,Family medicine ,Family Planning Services ,Female ,0305 other medical science ,Psychology ,business ,Delivery of Health Care - Abstract
Introduction In the context of a shifting health care landscape, better understanding of the factors that motivate women to seek services from specialized family planning clinics like Planned Parenthood (PP) can provide insights about potential changes in the role of specialized family planning clinics. Methods We surveyed 725 women seeking services at two PP health centers in Louisiana and Kentucky from March 2016 to May 2017. We examined differences in care-seeking between women who had varying levels of access including those who did and did not have insurance instability or a regular source of care (RSOC) besides the clinic. Results More than 60% of women attending the health centers did not have a regular source of care and nearly 40% experienced instability in insurance. Women who experienced insurance instability and a lack of a regular source of care more frequently sought primary preventive services such as pap tests and well-woman care at PP than women with better access. For women with better access, PP health centers also served important roles for those seeking contraceptive and sexually transmitted infection–related services. The most frequent reasons for choosing the PP were that it was faster to get an appointment, wanting to go to the PP clinic more than other clinics, and the confidentiality of services. Conclusions Our analysis suggests that PP health centers in Southern states still provide vital services for women with and without other sources of care and are critical for women needing access to timely services for preventative and sexually transmitted infection–related care.
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- 2020
33. Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155) (Preprint)
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Anandi N Sheth, Sophia A Hussen, Cam Escoffery, Lisa B Haddad, Leah Powell, Nakita Brown, Teresa R Filipowicz, Micah McCumber, Maria Sanchez, Laura Renshaw, Matthew A Psioda, and Jessica M Sales
- Abstract
BACKGROUND Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X–funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. OBJECTIVE The objective of this study is two-fold: to evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. METHODS Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. RESULTS Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. CONCLUSIONS This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X–funded clinics across the Southern United States. CLINICALTRIAL ClinicalTrials.gov NCT04097834; https://clinicaltrials.gov/ct2/show/NCT04097834 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18784
- Published
- 2020
34. Cultural Consensus Modeling to Understand South African Adolescent Girls' Attitudes, Awareness, and Uptake of Dual Protection Strategies
- Author
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Philile Marime, Kholisa Rani, Jan Cloete, Refuwe Moqolo, Molefi Lenka, Jessica M. Sales, Lochner Marais, Carla Sharp, Jennifer L. Brown, Irene Ditlhare, and Disebo Peterson
- Subjects
Male ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Consensus ,Adolescent ,Psychological intervention ,Human immunodeficiency virus (HIV) ,Sexually Transmitted Diseases ,HIV Infections ,medicine.disease_cause ,Condoms ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Medicine ,Humans ,030212 general & internal medicine ,Culturally tailored ,business.industry ,Public Health, Environmental and Occupational Health ,virus diseases ,medicine.disease ,Cultural consensus analysis ,Psychiatry and Mental health ,Contraception ,Attitude ,Family medicine ,Pediatrics, Perinatology and Child Health ,Sti hiv prevention ,Female ,business ,Male condoms ,Pregnancy prevention - Abstract
Purpose This study used cultural consensus modeling to elucidate culturally relevant factors associated with dual protection use (strategies to prevent both pregnancy and sexually transmitted infection [STI]/HIV) among South African adolescent girls aged 14–17 years. Methods In Phase 1, participants (N = 50) completed a free-listing survey assessing pregnancy and STI/HIV methods used by peers. In Phase 2, participants (N = 100) completed a rating survey to examine perceived peer acceptability of Phase 1 pregnancy and STI/HIV prevention methods. In Phase 3, qualitative individual interviews (N = 25) gathered in-depth information regarding the cultural acceptability of pregnancy and STI/HIV prevention strategies. In Phase 4, participants (N = 300) completed the Phase 2 rating survey for individual beliefs regarding the acceptability of pregnancy and STI/HIV prevention methods. Results In Phase 1, 41 pregnancy and 29 STI/HIV prevention strategies, along with 16 factors influencing pregnancy prevention method acceptability were endorsed; male condoms were the most commonly endorsed pregnancy and STI/HIV prevention method. In Phase 2, using cultural consensus analysis, participants were consistent in the perceived acceptability of pregnancy and STI/HIV prevention methods (73.4% variance accounted for in single cultural model). In Phase 3, qualitative findings provided in-depth information regarding factors influencing commonly used pregnancy (e.g., injectable contraception) and STI/HIV (e.g., condoms) prevention methods. In Phase 4, a single cultural model was identified (56.3% variance accounted for), with similar acceptability ratings as Phase 2. Conclusions A singular cultural model of pregnancy and STI/HIV prevention method acceptability was observed, with little awareness of dual protection. The findings highlight cultural factors for future culturally tailored dual protection interventions for South African adolescent girls.
- Published
- 2019
35. Impact of Behavioral Drug Abuse Treatment on Sexual Risk Behaviors: An Integrative Data Analysis of Eight Trials Conducted Within the National Drug Abuse Treatment Clinical Trials Network
- Author
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Nicole K. Gause, Michael D. Eriksen, Jessica M. Sales, Gene H. Brody, and Jennifer L. Brown
- Subjects
Adult ,Data Analysis ,Male ,Sexual partner ,Sexual Behavior ,Affect (psychology) ,Logistic regression ,Article ,law.invention ,03 medical and health sciences ,Risk-Taking ,0302 clinical medicine ,0504 sociology ,Randomized controlled trial ,Behavior Therapy ,law ,Intervention (counseling) ,medicine ,Humans ,030212 general & internal medicine ,Substance Abuse, Intravenous ,Randomized Controlled Trials as Topic ,business.industry ,05 social sciences ,Public Health, Environmental and Occupational Health ,050401 social sciences methods ,medicine.disease ,Government Programs ,Clinical trial ,Substance abuse ,Health psychology ,Female ,business ,Clinical psychology - Abstract
BACKGROUND: The extent to which behavioral drug abuse treatments affect sexual risk behaviors is largely unknown. This study examined the impact of behavioral drug abuse treatments on sexual risk behaviors using an integrative data analysis approach across eight trials conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN). METHODS: Participants (N = 1,305) from eight randomized controlled trials who were sexually active at baseline were included in the pooled dataset; 48.7% were female, 64.1% self-identified as a racial/ethnic minority, with M (SD) age of 34.9 (9.6). Longitudinal logistic regression estimated the probability of risky sexual behavior (i.e., inconsistent condom use and/or >1 sexual partner in past 30 days) post-intervention with an indicator variable (1 for post-intervention), study condition (control, intervention), and their interaction as predictors; the analysis employed random effects for each trial and included relevant control variables. Time-varying differences in effects based on weeks post-intervention were incorporated using interacted linear and quadratic terms with condition status. RESULTS: Approximately 84.2% reported risky sexual behaviors at baseline. The control and intervention conditions were 18.5 and 17.3 percentage points less likely to report risky sexual behavior post-intervention, respectively. Results suggest decreasing rates of risky sex engagement until eight weeks (control) or nine weeks (intervention) post-intervention; risky sexual behavior subsequently increased. CONCLUSIONS: Behavioral CTN trial participation was associated with decreased sexual risk behaviors in both the intervention and control trial conditions. Participation in behavioral substance use treatment may result in secondary benefits of sexual risk behavior reductions.
- Published
- 2018
36. Moving the Message Beyond the Methods: Toward Integration of Unintended Pregnancy and Sexually Transmitted Infection/HIV Prevention
- Author
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Riley J. Steiner, Andrea Swartzendruber, Nicole Liddon, Jessica M. Sales, and Karen Pazol
- Subjects
Adult ,Male ,medicine.medical_specialty ,Epidemiology ,Sexually Transmitted Diseases ,MEDLINE ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Preventive Health Services ,medicine ,Humans ,030212 general & internal medicine ,Contraception Behavior ,Delivery of Health Care, Integrated ,Contraceptive Devices ,Obstetrics ,business.industry ,Public Health, Environmental and Occupational Health ,Pregnancy, Unplanned ,medicine.disease ,United States ,Contraception ,Family Planning Services ,Female ,business ,Unintended pregnancy - Published
- 2018
37. The association between monetary and sexual delay discounting and risky sexual behavior in an online sample of men who have sex with men
- Author
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Jodie L. Guest, Jeb Jones, Michael R. Kramer, Patrick S. Sullivan, Jessica M. Sales, and Samuel M. Jenness
- Subjects
Adult ,Male ,0301 basic medicine ,Health (social science) ,Adolescent ,Social Psychology ,Sexual Behavior ,Human immunodeficiency virus (HIV) ,HIV Infections ,Sample (statistics) ,Impulsivity ,medicine.disease_cause ,Article ,Men who have sex with men ,Sexual and Gender Minorities ,03 medical and health sciences ,Risk-Taking ,0302 clinical medicine ,Risky sexual behavior ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Homosexuality, Male ,Association (psychology) ,health care economics and organizations ,Sexual risk ,Unsafe Sex ,business.industry ,Delay discounting ,Public Health, Environmental and Occupational Health ,Middle Aged ,030112 virology ,United States ,Cross-Sectional Studies ,Sexual Partners ,Delay Discounting ,medicine.symptom ,business ,Clinical psychology - Abstract
Delay discounting is a measure of impulsivity that has been found to be associated with numerous health-related outcomes. To the extent that delay discounting is associated with sexual risk-taking, it might serve as a marker for HIV risk or as the basis for novel HIV prevention interventions. The goal of the current study was to examine the association between monetary and sexual delay discounting and condomless anal intercourse (CAI) in a cross-sectional sample of men who have sex with men. Based on previous findings, we examined whether these associations were age-dependent. Sexual, but not monetary, delay discounting was found to be associated with CAI in the past 12 months. These results suggest that delay discounting is associated with sexual risk-taking. More high risk sexual behaviors and their associations with delay discounting should be investigated in the future.
- Published
- 2018
38. Cultural consensus modelling to understand the reproductive health needs of South African adolescent girls
- Author
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Jennifer L Brown, Jessica M Sales, Carla Sharp, Jan Cloete, Molefi Lenka, Kholisa Rani, Philile Marime, Irene Ditlhare, Refuwe Moqolo, Disebo Peterson, and Lochner Marais
- Subjects
03 medical and health sciences ,05 social sciences ,Pediatrics, Perinatology and Child Health ,050602 political science & public administration ,030508 substance abuse ,0305 other medical science ,Article ,0506 political science - Abstract
BACKGROUND. Cultural consensus modelling (CCM) is an approach whereby individuals define the boundaries regarding a set of knowledge or behaviours shared by a group within a culture using an ethnographic approach. OBJECTIVES. To provide an overview of CCM methods and the application of CCM to examine South African adolescent girls' contraceptive and HIV prevention practices. METHODS. In phase 1 of a CCM approach, individuals respond to questions about their culture rather than their individual behaviours, allowing individuals to draw upon a shared cultural knowledge. Utilising these identified group beliefs, phase 2 asks individuals to rate the extent to which factors identified in phase 1 are valued. Phase 3 utilises qualitative interviews with key informants from phase 2 to gather in-depth information regarding the identified determinants of the health behaviour. Lastly, phase 4 of this approach conducts a quantitative survey to determine the extent to which cultural consensus model types are associated with differences in actual behaviours. RESULTS. CCM data analytic approaches are described. Frequencies and descriptive statistics for the free listing are conducted. For phase 2, cultural consensus analysis is conducted to examine whether one or several consensus models exist and competence scores are calculated. Standard qualitative analysis approaches are utilised for phase 3. Phase 4 employs regression to examine the association between cultural models and an outcome of interest. CONCLUSION. CCM provides a novel, culturally sensitive understanding of reproductive health practices among South African adolescent girls; CCM also has broad applicability to other adolescent health research domains.
- Published
- 2018
39. 973. PrEP Care Continuum among Transgender Women at a Patient-Centered PrEP Program in Atlanta, GA
- Author
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Grant H Roth, Akanksha Vaidya, Ana Paula Duarte, Ziduo Zheng, Jessica M. Sales, Bradley L Smith, Meredith Lora, Amalia Aldredge, Suprateek Kundu, Anandi N. Sheth, Judah K Gruen, and Valeria D Cantos
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Patient-centered care ,biology.organism_classification ,Care Continuum ,Transgender women ,Atlanta ,Pre-exposure prophylaxis ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,Family medicine ,Poster Abstracts ,medicine ,Transgender Person ,business ,Patient centered - Abstract
Background HIV disproportionally affects transgender women (TGW) of color, with a prevalence of 26% and 44% among Latinx and Black TGW, respectively. Low medication adherence likely contributed to suboptimal pre-exposure prophylaxis (PrEP) efficacy among TGW in clinical trials, but real-world PrEP outcome data for TGW is limited. In this study, we developed the PrEP care continuum for TGW referred to a PrEP program at a large, safety-net urban hospital in the Southeast. Figure 1. PrEP care continuum of TGW referred a PrEP program. Referrals include all TGW referred to PrEP clinic, eligibility includes all those referred who were deemed eligible for PrEP, linkage refers to those eligible who had ongoing care at the PrEP clinic, prescription refers to those who received their first prescription of PrEP, initiation includes those who started taking the PrEP they were prescribed, and persistence includes those who had a visit within 6 months of study end. Methods We analyzed data for those referred to the PrEP program from 3/2018 to 2/2020. We determined the proportion of TGW who were linked to the program, provided a PrEP prescription, started PrEP, and persisted in PrEP care, defined as having at least one follow-up visit within 6 months. Using a multivariate regression model, including age, race, ethnicity, mental health co-morbidities, and substance use, we determined factors associated with persistence in PrEP care. We calculated rates of sexually transmitted infections (STIs) and HIV incidence. Results Of the 321 total referrals for PrEP, 42 (13%) were TGW. 81% of TGW were referred from a co-located gender clinic. Median age was 28.5 years (IQR 23-34), 62% were Black, 21% had mental health co-morbidities, 45% used substances, and 35% engaged in transactional sex. Of all TGW who were referred, 37 (88%) were eligible for PrEP and linked to care, 36 (85.7%) were prescribed and initiated PrEP, and 22 (52.4%) persisted in care at the end of the study period. There were no factors associated with persistence in PrEP care. The most common STIs during the first visit were pharyngeal gonorrhea (22.7%) and syphilis (16.7%). STI incidence was highest for rectal chlamydia (12.5%) and pharyngeal gonorrhea (6.5%). There was one HIV seroconversion during the study period. Conclusion In a public hospital-based PrEP clinic in Atlanta with a co-located gender clinic, TGW had high rates of linkage to care and PrEP prescription and initiation, despite high rates of mental health diagnoses and substance use. However, there was a significant drop-off in persistence. STI prevalence and incidence were high, but there was only one HIV seroconversion, highlighting the potential benefits of PrEP. Future studies are needed to assess interventions to optimize persistence in PrEP care among TGW. Disclosures Bradley L. Smith, PharMD, AAHIVP, Gilead Sciences, Inc (Advisor or Review Panel member)
- Published
- 2020
40. Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women: Comparison to Self-Report Assessments of Alcohol Use
- Author
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Polina Safonova, Andrew K. Littlefield, Ralph J. DiClemente, Eve Rose, Jennifer L. Brown, Vadim V. Rassokhin, Jessica M. Sales, and Nikolay Belyakov
- Subjects
Adult ,medicine.medical_specialty ,Alcohol Drinking ,Social Psychology ,Concordance ,Population ,030508 substance abuse ,HIV Infections ,Alcohol ,Glycerophospholipids ,Article ,Russia ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Environmental health ,Humans ,Medicine ,Prospective Studies ,education ,education.field_of_study ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Health psychology ,Infectious Diseases ,chemistry ,Biomarker (medicine) ,Female ,Phosphatidylethanol ,Self Report ,0305 other medical science ,business ,Social psychology ,Alcohol consumption ,Biomarkers ,030217 neurology & neurosurgery - Abstract
Alcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman's r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.
- Published
- 2017
41. Alcohol Use, Partner Characteristics, and Condom Use Among HIV-Infected Russian Women: An Event-Level Study
- Author
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Ralph J. DiClemente, Polina Safonova, Jennifer L. Brown, Eve Rose, Olga Levina, Jessica M. Sales, Nicole K. Gause, Vadim V. Rassokhin, and Nikolay Belyakov
- Subjects
Adult ,Safe Sex ,0301 basic medicine ,Health (social science) ,Alcohol Drinking ,030106 microbiology ,Population ,Developing country ,HIV Infections ,Alcohol ,Toxicology ,Logistic regression ,Russia ,law.invention ,Condoms ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Condom ,law ,Odds Ratio ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Situational ethics ,education ,education.field_of_study ,business.industry ,virus diseases ,Psychiatry and Mental health ,Logistic Models ,Sexual Partners ,chemistry ,Family planning ,Female ,Brief Reports ,business ,Serostatus ,Social psychology ,Demography - Abstract
Alcohol use is a prominent factor correlated with HIV risk behavior engagement. Hazardous drinking is prevalent among Russian women and may contribute to decreased condom use. Event-based studies suggest that HIV risk behaviors may vary based on situational factors including partner characteristics and alcohol use. This study investigated the effect of situational factors on condom use during the most recent sexual encounter among a sample of HIV-infected Russian women.HIV-infected women (n = 239; mean age = 30.0 years) receiving medical care in St. Petersburg, Russia, completed an audio computer-assisted self-interview that assessed characteristics of their last sexual encounter. Multivariable logistic regression examined the associations between the following situational factors: (a) alcohol use, (b) partner type, (c) partner's serostatus, and (d) partner's alcohol use on whether a condom was used for vaginal and/or anal sex during the last sexual encounter.A total of 54.0% engaged in unprotected vaginal and/or anal sex during their last sexual encounter. In an adjusted logistic regression model, unprotected sex did not differ by participants' alcohol use (adjusted odds ratio [AOR] = 0.72, 95% CI [0.29, 1.8]) but was more likely with partners who had consumed alcohol (AOR = 2.3, 95% CI [1.1, 5.2]) and HIV-infected partners (AOR = 2.8, 95% CI [1.6, 4.9]) and less likely to occur in the context of nonsteady partnerships (AOR= 0.36, 95% CI [0.13, 0.99]).More stable, steady relationships with HIV-infected partners who consumed alcohol were associated with greater likelihood of noncondom use. Results highlight the need to address the intersection of alcohol and sexual risk engagement within the context of HIV-infected women's relationships.
- Published
- 2016
42. You have to be twice as good and work twice as hard: a mixed-methods study of perceptions of sexual harassment, assault and women's leadership among female faculty at a research university in the USA
- Author
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Carlos del Rio, Jessica M. Sales, Kathleen H. Krause, and Dabney P. Evans
- Subjects
leadership ,medicine.medical_specialty ,medicine ,Higher education ,Epidemiology ,media_common.quotation_subject ,Poison control ,Policy and Society ,Suicide prevention ,03 medical and health sciences ,0302 clinical medicine ,Promotion (rank) ,0504 sociology ,030212 general & internal medicine ,Original Research Article ,media_common ,Medical education ,business.industry ,Public health ,05 social sciences ,public health ,Public Health, Environmental and Occupational Health ,050401 social sciences methods ,Human factors and ergonomics ,Gender ,Accountability ,Harassment ,Psychology ,business - Abstract
Introduction The purpose of this study was to examine the perceptions of institutional policies and practices for the prevention of and response to gender inequities as experienced by female faculty working in the health sciences at a US research university. Methods Data from the institution's Faculty Campus Climate Survey (n = 260 female faculty) were coupled with qualitative interviews (n = 14) of females in leadership positions, exploring campus climate, and institutional policies and practices aimed at advancing women. Results Two-thirds (59%) of the female faculty respondents indicated witnessing sexual harassment and 28% reported experiencing sexual harassment. Several organizational themes emerged to address this problem: culture, including cultural change, transparency, and accountability. Conclusions The findings reveal the ways in which university culture mimics the larger societal context. At the same time, the distinct culture of higher education processes for recruitment, career advancement – specifically tenure and promotion – are identified as important factors that require modifications in support of reductions in gender inequalities.
- Published
- 2019
43. Low provider and staff self-care in a large safety-net HIV clinic in the Southern United States: Implications for the adoption of trauma-informed care
- Author
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Kaitlin N. Piper, Clara Riddick, Betelihem Getachew, Jonathan Colasanti, Ameeta S. Kalokhe, and Jessica M. Sales
- Subjects
medicine.medical_specialty ,lcsh:R5-920 ,burnout ,business.industry ,Safety net ,Human immunodeficiency virus (HIV) ,trauma-informed care ,General Medicine ,Burnout ,medicine.disease_cause ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,030220 oncology & carcinogenesis ,Family medicine ,Needs assessment ,medicine ,Self care ,HIV/AIDS ,Original Article ,030212 general & internal medicine ,Self-care ,business ,lcsh:Medicine (General) - Abstract
Objective: This mixed-methods needs assessment study examined self-care practices among providers, staff, and administrators at an HIV clinic and identified barriers and facilitators to strengthening self-care services in this setting. Methods: Surveys (n = 31) and qualitative interviews (n = 23) were conducted with staff, providers, and administrators at a large, safety-net HIV clinic. Results: Surveys indicated an overall absence of formal self-care services including resources to manage stress, opportunities to debrief, and formal mechanisms to voice concerns. Based on interviews with staff and providers, deficiencies in self-care services included support for dealing with complex patients, formal mechanisms for feedback, and time for self-care. Administrators recognized the need for more support, acknowledged that opportunities for employees to voice concerns were lacking, and felt that implementing multi-disciplinary team meetings could improve morale and reduce stress and burnout. Conclusion: This assessment revealed a need to enhance self-care in safety-net HIV services. Adoption of trauma-informed care, which includes activities to strengthen self-care, could reduce workplace burnout.
- Published
- 2019
44. Associations among Perceived HIV Risk, Behavioral Risk and Interest in PrEP among Black Women in the Southern US
- Author
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Jessica M. Sales and Anandi N. Sheth
- Subjects
Adult ,Risk ,medicine.medical_specialty ,Index (economics) ,Social Psychology ,Adolescent ,Human immunodeficiency virus (HIV) ,Sexually Transmitted Diseases ,HIV Infections ,Hiv risk ,medicine.disease_cause ,Article ,Behavioral risk ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk-Taking ,Medicine ,Humans ,Women ,030212 general & internal medicine ,Black women ,030505 public health ,Bacteria ,Unsafe Sex ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,virus diseases ,United States ,Black or African American ,Health psychology ,Infectious Diseases ,Sexual Partners ,Female ,Perception ,Pre-Exposure Prophylaxis ,0305 other medical science ,business ,Demography - Abstract
Utilizing data from Southern women, we created an HIV risk index with expanded partner-level factors to better capture women who may benefit from HIV pre-exposure prophylaxis (PrEP). We examined the relationships between potential HIV risk as estimated by laboratory-confirmed bacterial STIs, HIV risk index, perceived HIV risk, and interest in PrEP. Women had multiple PrEP indications; partner characteristics better differentiated STI status than other indicators. Perceived HIV risk differentiated STI status, significantly correlated with the HIV risk index, as well as predicted greater interest in PrEP. Findings can inform how best to evaluate HIV risk and PrEP acceptability among women.
- Published
- 2019
45. Preferred Product Attributes of Potential Multipurpose Prevention Technologies for Unintended Pregnancy and Sexually Transmitted Infections or HIV Among U.S. Women
- Author
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Lisa B. Haddad, Eva Lathrop, Jessica M. Sales, Jenna S. Hynes, and Anandi N. Sheth
- Subjects
0301 basic medicine ,Adult ,medicine.medical_specialty ,Adolescent ,Human immunodeficiency virus (HIV) ,Sexually Transmitted Diseases ,HIV Infections ,medicine.disease_cause ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pregnancy ,Surveys and Questionnaires ,Medicine ,Infection control ,Humans ,030212 general & internal medicine ,Product (category theory) ,business.industry ,Contraceptive Devices, Female ,Pregnancy, Unplanned ,Patient Preference ,General Medicine ,Odds ratio ,Original Articles ,medicine.disease ,United States ,030104 developmental biology ,Contraception ,Cross-Sectional Studies ,Sexual behavior ,Family medicine ,Residence ,Female ,business ,Attitude to Health ,Unintended pregnancy - Abstract
Background: Multipurpose prevention technologies (MPTs) are being developed to simultaneously protect women from unintended pregnancy and sexually transmitted infections (STIs) or human immunodeficiency virus. This study aims to determine MPT characteristics desired by young women in the United States (U.S.). Materials and Methods: This is a cross-sectional national survey administered online by MTurk. Eligibility criteria included female sex, age 18-29 years, U.S. residence, and sexual activity with a male partner in the past 3 months. MPT characteristics were rated for importance. Odds ratios were generated to explore associations between demographics, sexual behaviors, and prior contraceptive use and likelihood of using various MPT formulations. Results: Of 835 women, the largest proportion reported being likely to use MPTs in the form of injectables (45.6%), followed by vaginal gels (33.7%), vaginal rings (26.3%) and diaphragms (17.3%). Women with prior experience using a specific method of contraception appeared more likely to try an MPT of the same form. Women concerned about STIs and unwanted pregnancy, or with a history of such undesirable outcomes, expressed higher likelihood of use for a broad range of products. Women indicated that safety and efficacy at preventing pregnancy were the most important product characteristics when choosing an MPT. Conclusions: MPTs in the form of injectables are most highly desired, but many women would use vaginal methods, highlighting the importance of developing different delivery methods. Women desire safety and emphasize contraceptive efficacy over infection prevention. MPT preferences must be considered during product development to promote future acceptance among young women in the U.S.
- Published
- 2019
46. Brief Report: Impact of PrEP Training for Family Planning Providers on HIV Prevention Counseling and Patient Interest in PrEP in Atlanta, Georgia
- Author
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Lisa B. Haddad, Anandi N. Sheth, Ilyssa Tamler, Ashley L. Phillips, Jessica M. Sales, Leah Powell, and Carrie Cwiak
- Subjects
Adult ,Counseling ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Georgia ,Adolescent ,Anti-HIV Agents ,Safety net ,Human immunodeficiency virus (HIV) ,Sexually Transmitted Diseases ,HIV Infections ,030312 virology ,medicine.disease_cause ,Article ,03 medical and health sciences ,Young Adult ,medicine ,Disease Transmission, Infectious ,Ethnicity ,Humans ,Pharmacology (medical) ,Health Education ,Aged ,0303 health sciences ,Ideal (set theory) ,biology ,Middle Aged ,Patient Acceptance of Health Care ,biology.organism_classification ,Health Surveys ,Atlanta ,Infectious Diseases ,Family planning ,Family medicine ,Family Planning Services ,Female ,Pre-Exposure Prophylaxis ,Psychology - Abstract
BACKGROUND: Safety net family planning (FP) clinics provide vital care for women in high HIV-burden areas and may be ideal preexposure prophylaxis (PrEP) delivery sites. Yet, many FP providers lack knowledge about PrEP. SETTING: Four safety net FP clinics in Atlanta, Georgia. METHODS: We provided a 1.5-hour PrEP informational training for 28 providers working in these sites. To assess the training’s impact on PrEP counseling, we enrolled 500 female patients after training (47% ≤ 28 years; 69% black; 12% Hispanic) and determined their PrEP indication based on CDC guidelines. We conducted a postvisit survey to assess provider counseling and patients’ interest in PrEP and acceptance of off-site PrEP referral. RESULTS: From pre-training to post-training, provider PrEP knowledge and confidence to identify women who may benefit from PrEP significantly increased. Only 19% of women knew about PrEP before the visit. Among 376 sexually active women, 29% had risk consistent with PrEP indication. Among PrEP-indicated women, 66% reported the provider discussed PrEP, 29% were interested in taking PrEP, but only 18% accepted off-site PrEP referral. Most (76%) were more willing to take PrEP if provided by the FP clinic. CONCLUSIONS: After a brief PrEP training, most women with HIV-risk indicators received PrEP counseling during their visits. Once counseled, women expressed interest if it were offered at the FP clinic rather than through off-site referral. Findings highlight the potential impact that PrEP capacity building within safety net FP clinics in high HIV-burden areas may have on PrEP scale-up for women.
- Published
- 2019
47. Patient Recommendations for PrEP Information Dissemination at Family Planning Clinics in Atlanta, Georgia
- Author
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Anandi N. Sheth, Ashley L. Phillips, Tatiana Munoz, Carrie Cwiak, Jessica M. Sales, and Ilyssa Tamler
- Subjects
medicine.medical_specialty ,Georgia ,Human immunodeficiency virus (HIV) ,Information Dissemination ,HIV Infections ,medicine.disease_cause ,Hiv risk ,Ambulatory Care Facilities ,Article ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Obstetrics and Gynecology ,biology.organism_classification ,Atlanta ,Reproductive Medicine ,Risk indicator ,Family planning ,Family medicine ,Community setting ,Female ,Pre-Exposure Prophylaxis ,Thematic analysis ,business - Abstract
Objective Family planning (FP) clinics are an ideal setting to disseminate information about pre-exposure prophylaxis (PrEP), but little is known about women's preferences for learning about PrEP in this setting. Study design We surveyed 500 women seeking care at 4 FP clinics in Atlanta. Before their provider visit, participants completed an HIV-risk screener. After, we asked participants about the HIV prevention counseling they received and how clinics could share information about PrEP. We performed descriptive analyses on demographics, HIV risk, and PrEP awareness/interest, and conducted thematic analysis on open-ended responses. Results Only 18% knew about PrEP before the study; 28% of 376 sexually-active women had≥1 risk indicator consistent with PrEP eligibility. Three hundred forty seven women (69%) shared suggestions about how clinics should share PrEP information. We categorized suggestions into 4 themes - Advertising, Conversations, Awareness and Access. Participants (n=150) suggested clinics should advertise PrEP via brochures, posters, texts, or emails; 134 wanted providers to talk to patients about PrEP. Several (n=71) suggested sharing PrEP information broadly in the community and with other clinics/providers; others (n=11) wanted improved access to PrEP services. Conclusions Our results demonstrate overwhelming patient interest in learning more about PrEP through educational materials and directly from FP providers. Women were vocal about increasing PrEP awareness in the community, particularly among populations especially at risk for HIV (e.g., teens). These suggestions can be translated into actionable steps FP clinics can take to increase PrEP awareness and expand their reach to benefit women at risk for HIV. Implications High HIV rates among women in the South make it imperative to increase awareness of PrEP among women. Atlanta women seeking care in FP clinics valued learning about PrEP and recommended feasible strategies for disseminating information about PrEP in community settings, the clinic or during patient-provider discussion.
- Published
- 2019
48. Brief Report: PrEP Eligibility Among At-Risk Women in the Southern United States: Associated Factors, Awareness, and Acceptability
- Author
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Lakshmi Goparaju, Seble Kassaye, Margaret A. Fischl, Mirjam-Colette Kempf, Adaora A. Adimora, Audrey L. French, Dominika Seidman, Anar S. Patel, Elizabeth T. Golub, Anandi N. Sheth, Jessica M. Sales, Oni J. Blackstock, Gina M. Wingood, Cyra Christina Mehta, Jack DeHovitz, and Igho Ofotokun
- Subjects
Adult ,Health Knowledge, Attitudes, Practice ,MEDLINE ,Human immunodeficiency virus (HIV) ,Health knowledge ,HIV Infections ,030312 virology ,medicine.disease_cause ,Article ,03 medical and health sciences ,Risk Factors ,Environmental health ,Medicine ,Humans ,Pharmacology (medical) ,Black women ,High rate ,0303 health sciences ,Unsafe Sex ,business.industry ,Extramural ,Patient Acceptance of Health Care ,Southeastern United States ,Infectious Diseases ,Female ,Pre-Exposure Prophylaxis ,business - Abstract
BACKGROUND: Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV. SETTING AND METHODS: We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women’s Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models. RESULTS: Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models. CONCLUSIONS: Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.
- Published
- 2019
49. Integrating PrEP into Family Planning Services at Title X Clinics in the Southeastern US – Phase 1 (ATN 155) (Preprint)
- Author
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Jessica M. Sales, Cam Escoffery, Sophia A. Hussen, Lisa B. Haddad, Ashley Phillips, Teresa Filipowicz, Maria Sanchez, Micah McCumber, Betty Rupp, Evan Kwiatkowski, Matthew A. Psioda, and Anandi N. Sheth
- Abstract
BACKGROUND Black adolescent and young adult women (AYAW) in the Southern United States (US) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to health services that AYAW already trust, access routinely, and deem useful for their sexual health offers an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. These services include those of family planning (FP) providers in high HIV incidence settings. However, PrEP has not been widely integrated into FP services, including Title X-funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern US are uniquely positioned to be focal sites for conceptually-informed and thoroughly-evaluated PrEP implementation science studies. OBJECTIVE Assess inner and outer context factors (barriers and facilitators) that may influence the adoption of PrEP prescription and treatment services in Title X clinics serving AYAW in the Southern US. METHODS Phase 1 of Planning4PrEP is an explanatory sequential, mixed methods study consisting of a geographically-targeted online survey of Title X clinic administrators and providers in the Southern US, followed by key informant interviews (KIIs) among a purposively-selected subset of responders to more comprehensively access inner and outer context factors that may influence adoption and implementation of PrEP in Title X FP clinics in the South. RESULTS Phase 1 of Planning4PrEP research activities began in October 2017and are ongoing. To date, survey and KII administration is near completion with quantitative and qualitative data analysis scheduled to begin soon after data collection completion CONCLUSIONS This study seeks to assess inner and outer contextual factors (barriers and facilitators) that may influence the adoption and integration of PrEP prescription and treatment services in Title X clinics serving AYAW in the Southern US.
- Published
- 2018
50. Describing the Shape of the Relationship Between Gestational Age at Birth and Cognitive Development in a Nationally Representative U.S. Birth Cohort
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Jessica M. Sales, Jennifer L. Richards, Michael R. Kramer, W D Flanders, and Carolyn Drews-Botsch
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Population ,Gestational Age ,Academic achievement ,Article ,Young Adult ,03 medical and health sciences ,Age Distribution ,Child Development ,Cognition ,0302 clinical medicine ,Intellectual Disability ,030225 pediatrics ,Cognitive development ,Humans ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,Early childhood ,education ,Full Term ,education.field_of_study ,business.industry ,Obstetrics ,Gestational age ,Middle Aged ,Child development ,United States ,Reading ,Social Class ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cohort ,Educational Status ,Female ,business ,Infant, Premature ,Mathematics ,Maternal Age ,Demography - Abstract
Background Preterm children face higher risk of cognitive and academic deficits compared with their full-term peers. The objective of this study was to describe early childhood cognitive ability and kindergarten academic achievement across gestational age at birth in a population-based longitudinal cohort. Methods The study population included singletons born at 24–42 weeks gestation enrolled in the Early Childhood Longitudinal Study-Birth Cohort (n = 6150 for 2-year outcome, n = 4450 for kindergarten outcome). Home-based assessments measured cognitive ability at 2 years and reading and mathematics achievement at kindergarten age. Linear regression models estimated the association between gestational age and cognitive and academic scores using four different ways of modelling gestational age: continuous variable in linear and quadratic terms; categories for individual weeks; and clinical categories for early preterm, moderate preterm, late preterm, early term, full term, late term, and post-term. Results Children born at early preterm (24–27 weeks), moderate preterm (28–33 weeks), and late preterm (34–36 weeks) scored significantly worse than full-term (39–40 weeks) peers on 2-year and kindergarten assessments; however, no deficits were observed for early term (37–38 weeks). These categories were a clinically useful and parsimonious approach to stratifying risk of adverse cognitive and academic outcomes. Conclusions This study estimated the relative performance of children born at 24–42 weeks in a population-based birth cohort using multiple approaches to modelling gestational age, providing a more rigorous understanding of the relationships between the full spectrum of gestational age and cognitive and academic outcomes in early childhood and at school age.
- Published
- 2016
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