39,594 results on '"HIV Prevention"'
Search Results
2. Two into one does go: Formulation development of a multipurpose combination vaginal ring releasing dapivirine and metronidazole for prevention of HIV infection and treatment of bacterial vaginosis
- Author
-
Zhao, Xinyu, Boyd, Peter, Bashi, Yahya Dallal, Murphy, Diarmaid J., McCoy, Clare F., Coulter, Sophie, Laverty, Garry, and Malcolm, R. Karl
- Published
- 2023
- Full Text
- View/download PDF
3. Factors Associated with Usage of Oral-PrEP among Female Sex Workers in Nairobi, Kenya, Assessed by Self-Report and a Point-of-Care Urine Tenofovir Immunoassay.
- Author
-
Shah, Pooja, Spinelli, Matthew, Irungu, Erastus, Kabuti, Rhoda, Ngurukiri, Pauline, Babu, Hellen, Kungu, Mary, Champions, The, Nyabuto, Chrispo, Mahero, Anne, Devries, Karen, Kyegombe, Nambusi, Medley, Graham, Gafos, Mitzy, Seeley, Janet, Weiss, Helen, Kaul, Rupert, Gandhi, Monica, Beattie, Tara, and Kimani, Joshua
- Subjects
Adolescent girls and young women ,Female sex workers ,HIV prevention ,Hierarchical modelling ,Kenya ,PrEP ,Humans ,Female ,Sex Workers ,Kenya ,Pre-Exposure Prophylaxis ,Adult ,HIV Infections ,Tenofovir ,Self Report ,Anti-HIV Agents ,Medication Adherence ,Young Adult ,Adolescent ,Point-of-Care Systems ,Administration ,Oral ,Point-of-Care Testing ,Cross-Sectional Studies ,Social Stigma - Abstract
Pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV acquisition. We aimed to estimate usage of oral-PrEP, and factors associated with adherence among female sex workers (FSWs) in Nairobi, Kenya, using a novel point-of-care urine tenofovir lateral flow assay (LFA). The Maisha Fiti study randomly selected FSWs from Sex Worker Outreach Program clinics in Nairobi. Data were collected from 1003 FSWs from June-October 2019, including surveys on self-reported oral-PrEP adherence. Adherence was also measured using the LFA for HIV-negative FSWs currently taking oral-PrEP. Informed by a social-ecological theoretical framework, we used hierarchical multivariable logistic regression models to estimate associations between individual, interpersonal/community, and structural/institutional-level factors and either self-reported or LFA-assessed adherence. Overall, 746 HIV-negative FSWs aged 18-40 participated in the study, of whom 180 (24.1%) self-reported currently taking oral-PrEP. Of these, 56 (31.1%) were adherent to oral-PrEP as measured by LFA. In the multivariable analyses, associations with currently taking oral-PrEP included having completed secondary education, high alcohol/substance use, feeling empowered to use PrEP, current intimate partner, no recent intimate partner violence, having support from sex worker organisations, experiencing sex work-related stigma, and seeking healthcare services despite stigma. Associations with oral-PrEP LFA-measured adherence measured included having only primary education, experience of childhood emotional violence, belonging to a higher wealth tertile, and being nulliparous. Oral-PrEP adherence, measured by self-report or objectively, is low among FSWs in Nairobi. Programs to improve oral-PrEP usage among FSWs should work to mitigate social and structural barriers and involve collaboration between FSWs, healthcare providers and policymakers.
- Published
- 2024
4. A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California
- Author
-
Beltran, Raiza M, Hunter, Lauren A, Packel, Laura J, De Martini, Loriann, Holloway, Ian W, Dong, Betty J, Lam, Jerika, McCoy, Sandra I, and Ochoa, Ayako Miyashita
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Research ,HIV/AIDS ,Health Disparities ,Infectious Diseases ,Sexually Transmitted Infections ,Good Health and Well Being ,Humans ,California ,Pharmacists ,Pre-Exposure Prophylaxis ,Male ,Female ,HIV Infections ,Cross-Sectional Studies ,Adult ,Anti-HIV Agents ,Middle Aged ,Surveys and Questionnaires ,Attitude of Health Personnel ,Injections ,Young Adult ,HIV prevention ,pre-exposure prophylaxis ,long-acting injectable PrEP ,pharmacies ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundPre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.MethodsIn 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP.ResultsHalf of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services.ConclusionPharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.
- Published
- 2024
5. First Case of HIV Seroconversion With Integrase Resistance Mutations on Long-Acting Cabotegravir for Prevention in Routine Care
- Author
-
Koss, Catherine A, Gandhi, Monica, Halvas, Elias K, Okochi, Hideaki, Chu, Carolyn, Glidden, David V, Gomez, Lisa Georgetti, Heaps, Amy L, Conroy, Amy A, Tran, Michael, Shetler, Cory, Hoeth, Dianna, Kuncze, Karen, Louie, Alexander, Garza, Hana Rivera, Mugoma, Erick Wafula, Penrose, Kerri J, Chohan, Bhavna H, Ayieko, James O, Mills, Anthony, Patel, Rupa R, Mellors, John W, and Parikh, Urvi M
- Subjects
Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Genetics ,Sexually Transmitted Infections ,Women's Health ,Infectious Diseases ,HIV/AIDS ,Prevention ,Infection ,Good Health and Well Being ,breakthrough infection ,HIV prevention ,pharmacokinetics ,pre-exposure prophylaxis ,resistance ,Clinical sciences ,Medical microbiology - Abstract
BackgroundLong-acting cabotegravir (CAB-LA) is highly effective for HIV prevention, but delayed HIV diagnoses and integrase strand transfer inhibitor (INSTI) resistance were observed in trials. We report the first case in routine clinical care of HIV infection on CAB-LA with INSTI resistance.MethodsThe SeroPrEP study enrolls individuals in the United States who acquire HIV on pre-exposure prophylaxis modalities to assess diagnostics, antiretroviral (ARV) drug levels, resistance, and treatment outcomes. Resistance mutations in full-length HIV-1 integrase were identified by single-genome sequencing (SGS). Cabotegravir concentrations in plasma and hair segments were measured by liquid chromatography-tandem mass spectrometry.ResultsA 23-year-old gender-nonbinary person, male at birth, restarted CAB-LA 6 months after discontinuation due to losing insurance. Prior to restart, HIV-1 RNA was not detected, but 20 days elapsed before CAB-LA injection. After the second CAB-LA injection, HIV antigen/antibody returned reactive (HIV-1 RNA 451 copies/mL). SGS of plasma HIV-1 RNA identified INSTI mutation Q148R in 2/24 sequences 2 days postdiagnosis; commercial genotype failed amplification. Cabotegravir hair concentration was 0.190 ng/mg 2 weeks prediagnosis; plasma cabotegravir was high (3.37 μg/mL; ∼20× PA-IC90) 14 days postdiagnosis. Viral suppression was maintained for 6 months on darunavir/cobicistat/emtricitabine/tenofovir alafenamide, then switched to doravirine + emtricitabine/tenofovir alafenamide due to nausea.ConclusionsIn this first case of HIV infection on CAB-LA with INSTI resistance in routine care, cabotegravir resistance was detected only with a sensitive research assay. Accelerated pathways to minimize time between HIV testing and CAB-LA initiation are needed to optimize acute HIV detection and mitigate resistance risk. Sustained product access regardless of insurance is imperative to reduce HIV infections on CAB-LA.
- Published
- 2024
6. High Interest in the Use of mHealth Platform for HIV Prevention among Men Who Have Sex with Men in Nepal.
- Author
-
Gautam, Kamal, Paudel, Kiran, Ahmed, Ali, Dhakal, Manisha, Wickersham, Jeffrey, Poudel, Krishna, Pagoto, Sherry, Acharya, Bibhav, Deuba, Keshab, Valente, Pablo, and Shrestha, Roman
- Subjects
HIV Prevention ,Men who have sex with men ,Mobile Phone ,Nepal ,mHealth ,Humans ,Male ,Nepal ,HIV Infections ,Adult ,Telemedicine ,Cross-Sectional Studies ,Homosexuality ,Male ,Young Adult ,Adolescent ,Middle Aged - Abstract
Mobile technology growth in Nepal offers promising opportunities for using mobile health (mHealth) interventions to facilitate HIV prevention efforts. However, little is known about access and utilization of communication technology and their willingness to use mHealth for HIV prevention services in Nepal. We conducted a cross-sectional respondent-driven sampling survey of 250 MSM in Kathmandu Valley of Nepal from October to December 2022. We collected information on participant characteristics, HIV risk-related behaviors, ownership, or access to and frequency of use of communication technology (phones, tablets, laptops, and computers), and willingness to use mHealth to access HIV prevention services. Descriptive, bivariate, and multivariate linear regression analyses were performed. Almost all participants had smartphones with the internet (231/250, 92.4%) and accessed the internet daily (219/250, 87.6%) on the smartphone (236/250, 94.4%). The median score for willingness to use mHealth for HIV prevention was 10 (IQR: 3 to 17). Willingness to use mHealth was higher among those participants with a high school or above education (β = 0.223, p = < 0.001), had experienced violence (β = 0.231, p = 0.006), and had moderate to severe depressive symptoms (β = 0.223, p = < 0.001). However, monthly income above NPR 20,000 (USD 150) (β= -0.153, p = 0.008), disclosure of their sexual orientation to anyone (β= -0.159, p = < 0.007), and worry about being negatively judged by health care workers (β= -0.136, p = 0.023) were less willing to use mHealth strategies. The findings from this study suggest that there is a high willingness for utilizing mHealth interventions for HIV prevention in MSM population who are at higher risk of HIV acquisition.
- Published
- 2024
7. Occupational post-exposure prophylaxis among healthcare workers: a scoping review of factors affecting optimal utilization.
- Author
-
Auerbach, Judith, Malone, Siobhan, and Forsyth, Andrew
- Subjects
HIV prevention ,LMIC ,PEP ,healthcare workers ,occupational exposure ,post‐exposure prophylaxis ,Humans ,Post-Exposure Prophylaxis ,Health Personnel ,HIV Infections ,Occupational Exposure ,Africa ,Anti-HIV Agents ,Asia - Abstract
INTRODUCTION: Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs. METHODS: We conducted a scoping review to elucidate factors influencing HCWs use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post-exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes. RESULTS: Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEPs perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma. DISCUSSION: Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs PEP use. CONCLUSIONS: Lessons from HCWs experience in LMICs may inform understanding of PEP under-use among people in these settings with non-occupational exposures.
- Published
- 2024
8. We chose PrEP because I wanted to be sure that this child my wife was going to conceive was indeed mine. Factors influencing the choice of safer conception methods and experiences with its use: a qualitative study among HIV sero-discordant couples in Zimbabwe.
- Author
-
Brown, Joelle, Musara, Petina, Gitome, Serah, Chitukuta, Miria, Mataveke, Bismark, Chirenda, Thandiwe, Mgodi, Nyaradzo, Mutero, Prisca, Matubu, Allen, Chareka, Gift, Chasakara, Charles, Murombedzi, Caroline, Makurumure, Tinei, Hughes, Carolyn, Bukusi, Elizabeth, Cohen, Craig, Shiboski, Stephen, Darbes, Lynae, Rutherford, George, Chirenje, Z, and Mhlanga, Felix
- Subjects
ART ,HIV prevention ,HIV-discordant couples ,LMIC ,PrEP ,Safer conception ,Semen washing ,Vaginal insemination ,Zimbabwe ,sub-Saharan Africa ,Humans ,Zimbabwe ,Male ,Female ,Adult ,HIV Infections ,Qualitative Research ,Pre-Exposure Prophylaxis ,Fertilization ,Choice Behavior ,Interviews as Topic ,Middle Aged ,Pilot Projects ,Young Adult ,HIV Seropositivity ,Pregnancy - Abstract
BACKGROUND: Safer conception services are needed to minimize HIV transmission among HIV sero-discordant couples desiring pregnancy. Few studies have evaluated the choices couples make when they are offered multiple safer conception methods or real-world method acceptability. This paper addresses an important knowledge gap regarding factors that influence the choice of safer conception methods, couples actual experiences using safer conception methods, and why some couples switch safer conception methods. METHODS: Between February and June 2019, we conducted semi-structured in-depth interviews among 14 men and 17 women, representing 17 couples who exited the SAFER study-a pilot safer conception study for HIV sero-discordant couples in Zimbabwe that offered couples a choice of ART with monthly viral load monitoring (ART/VL), oral PrEP, vaginal insemination, and semen washing. All couples in SAFER had used at least two safer conception methods. RESULTS: We found that safer conception method choice often centered around a desire for intimacy, condomless sex, and certainty in the conception process, particularly for men. Method-related attributes such as familiarity, perceived ease of use, side effects, and perceived level of effectiveness in preventing HIV and achieving pregnancy influenced method choice, switching, and satisfaction. Concerns were expressed about each safer conception method and couples were willing to try different methods until they found method(s) that worked for them. The majority of participants reported having positive experiences using safer conception, especially those using ART/VL + PrEP, citing that they were able to attempt pregnancy for the first time with peace of mind and experienced joy and satisfaction from being able to achieve pregnancy safely. CONCLUSIONS: The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals.
- Published
- 2024
9. Neighborhood-level characteristics as effect modifiers on the efficacy of the MyPEEPS mobile intervention in same-sex attracted adolescent men.
- Author
-
Cordoba, Evette, Garofalo, Robert, Kuhns, Lisa, Pearson, Cynthia, Scott Batey, D, Janulis, Patrick, Jia, Haomiao, Bruce, Josh, Hidalgo, Marco, Hirshfield, Sabina, Radix, Asa, Belkind, Uri, Duncan, Dustin, Kim, Byoungjun, and Schnall, Rebecca
- Subjects
Adolescent health ,Community health ,Gay/bisexual/transgender persons ,Geospatial epidemiology ,HIV prevention ,HIV/AIDS ,Mens health ,Young sexual minority men - Abstract
To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men. A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.
- Published
- 2024
10. HPTN 083‐02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study
- Author
-
Psaros, Christina, Goodman, Georgia R, Lee, Jasper S, Rice, Whitney, Kelley, Colleen F, Oyedele, Temitope, Coelho, Lara E, Phanuphak, Nittaya, Singh, Yashna, Middelkoop, Keren, Griffith, Sam, McCauley, Marybeth, Rooney, James, Rinehart, Alex R, Clark, Jesse, Go, Vivian, Sugarman, Jeremy, Fields, Sheldon D, Adeyeye, Adeola, Grinsztejn, Beatriz, Landovitz, Raphael J, Safren, Steven A, and Team, the HPTN 083‐02 Study
- Subjects
Public Health ,Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Health Disparities ,Sexual and Gender Minorities (SGM/LGBT*) ,Infectious Diseases ,Clinical Trials and Supportive Activities ,Social Determinants of Health ,Minority Health ,Sexually Transmitted Infections ,HIV/AIDS ,Behavioral and Social Science ,Clinical Research ,Prevention ,Mental Health ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Good Health and Well Being ,Quality Education ,Humans ,Male ,Pre-Exposure Prophylaxis ,Medication Adherence ,HIV Infections ,Female ,Anti-HIV Agents ,Adult ,Transgender Persons ,Homosexuality ,Male ,Young Adult ,Pyridones ,Brazil ,Injections ,Pyridines ,Interviews as Topic ,Tenofovir ,Emtricitabine ,Tenofovir Disoproxil Fumarate Drug Combination ,Middle Aged ,Diketopiperazines ,HIV prevention ,injectable PrEP ,men who have sex with men ,pre-exposure prophylaxis ,qualitative ,transgender women ,HPTN 083‐02 Study Team ,pre‐exposure prophylaxis ,Public Health and Health Services ,Other Medical and Health Sciences ,Clinical sciences ,Epidemiology ,Public health - Abstract
IntroductionHPTN 083 demonstrated the superiority of long-acting cabotegravir (CAB-LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre-exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial.MethodsParticipants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non-adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis.ResultsParticipants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study-related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non-judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection-related anxiety, which abated with time and when given some measure of control (e.g. pre-injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules).ConclusionsRespondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non-judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.
- Published
- 2024
11. Sexual network characteristics, condomless anal intercourse, and the HIV care cascade among MSM living with controlled versus uncontrolled HIV infection in Lima, Peru: a population-based cross-sectional analysis
- Author
-
Harris, Carlyn L, Blair, Cherie S, Segura, Eddy R, Gutiérrez, Jessica, Lake, Jordan E, Cabello, Robinson, and Clark, Jesse L
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Pediatric AIDS ,Infectious Diseases ,Sexual and Gender Minorities (SGM/LGBT*) ,Clinical Research ,Sexually Transmitted Infections ,Behavioral and Social Science ,Prevention ,Pediatric ,HIV/AIDS ,Infection ,Good Health and Well Being ,HIV prevention ,Sexual networks ,Men who have sex with men ,Sexually transmitted infections ,Detectable viremia - Abstract
BackgroundDespite high rates of HIV transmission among men who have sex with men (MSM) in Lima, Peru, limited data exist on the sexual network characteristics or risk factors for secondary HIV transmission among MSM with uncontrolled HIV infection. We report the frequency of serodiscordant, condomless anal intercourse (CAI) and associated sexual network characteristics among MSM in Lima with detectable HIV viremia and compare to those with undetectable viremia.MethodsThis cross-sectional analysis includes MSM who tested positive for HIV-1 during screening for a trial of partner management and STI control (June 2022-January 2023). Participants were tested for HIV, gonorrhoea, chlamydia, and syphilis, and completed questionnaires on their demographic characteristics, sexual identity and behaviour, sexual network structures and engagement in HIV care.FindingsOf 665 MSM, 153 (23%) had detectable (>200 copies/mL) viremia. 75% (499/662) of men living with HIV were previously diagnosed, with 94% (n = 469/499) reporting that they were on ART, and 93% (n = 436/469) virally suppressed. 96% (n = 147/153) of men with detectable viremia reported serodiscordant CAI with at least one of their last three sexual partners, and 74% (n = 106/144) reported the same with all three of their recent partners. In contrast, 62% (n = 302/489) of men with undetectable viral load reported serodiscordant CAI with all of their last three partners (p
- Published
- 2024
12. Acceptability of the Dapivirine Vaginal Ring and Oral Truvada Among African Users in Late-Stage of Pregnancy.
- Author
-
Hawley, Imogen, Fairlie, Lee, Bunge, Katie, Mathebula, Florence, Etima, Juliane, Mutero, Prisca, Senyama, Linly, Mayo, Ashley, Stoner, Marie, Piper, Jeanna, Balan, Ivan, van der Straten, Ariane, and Montgomery, Elizabeth
- Subjects
Dapivirine ring ,HIV prevention ,Malawi ,Oral PrEP ,Pregnant women ,South Africa ,Uganda ,Zimbabwe ,Female ,Humans ,Pregnancy ,Africa ,Anti-HIV Agents ,Contraceptive Devices ,Female ,Emtricitabine ,Tenofovir Disoproxil Fumarate Drug Combination ,HIV Infections ,Pyrimidines ,Randomized Controlled Trials as Topic ,Clinical Trials ,Phase III as Topic - Abstract
The Microbicide Trials Network 042 study (MTN-042/DELIVER) is a two-arm, randomized, open-label Phase 3b trial that is evaluating the safety, adherence, and acceptability of the monthly ring and daily oral PrEP among HIV-uninfected pregnant people in four African countries. This analysis focuses on acceptability data captured qualitatively from a subset (n = 48) of the 150 people in the first cohort of the trial who were enrolled in late-stage pregnancy at 36 to 38 weeks gestational age and followed until after delivery. Single IDIs were conducted by trained interviewers at each clinic site using a semi-structured guide. Data excerpts of key codes pertaining to acceptability, pregnancy, and maternal health were summarized, reviewed and interpreted by multinational analyst teams. Although the product use period was relatively short, the data suggested several acceptability findings that may directly translate to longer durations of product use in pregnancy. The first was the overarching maternal sentiment that being able to protect both oneself and their baby was highly valued. The second was the importance of counseling support from providers not only because participants used methods that might generate side effects, but because pregnancy itself is a period with its own set of side effects. The third was that, similar to non-pregnant participants in other trials, here study products were generally liked and described as easy to use. Concerns about ring and oral PrEP use could be addressed with provider counseling and support and should form an essential component rollout among pregnant people.
- Published
- 2024
13. Formulation development of dual-compartment topical inserts combining tenofovir alafenamide and elvitegravir for flexible on-demand HIV prevention.
- Author
-
Agrahari, Vivek, Peet, M. Melissa, Chandra, Neelima, Ramalingam, Prakash, Gupta, Pardeep K., Jonnalagadda, Sriramakamal, Singh, Onkar N., McCormick, Timothy J., Doncel, Gustavo F., and Clark, Meredith R.
- Subjects
- *
RECTAL administration , *CURRENT good manufacturing practices , *TRANSGENDER people , *PRE-exposure prophylaxis , *TECHNOLOGY transfer , *HIV prevention - Abstract
Pre-exposure prophylaxis (PrEP) has emerged as a prominent approach for the prevention of HIV infections. While the latest advances have resulted in effective oral and injectable product options, there are still gaps in on-demand, event-driven, topical products for HIV prevention that are safe and effective. Here we describe the formulation development of a dual-compartment topical insert containing tenofovir alafenamide fumarate (TAF) and elvitegravir (EVG) that may be administered when needed, vaginally or rectally, pre- or post-coitus, for flexible HIV prophylaxis. Specifically, we describe the lab-scale formulation development, preclinical mucosal safety and pharmacokinetics (PK) testing in rabbits, long-term stability, and scale-up clinical manufacturing of the lead TAF/EVG (20 mg/16 mg) inserts, which are currently in clinical stages of development. As designed, the inserts are small, discreet and portable, offering a number of promising attributes, such as simple and robust direct-compression manufacturing, fast initial disintegration/dissolution, and suitable mechanical strengths showing low hardness (<8 kg), friability (<1 %), and moisture content (<1 %). The inserts initiated disintegration quickly (∼ ≤ 15 min) providing full in vitro release (>90 %) of TAF and EVG within 60 min of dissolution. The lead insert was selected from formulation prototypes that met the evaluation criteria for manufacturability and characterization, along with a dose-ranging PK study in non-human primates. Successful technology transfer for clinical development of the lead TAF/EVG (20 mg/16 mg) insert was confirmed under current Good Manufacturing Practices (cGMP) conditions. Based on the 12 months (lab-scale) and 24 months (clinical batch) stability data, the TAF/EVG inserts are projected to have a long shelf life of over 2 years, if stored at or below 30 °C/65 % RH. Overall, these newly designed topical inserts have formulation properties that enable stable storage and fast release of the antiretroviral payload from a small, portable and discreet dosage form. They are safe and effective when applied vaginally or rectally, before or after coitus, providing the basis for a new method of flexible on-demand HIV prevention for cisgender and transgender women and men. The TAF/EVG inserts are currently the most clinically advanced on-demand topical product, as attested by their completed and ongoing clinical trials. [Display omitted] • Lab-scale formulation development through technology transfer, scale-up and clinical batch manufacturing of TAF/EVG inserts • TAF/EVG inserts provide fast drug release, allowing for flexible pre- or post-exposure HIV prophylaxis • Repeated vaginal/rectal dosing in rabbits resulted in no safety concerns, high drug tissue levels, and low systemic exposure • The inserts are projected to have a long shelf life of more than two years if stored at or below 30 °C/65 % RH [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
14. Preferences for and acceptability of long-acting HIV prevention products among pregnant and lactating women accessing health services in Kenya: a mixed method cross-sectional analysis.
- Author
-
Ogello, Vallery, Mwangi, Paul, Kwena, Zachary, Thuo, Nicholas, Makokha, Catherine, Owidi, Emmah, Muteti, Nelson, Kiptinness, Catherine, Mugo, Nelly R., and Ngure, Kenneth
- Abstract
Background: Increased risk of HIV acquisition during pregnancy and lactation among women is evident, necessitating their inclusion in the evaluation of new HIV prevention interventions. Pregnant and postpartum women specifically face challenges with oral PrEP associated with stigma, and the burden of using other tablets. Long-acting products may address challenges related to oral PrEP, however, there is limited data on product-specific preferences and acceptability among pregnant and lactating women. Methods: We conducted a mixed-method study to assess the preferences and acceptability of long-acting PrEP modalities either under development or already established among pregnant and lactating women. We conducted quantitative surveys (n = 434) and in-depth interviews (n = 80) in central and western Kenya. We used descriptive statistics and categorical variables to summarize frequencies and proportions. Inductive and deductive content analytic approaches were used for in-depth interviews. Results: The median age of respondents was 25 years (IQR 19.3–31.0). Majority were married (263/434, 61%), had completed high school (222/434, 51%), with no condoms use in the prior 3 months (348/434, 80%). The most preferred PrEP formulations were injectable (251/434, 57%) and implantable (175/434, 40%) options. Participants who preferred injectable PrEP had 8.56 times higher odds of considering ease of use as a reason. (aOR = 8.56, 95% CI [3.81–20.48]) and 3.71 odds of choosing perceived discreteness (aOR = 3.71, 95% CI (1.57–9.97)) as their preference reasons. Participants who preferred Implant for HIV prevention had 2.31 odds of considering it due to perceived effectiveness in preventing HIV as a preference reason (aOR = 2.31, 95% CI (1.21—4.66)) and 2.53-fold of considering discreteness as a preference reason (aOR = 2.53, 95% CI (1.46—4.59)). From the in-depth interviews, women reported prospective acceptability due to the perceived convenience of LA products, perceived effectiveness, reduced cost, improved privacy, and reduced stigma. Women had concerns regarding the safety and efficacy of the products during pregnancy and lactation. Conclusion: Acceptability of LA products underscores the importance of considering the unique needs of pregnant and breastfeeding women in the development of future prevention interventions. Aligning preferences and needs would enhance the uptake and adherence outcomes of HIV prevention products. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
15. Linking Black women to PrEP care using warm handoff referrals from emergency departments to local PrEP clinics.
- Author
-
Mangum, Laurenia C., Heads, Angela M., Morris, Olivia, Sapp, Sarah, Campbell, Jeffrey, Hicks, Jovaun, Richmond, Teriya, McCants, Shadawn, Stotts, Angela, and Hill, Mandy J.
- Subjects
- *
AFRICAN Americans , *HIV , *HIV prevention , *PRE-exposure prophylaxis , *HOSPITAL emergency services , *BLACK women - Abstract
New Human Immunodeficiency Virus (HIV) cases continue to disproportionately burden cisgender Black/African American women in the United States due to a confluence of structural and systemic factors. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention option, yet there is a striking gap between PrEP eligibility and uptake among cisgender Black women. The current study evaluates a novel warm handoff process in a hospital emergency department setting linking eligible women to local PrEP clinics within 72 hours of hospital discharge in a large southwestern metropolitan city. Participants received follow-up telephone consultations at 1-month (T1), 3-months (T2), and 6-months (T3) post-enrollment. Of 40 participants, one was successfully linked to their initial PrEP clinic visit. One additional participant reported attending their PrEP visit, but staff were unable to confirm linkage. Twenty-eight percent of participants attended follow-up telephone visits at T1, T2, and T3, while 35% of participants attended a combination of some, and 37% of participants did not engage in any follow-up visits. Findings suggest that culturally tailored linkage interventions are suitable mechanisms for engaging cisgender Black women in PrEP care. Implications for future research include exploring the sustainability and scalability of such interventions are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
16. Factors associated with PrEP awareness and use among men who have sex with men who use drugs in the Southern United States.
- Author
-
Paschen-Wolff, Margaret M., Tross, Susan, Mindy Nelson, C., Hatch, Mary A., Meche, David, Ertl, Melissa M., Wright, Lynette, and Laschober, Tanja C.
- Subjects
- *
HIV infection risk factors , *HIV infection transmission , *PREVENTION of infectious disease transmission , *HIV prevention , *HEALTH literacy , *CROSS-sectional method , *RISK-taking behavior , *RESEARCH funding , *MULTIPLE regression analysis , *AGE distribution , *PRE-exposure prophylaxis , *MEN who have sex with men , *PSYCHOLOGY of drug abusers , *ANAL sex , *ODDS ratio , *MEN'S health , *CONDOMS , *HEALTH promotion , *EDUCATIONAL attainment - Abstract
Pre-exposure prophylaxis (PrEP) dramatically reduces HIV transmission risk. PrEP is underutilized among men who have sex with men who use substances (SU-MSM) in the Southern U.S., for whom there is limited research and high PrEP need. Using cross-sectional data from the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) 0082 study, we explored factors associated with PrEP awareness and use among 225 SU-MSM in the Southern U.S. Participants were recruited from community-based sexually transmitted infection clinics, syringe services programs and outpatient substance use treatment programs in eight cities across five Southern states with high HIV incidence. Multinomial logistic regressions examined PrEP awareness and use relative to sociodemographic factors, sexual behaviors and substance use. Results demonstrated overall high awareness, yet limited uptake of PrEP. Younger age, higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP awareness. Higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP use. Results highlight the need for innovative PrEP outreach to Southern SU-MSM that accounts for age, education and substances used. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
17. Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications.
- Author
-
Orser, Lauren, MacPherson, Paul, O'Byrne, Patrick, and Saeed, Maheen
- Subjects
- *
HIV infection risk factors , *HIV prevention , *PATIENT compliance , *RISK assessment , *RESEARCH funding , *CHI-squared test , *DESCRIPTIVE statistics , *PRE-exposure prophylaxis , *MEN who have sex with men , *ATTITUDE (Psychology) , *DRUGS , *RISK perception , *DATA analysis software , *MEDICAL referrals , *SOCIAL stigma - Abstract
HIV PrEP is over 99% effective in preventing HIV when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated whether gbMSM with objective risk factors for HIV who were automatically offered PrEP would have higher uptake and retention in PrEP care. For this, gbMSM with clinical evidence of HIV risk received a reflexive offer for PrEP from a nurse. The number of offers, referral acceptance, presentation to the first appointment, initiation and retention at 6 months were examined. Of 1181 gbMSM with objective HIV risk factors who were offered PrEP, only 50% accepted, 28% initiated and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between recent STI diagnosis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at-risk individuals were retained on PrEP because of an active offer. PrEP delivered by nurses was as effective as that delivered by infectious disease physicians. While active offer PrEP successfully brought at-risk individuals into care, more work is required to understand the perceptions of risk, the benefits and challenges of PrEP use, and how stigma and structural barriers affect retention among diverse groups affected by HIV. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
18. What makes peers credible? A qualitative analysis to operationalize peer credibility in HIV-prevention and treatment programs for Latino MSM.
- Author
-
Jaramillo, Jahn, Maya, Daniel H.A., Safren, Steven A., and Harkness, Audrey
- Subjects
- *
HIV prevention , *HEALTH literacy , *RESEARCH funding , *QUALITATIVE research , *FOCUS groups , *HISPANIC Americans , *AFFINITY groups , *INTERVIEWING , *HIV infections , *MEN who have sex with men , *RESEARCH methodology , *TRUST - Abstract
The potential of peers to be effective in delivering HIV interventions is linked at least in part to the degree to which they are perceived as credible sources of HIV-related information. This study aimed to operationalize qualities that would make a LMSM peer implementer credible. We conducted a qualitative analysis of semi-structured interviews with 20 LMSM and focus groups with 11 HIV service implementers. The parent study collected formative data to inform the design of a strategy to enhance the reach of HIV prevention and treatment services to LMSM. The present study examined participant views on qualities necessary for peer implementers to establish credibility among LMSM. We identified five themes regarding peer credibility, including (1) Peers must be trained in HIV prevention and care, (2) Peers should be verified and have a special designation indicating their knowledge and trustworthiness, (3) Peers should convey accurate information and not spread misinformation, (4) Peers should be relatable and interpersonally skilled, and (5) Peers should be engaged with the general LGBTQ + community to generate trust and credibility. Findings can inform the development of acceptable peer strategies for LMSM, peer recruitment, training, and peer supervision. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
19. Crisis prevention and response in Ryan white-funded HIV clinics.
- Author
-
Jenkins, Jakarra, Manders, Olivia C., Kokubun, Caroline W., Anderson, Kate, Sales, Jessica M., and Kalokhe, Ameeta S.
- Subjects
- *
HIV prevention , *MENTAL health services , *RESEARCH funding , *PATIENT safety , *INTERVIEWING , *CRISIS intervention (Mental health services) , *WOUND nursing , *PATIENT care , *HIV infections , *EMOTIONAL trauma , *THEMATIC analysis , *RESEARCH methodology , *ELECTRONIC health records , *CONCEPTUAL structures , *WELL-being , *DISEASE risk factors - Abstract
The high prevalence of trauma among people with HIV (PWH) and its negative impact on HIV outcomes underscore the need for Ryan White-funded HIV clinics (RWCs) to implement trauma-informed care (TIC) inclusive of crisis prevention and response. As part of a mixed-methods study of TIC practices employed by RWCs, we conducted qualitative interviews with 36 administrators, providers, and staff from Southeastern RWCs exploring crisis prevention and response strategies. Interviews were guided by the Substance Abuse and Mental Health Services Administration TIC framework and analyzed using a framework-driven, qualitative thematic approach. Crisis prevention strategies included: using electronic medical records to identify patients at risk for experiencing crisis, peer navigators to help patients bypass clinic public spaces, protocols to ensure perpetrator-victim pairs were not concurrently scheduled, and social workers to help patients identify crisis triggers and develop safety plans, plus dedicating safe spaces for patients with extensive trauma histories. Crisis response included patient referral to onsite and community crisis intake, trauma support, and mental health services and having onsite security personnel and alarm systems. Several participants requested additional training in response protocols. Study findings highlight the need for RW network-wide TIC training and sharing of best practices in crisis prevention and response. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
20. Intersectional stigma among Latino MSM and HIV prevention: barriers to HIV prevention and strategies to overcome the barriers.
- Author
-
Zhu, Helen, Stadnick, Nicole A., Stockman, Jamila K., Katague, Marina, Moore, Veronica, Torres, Vicente, Cano, Rosalinda, Penninga, Katherine, Aldous, Jeannette, and Tsuyuki, Kiyomi
- Subjects
- *
CULTURE -- Psychological aspects , *HIV prevention , *HEALTH services accessibility , *EMPATHY , *AIDS education , *RESEARCH funding , *QUALITATIVE research , *HISPANIC Americans , *INTERVIEWING , *MOBILE hospitals , *PRIVACY , *SERVICES for caregivers , *DESCRIPTIVE statistics , *MEN who have sex with men , *THEMATIC analysis , *HEALTH equity , *MEDICAL screening , *SEXUAL minorities , *SOCIAL stigma , *INTEGRATED health care delivery , *MEDICAL ethics - Abstract
Latino men, especially Latino men who have sex with men (LMSM), experience disparities in HIV prevention. Lack of attention to key barriers to care, such as stigma, result in inequitable access to HIV prevention and care for LMSM. This paper describes how intersectional stigma and related factors act as barriers to HIV prevention among Latino men and proposes strategies to overcome these barriers. Qualitative data were collected via in-depth interviews (n = 15) with Latino men about HIV prevention services, mobile outreach, peer navigation and care coordination, and analyzed using rapid qualitative methods. Three key themes emerged: (1) HIV stigma as a barrier to HIV testing, (2) sexual minority stigma as a barrier to accessing HIV prevention services and (3) strategies for stigma reduction, such as confidentiality, comprehensive education about HIV and prevention, and empathy and warmth from staff/care providers. Identified stigmas were intersectional. Addressing and reducing stigma is critical to engaging Latino men in HIV prevention and care, and requires strategies sensitive to the Latino cultural context and community. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
21. Characterizing syndemic HIV risk profiles and mHealth intervention acceptability among patients in the emergency department.
- Author
-
Glynn, Tiffany R., Khanna, Simran S., Hasdianda, Mohammad Adrian, O'Cleirigh, Conall, and Chai, Peter R.
- Subjects
- *
HIV infection risk factors , *HIV prevention , *HEALTH services accessibility , *RISK assessment , *CROSS-sectional method , *SUBSTANCE abuse , *SYNDEMICS , *RISK-taking behavior , *RESEARCH funding , *PATIENTS , *HOSPITAL emergency services , *DESCRIPTIVE statistics , *EMERGENCY medical services , *UNSAFE sex , *TELEMEDICINE , *STATISTICS , *SOCIODEMOGRAPHIC factors - Abstract
Syndemic theory proposes that co-occurring, mutually reinforcing psychosocial challenges (mental health, substance use, minority stress [discrimination/stigma], abuse, unmet basic needs) drive HIV risk behavior and create barriers to care for marginalized populations. It is thus necessary to address this holistic, complex picture in HIV prevention. Emergency department (ED) visits are a prime opportunity to engage key risk groups, given their low engagement in regular clinic-based care and high utilization of drop-in care via EDs. Yet, EDs are overburdened and under-resourced; mHealth may be a vehicle for intervention delivery in this context. This study aimed to 1) characterize demographics, syndemic profiles, and HIV risk behavior among ED patients and 2) assess the acceptability of addressing syndemic issues, particularly via an mHealth approach, in the ED. A sample of N = 198 ED patients with an indication of HIV risk completed a cross-sectional psychosocial assessment. Descriptive statistics and bivariate correlations between syndemic issues were examined. Patients presenting to the ED reported marginalized identities and complex syndemic profiles including mental health issues (77%), at risk substance use (30%), childhood abuse (35%), adult abuse (31%), minority stress (63%), and unmet basic needs (37%). Over half the sample reported at least three syndemic issues (54%). All syndemic issues were significantly correlated with each other, supporting a synergistic nature. The sample reported indicators of HIV risk including lack of PrEP awareness (33%)/uptake (94%), condomless sex (37%), and not testing for HIV (41%). Majority reported syndemic profiles have never been addressed in the ED (71%), think it would be helpful (88%), and willing to utilize mHealth during an ED visit (76%). The current study provides information to guide next steps for ED-based point-of-care HIV prevention, and more broadly, working towards equitable HIV prevention services reaching those missed by existing interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
22. Long-Acting Injectable Pre-Exposure Prophylaxis Perceptions and Preferences Among Transgender and Nonbinary Young Adults in the United States.
- Author
-
Gordon, Allegra R., Haiken, Samantha, Murchison, Gabriel R., Agénor, Madina, Hughto, Jaclyn M. W., and Nelson, Kimberly M.
- Subjects
- *
HIV prevention , *PATIENT compliance , *HEALTH services accessibility , *ANTIRETROVIRAL agents , *THERAPEUTICS , *RESEARCH funding , *QUALITATIVE research , *TRANSGENDER people , *INTERVIEWING , *GENDER affirming care , *DRUG administration , *MEDICAL care , *NONBINARY people , *COMMUNITIES , *ORAL drug administration , *POPULATION geography , *DECISION making , *CONTINUUM of care , *JUDGMENT sampling , *DESCRIPTIVE statistics , *PRE-exposure prophylaxis , *INJECTIONS , *ATTITUDE (Psychology) , *THEMATIC analysis , *TRANSPORTATION , *RACISM , *RESEARCH methodology , *RESEARCH , *CONCEPTUAL structures , *DRUGS , *DISCRIMINATION against people with disabilities , *HEALTH equity , *PSYCHOSOCIAL factors , *PATIENTS' attitudes , *ADOLESCENCE , *ADULTS - Abstract
Long-acting injectable pre-exposure prophylaxis for HIV prevention (LAI-PrEP) was approved for use in the United States in 2021, yet little is known about perceptions of LAI-PrEP among transgender and nonbinary young adults, a group that faces substantial barriers to HIV prevention. We investigated US transgender and nonbinary young adults' perceptions of and attitudes toward LAI-PrEP and how perceived advantages and disadvantages of LAI-PrEP related to the PrEP continuum of care. We conducted semi-structured interviews with 31 transgender and nonbinary young adults who reported oral PrEP use or were PrEP-eligible. We analyzed responses using both a deductive RADaR approach, to identify LAI-PrEP perceptions relevant to the PrEP continuum of care, and an inductive thematic analysis to explore key themes. In this study, all PrEP-experienced and most PrEP-naïve participants indicated an interest in LAI-PrEP, citing advantages over daily oral medication (e.g., fewer adherence challenges). Three key themes emerged: (1) Some participants linked perceived advantages of LAI-PrEP to experiences with gender-affirming care (e.g., familiarity with needles via hormone use). (2) Participants weighed trade-offs and contextual factors that influenced their LAI-PrEP preferences (e.g., interest contingent on whether location for receiving injection was geographically accessible). (3) Participants envisaged alternative delivery methods that could enhance LAI-PrEP acceptability and uptake (e.g., home injection). HIV prevention programs should incorporate the insights of transgender and nonbinary young adults to ensure that emerging HIV prevention technologies are accessible and responsive to the needs and concerns of people of all gender modalities. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
23. The role of network communication in mediating the effect of a social network intervention on HIV seroconversion among people who inject drugs in Ukraine.
- Author
-
Espinosa da Silva, Cristina, Pines, Heather A., Patterson, Thomas L., Brodine, Stephanie, Garfein, Richard S., Booth, Robert E., and Pitpitan, Eileen V.
- Subjects
HIV seroconversion ,RESOURCE-limited settings ,HIV infections ,HIV prevention ,TELECOMMUNICATION systems - Abstract
We examined the role of network communication about HIV-related topics in mediating the efficacy of a social network intervention on HIV seroconversion among people who inject drugs (PWID) in Ukraine, where Eastern Europe's second-largest HIV epidemic is concentrated among PWID. We used randomized controlled trial data from 1200 HIV-negative PWID (Ukraine; 2010–2012) in an inverse-odds weighted analysis to examine mediation by network communication. Network communication mediated 24 % (95 % CI= 19.22–29.38) of the intervention's effect. Integrating training to support network communication about additional HIV prevention resources could enhance the impact of social network HIV prevention interventions among PWID. • We assessed a mechanism through which a social network intervention reduced HIV seroconversion among PWID. • Network communication about HIV risk reduction mediated 24 % of the intervention's effect. • Our findings support increasing communication about HIV risk reduction in social networks of PWID. • Leveraging existing social networks could impact HIV harm reduction among PWID. [ABSTRACT FROM AUTHOR]
- Published
- 2025
- Full Text
- View/download PDF
24. Voluntary Medical Male Circumcision's (VMMC) strategy for HIV prevention in Sub-Saharan Africa, prevalence, risks, costs, benefits and best practice: A scoping review study protocol of progress and unfolding insights.
- Author
-
Maibvise, Charles, Munangatire, Takaedza, Tomas, Nestor, Ashipala, Daniel O., and Dlamini, Priscilla S.
- Subjects
- *
HIV prevention , *CIRCUMCISION , *SCIENCE publishing , *HIV infection transmission , *INSTITUTIONAL repositories , *HIV - Abstract
Campaigns to scale up Voluntary Medical Male Circumcision (VMMC) for the prevention of HIV transmission has been going on for years in selected Southern African countries, following recommendations from the World Health Organisations. Despite significant strides made in the initiative and its proven benefits, controversies surrounding the strategy have never ceased, and its future remains uncertain especially as some countries near their initial targets. Over the years, as the campaigns unfolded, a lot of insights have been generated in favour of continuing the VMMC campaigns, although some insights portray the impression that the strategy is not worthy of the risks and effort required, or that enough has been done, as the targets have now been achieved. This article proposes a scoping review that aims at synthesizing and consolidating that evidence into a baseline for a further systematic review aimed at developing sound recommendations for the future of the VMMC strategy for HIV prevention. The scoping review will target all scientific literature published on the Web of Science, Cochrane Library, Scopus, Science Direct, PubMed as well as grey literature from Google Scholar and WHO Institutional Repository for Information Sharing (IRIS) from the inception of the campaigns. The review shall be guided by Arksey and O'Malley's (2005) framework for scoping reviews, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist shall be followed. Discussion of the findings is envisioned to yield evidence that can be further analysed to give insights about risk/cost-benefits ratios of the strategy at this point in time as well as best clinical practices for the VMMC procedure, to inform the future of the strategy. This protocol is registered with the Open Science Framework, registration ID https://doi.org/10.17605/OSF.IO/SFZC9. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
25. HIV prevention and missed opportunities among people with recently acquired HIV infection: Α protocol for a systematic review.
- Author
-
Karakosta, Argyro, Ruiz-Burga, Elisa, Tariq, Shema, Touloumi, Giota, Jay Nicholls, Emily, Pantazis, Nikos, Jarrin, Inma, Van der Valk, Marc, Sabin, Caroline, Mussini, Cristina, Meyer, Laurence, Volny Anne, Alain, Carlander, Christina, Grabar, Sophie, Wittkop, Linda, Spire, Bruno, Gill, Jonh, Porter, Kholoud, and Burns, Fiona
- Subjects
- *
HIV prevention , *HIV infections , *HIV infection transmission , *MEMORY bias , *SCIENCE databases - Abstract
Background: Individuals who have recently acquired HIV represent a unique population because the time frame since HIV acquisition is relatively short and identification of missed HIV prevention opportunities is, therefore, closer to real time and less subject to recall bias. Identifying prevention measures used and missed opportunities for using them, can help stop further HIV transmission. Objectives: This systematic review aims to synthesise current global evidence on uptake of HIV prevention methods among people with recently acquired HIV from 2007, the year that the concept of ART as a prevention method was first introduced. Methods and analysis: MEDLINE/PubMed, EMBASE, PsycINFO, Cochrane and Web of Science databases, will be searched for articles published January 2007—December 2023. Eligible studies will be those that reported on HIV prevention methods among people with recently acquired HIV. Quality assessment of the studies selected will be undertaken, and reporting of the systematic review will be informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The systematic review is expected to provide comprehensive insights into the uptake, use and adherence to HIV prevention methods among individuals with recently acquired HIV. Analysis anticipates identifying gaps in prevention coverage, missed opportunities for intervention, and variations in access to and use of prevention strategies. Sociodemographic, personal, and behavioural factors influencing prevention uptake and adherence will also be synthesised. Conclusions: The findings will be of key relevance to researchers, healthcare providers including third sector organisations/ community groups and policymakers, as they will offer insight into better understanding of missed or failed HIV prevention efforts and will help ensure future efforts meet the needs of those in need of them. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
26. Contraceptive use, prevalence and incidence of pregnancy and associated factors among women participating in a vaccine preparedness cohort study in Masaka, Uganda, a retrospective secondary analysis.
- Author
-
Kusemererwa, Sylvia, Kansiime, Sheila, Nakamanya, Sarah, Mbabazi, Elizabeth, Fox, Julie, McCormack, Sheena, Kaleebu, Pontiano, and Ruzagira, Eugene
- Subjects
- *
HIV infection risk factors , *HIV infection epidemiology , *HIV prevention , *RISK assessment , *RESEARCH funding , *SECONDARY analysis , *MULTIPLE regression analysis , *PSYCHOLOGY of women , *RETROSPECTIVE studies , *DISEASE prevalence , *MULTIVARIATE analysis , *DESCRIPTIVE statistics , *LONGITUDINAL method , *CONTRACEPTION , *AIDS vaccines , *SOCIODEMOGRAPHIC factors , *CONFIDENCE intervals , *DISEASE incidence , *PREGNANCY - Abstract
Background: HIV prevention trials usually require that women of childbearing potential use an effective method of contraception. This is because the effect of most investigational products on unborn babies is unknown. We assessed contraceptive use, prevalence and incidence of pregnancy and associated factors among women in a HIV vaccine preparedness study in Masaka, Uganda. Methods: HIV sero-negative women (18–45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited between July 2018 and October 2022. Study procedures included collection of baseline socio-demographics and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Multivariable Logistic and Poisson regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy. Results: 652 (73%) of 891 women reported contraceptive use at baseline. Contraceptive use was higher in women who were in a relationship/married/cohabiting [adjusted odds ratio (aOR) = 1.60; 95% confidence interval (CI) 1.07–2.40] or divorced/separated/widowed [aOR = 1.86; 95% CI 1.24–2.79] versus those that were single, and among women reporting transactional sex [aOR = 2.10; 95% CI 1.16–3.80] versus those who did not. Baseline pregnancy prevalence was 4% (95% CI 3–6%) and lower in women who reported using long-acting contraceptive methods (aOR = 0.17; 95% CI 0.07–0.39) versus women who did not use these methods. A total of 65 pregnancies over 301.3 person-years of observation (PYO), an incidence rate of 21.6/100 (95% CI 16.9–27.5) PYO, higher among younger women (≤ 24 versus 25 + years, adjusted incidence rate ratio = 1.97; 95% CI 1.15–3.40). Conclusion: We observed a high pregnancy incidence in this cohort. Innovative strategies that promote sustained and consistent use of highly effective contraceptive methods especially for young women will be critical to the success of HIV prevention trials in this and similar populations. Plain Language Summary: HIV prevention trials require that women use contraception because the effect of most investigational products on unborn babies in not known. We assessed contraceptive use, incidence of pregnancy and factors associated with contraceptive use among women in a HIV vaccine preparedness study in Masaka, Uganda. HIV sero-negative women (18–45 years) at high risk of HIV infection identified through HIV counselling and testing (HCT) were recruited into the study between July 2018 and October 2022. Study procedures included collection of baseline socio-demographic and contraceptive use data, quarterly HCT, counselling on and provision of contraceptive methods onsite/through referral, and 6-monthly urine pregnancy tests. Regression analyses were conducted to determine factors associated with contraceptive use, prevalence, and incidence of pregnancy. Of 891 enrolled women, 73% reported contraceptive use at baseline. Contraceptive use was almost twice as high in women who were in a relationship/married/cohabiting or divorced/separated/widowed compared to those that were single. Women reporting transactional sex were twice as likely to use contraceptives than women who did not. 4% of the women were pregnant at the time of recruitment. Women using long-acting contraceptives had fewer pregnancies compared to non-users. Incidence of pregnancy was high, especially among younger women (≤ 24 years). Innovative strategies that promote sustained use of highly effective contraceptive methods especially for younger women will be critical to the success of HIV prevention trials. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
27. Acceptability and feasibility of a urine-based tenofovir adherence assay for monitoring and providing feedback on PrEP adherence in Kenya.
- Author
-
Okello, Phelix, Velloza, Jennifer, Ogello, Vallery, Owidi, Emmah, Mogere, Peter, Gakuo, Stephen, Chakravarty, Deepalika, Biwott, Charlene, Chatterjee, Purba, Mugo, Nelly, Gandhi, Monica, and Ngure, Kenneth
- Subjects
- *
MEDICAL personnel , *HIV prevention , *PRE-exposure prophylaxis , *WELL-being , *COUNSELING - Abstract
Objective measures of oral PrEP adherence – especially point-of-care (POC) measures that enable real-time assessment, intervention, and feedback – have the potential to improve adherence. Our team previously developed and validated a novel urine-based POC metric of PrEP adherence. In this study, we sought to determine whether this assay is acceptable and feasible among women taking PrEP and PrEP providers in Kenya. We conducted a trial comparing PrEP adherence counseling using the assay (intervention) versus standard-of-care counseling. We conducted in-depth interviews (IDIs) with intervention-arm participants (n = 20), and focus group discussions (n = 18) after the final (12-month) follow-up visit. We also conducted IDIs with purposively-sampled healthcare providers (HCPs) (n = 8) who administered the assay. The assay was highly acceptable among participants and HCPs as it was perceived to be accurate, could provide evidence of adherence, provides real-time results, and improves participant and provider relationship. HCPs reported that the assay facilitated counseling, seemed to increase adherence, and would be feasible to implement in routine care settings. Both participants and HCPs reported concerns about the assay related to the fear of being stigmatized for negative results, and test accessibility. Future studies should evaluate the impact of this novel test on adherence patterns over time in diverse populations.Trial registration: ClinicalTrials.gov identifier: NCT03935464. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
28. Perceptions on circumcision for HIV prevention: an application of the health belief model in a qualitative enquiry among young men in Eswatini.
- Author
-
Mamba, Samukelisiwe, Holton, Valerie, and Huang, Song-Lih
- Subjects
- *
HEALTH Belief Model , *SEXUALLY transmitted diseases , *HIV prevention , *UNSAFE sex , *HIV infections - Abstract
Voluntary medical male circumcision (VMMC) was identified as an effective strategy in HIV prevention. Although circumcision reduces heterosexual acquisition of HIV by 60%, there is low uptake of VMMC services in Eswatini. This study applies the health belief model (HBM) in understanding perceptions of young men in Eswatini towards VMMC for HIV prevention to upscale its adoption. A qualitative design was followed. Uncircumcised males aged 20–29 years were recruited among university students. In-depth interviews were conducted, transcribed verbatim, and transcripts imported into NVivo12 for line-by-line analysis. Emerging codes were categorized under major constructs of the HBM. Condomless sex, having multiple sex partners, genital caressing and being uncircumcised were seen as susceptible exposure. Taking life-long treatment and stigma were perceived as severity. However, participants had no intent to circumcise in the near future even after acknowledging the severity. Hygiene, prevention of sexually transmitted infections including HIV were perceived as main benefits. Fear of pain was perceived as key barrier impeding adopting circumcision and seemed to outweigh the benefits for some participants. These findings will assist programme planners to review and promote VMMC services that will improve good health and well-being of young men to avert HIV new infections in Eswatini. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
29. Barriers to PrEP use and adherence among adolescent girls and young women in Eastern, Southern, and Western Africa: a scoping review.
- Author
-
Admassu, Metasebia, Nöstlinger, Christiana, and Hensen, Bernadette
- Subjects
- *
TEENAGE girls , *HIV prevention , *YOUNG women , *MEDICAL sciences , *MEDICAL personnel , *PRE-exposure prophylaxis - Abstract
Background: Adolescent girls and young women (AGYW) are disproportionately affected by HIV. Globally, in 2022, an estimated 4000 AGYW 15–24 were newly infected with HIV weekly, and nearly 78% of these infections occurred in sub-Saharan Africa. Oral Pre-Exposure Prophylaxis (PrEP) is a key HIV prevention option within an overall HIV combination prevention approach with an efficacy of over 90% when taken correctly. However, uptake of and adherence to PrEP remains low, particularly among AGYW. This scoping review aims to map available evidence on factors that limit PrEP use among AGYW in Eastern, Southern, and Western African countries to inform research, policy, and practice on delivery of PrEP. Our review identified factors that affect PrEP journey among AGYW along the HIV prevention cascade. Methods: Guided by Arksey and O'Malley framework and using the PRISMA extension for scoping reviews, we searched the Web of Science, Global Health, and PubMed databases. Our review focused on oral PrEP, specifically papers reporting on barriers to PrEP experienced by AGYW, and peer-reviewed English-language articles published between 2012 and 2023. Results: Of 1063 papers screened, 25 were included. Over half (60%) of the studies were qualitative; 72% were conducted in Kenya and South Africa. The barriers affecting motivation were, fear of side effects and pill burden, percieved low HIV risk, perceived stigma, PrEP use disapproval from parents and partners. PrEP access was limited by healthcare providers' stigma, isolated clinic setup, and lack of resources. Effective PrEP use was limited by a lack of parental or partner support, stigma, and lifestyle changes. Conclusions: Adolescent girls and young women face multiple and often intersecting barriers to effective PrEP use with stigma being a factor cross-cutting all steps of the prevention cascade. Similarly, lack of social support, reflected through disapproval and judgmental attitudes and low HIV risk perception, also affected two steps of the prevention cascade. Our review identified gaps in available evidence, with most studies conducted in only two countries and few quantitative studies available. Improving PrEP uptake and adherence requires interventions that address barriers across the cascade, with a particular focus on stigma and social support. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
30. Non-adherence, discontinuation, and seroconversion among people on daily HIV pre-exposure prophylaxis (PrEP) in Brazil: a nationwide cohort study.
- Author
-
Crepalde-Ribeiro, Kennedy, Braga, Maria das Graças, Silveira, Micheline Rosa, Moura, Alexandre Sampaio, Vaz-de-Melo, Pedro O.S., Ferraz, Matheus Marchesotti Dutra, Pearson, Sallie-Anne, and Costa, Juliana de Oliveira
- Subjects
- *
HIV seroconversion , *HIV prevention , *PRE-exposure prophylaxis , *HIV infections , *PATIENT compliance - Abstract
The goal of this study was to evaluate characteristics associated with Pre-exposure Prophylaxis for HIV infection (PrEP) non-adherence or discontinuation in Brazil and assess the association between these outcomes and HIV seroconversion. We used linked national dispensing and pathology data to identify people aged 14+ years initiating PrEP in 2018. We estimated non-adherence using the proportion of days covered (PDC), defining non-adherence as PDC < 60%. We defined discontinuation as a gap in therapy of at least 120 days. We used logistic regression models to assess characteristics associated with non-adherence or discontinuation within 365 days and to assess HIV seroconversion and its association with non-adherence or discontinuation. In 2018, 5100 people initiated PrEP; 34.4% (95%CI 33.1%; 35.7%) were non-adherent and 34.3% (95%CI 33.0%; 35.6%) discontinued. People aged 34 years or less, women, people with lower education levels, or living in the Northern region of Brazil were more likely to be non-adherent or discontinue therapy. Thirty people (0.6% 95%CI 0.4%; 0.8%) seroconverted. HIV seroconversion was associated with PrEP non-adherence or discontinuation (OR = 6.2 for both). Non-adherence and discontinuation were common in people initiating PrEP and strongly associated with HIV seroconversion. Our work identifies populations at higher risk of non-adherence or discontinuation which could be targeted in interventions to reduce new HIV cases in Brazil. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
31. Disparities in PrEP use and unmet need across PEPFAR-supported programs: doubling down on prevention to put people first and end AIDS as a public health threat by 2030.
- Author
-
Mukherjee, Trena I., Yep, Mitchell, Koluch, Megan, Abayneh, Sisay Alemayehu, Eyassu, Gizachew, Manfredini, Elizabeth, and Herbst, Sara
- Abstract
Background: In 2023, an estimated 1.3 million people newly acquired HIV. In the same year, 3.5 million individuals received pre-exposure prophylaxis (PrEP), falling short of the UNAIDS target of 21.2 million by 2025. With over 90% of global PrEP programming supported by PEPFAR, a better understanding of disparities in PrEP provision is needed to inform PEPFAR's approach to reach and deliver prevention services and achieve UNAIDS 95-95-95 goals in all populations by 2025. The objective of this paper is to assess unmet PrEP need in PEPFAR-supported countries. Methods: We analyzed FY2023 Monitoring, Evaluation, and Reporting (MER) results from 48 PEPFAR-supported countries to calculate PrEP-to-need ratios (PnR) by geography and population. PnR offers an ecological measure to identify disparities and missed opportunities for PrEP programming. PnR was calculated as the ratio of PrEP users to the number of positive HIV tests. PrEP users are defined through new initiations (PrEP_NEW) and re-initiations or continuation (PrEP_CT). HTS_TST_POS measures the number of positive HIV tests and was used as a proxy for new diagnoses. PnR was also calculated using Naomi-estimated 2023 HIV incidence, where available. A higher PnR indicates more PrEP users relative to PrEP need in a population. Results: In FY23, 1,760,888 people initiated PrEP, and 1,736,144 people tested positive for HIV. PnR ranged from 0.12 (India) to 6.46 (Brazil), and 19 (40%) countries had fewer PrEP users than positive HIV tests (PnR <1.0). By population, people 15–24 years old, people who inject drugs, and transgender populations had the highest median PnR. When examining estimated HIV incidence, Mozambique and South Africa reported lower than average PnR and higher than average HIV incidence. Conclusion: PrEP use relative to population need varied greatly by country and subpopulation across PEPFAR programs, suggesting a need for greater advocacy, inclusivity, accessibility, and integrated prevention programming. PnR may be a useful indicator of population PrEP coverage and unmet need, and can inform effective, data-driven, and person-centered PEPFAR prevention programming and policies. Tailoring PrEP scale-up strategies by age, sex, key population, and geography is crucial to achieving UNAIDS targets and ending the AIDS epidemic as a public health threat for all by 2030. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
32. Anticipated facilitators and barriers for long-acting injectable antiretrovirals as HIV treatment and prevention in Vietnam: a qualitative study among healthcare workers.
- Author
-
Dang, My T., Le, Yen N., Naz-McLean, Sarah, Vo, Nhung T. T., Do, Phuong T., Doan, Linh T. T., Do, Nhan T., Nguyen, Mai T., Phan, An H., Dziuban, Eric J., Bhatia, Ramona, Cosimi, Lisa, Phan, Huong T. T., and Pollack, Todd M.
- Subjects
- *
MEDICAL personnel , *HIV prevention , *MEDICAL sciences , *PUBLIC health , *ORAL medication - Abstract
Background: Long-acting injectable antiretrovirals (LAI-ARVs) for HIV prevention and treatment have been demonstrated in clinical trials to be non-inferior to daily oral medications, providing an additional option to help users overcome the challenges of daily adherence. Approval and implementation of these regimens in low- and middle-income settings have been limited. Method: This study describes the anticipated barriers and facilitators to implementing LAI-ARVs in Vietnam to inform future roll-out. From July to August 2022, we conducted 27 in-depth interviews with healthcare workers and public health stakeholders involved in HIV programs at national, provincial, and clinic levels across four provinces in Vietnam. The interviews followed a semi-structured questionnaire and were audio recorded. Data were analyzed using a rapid thematic analysis approach to identify facilitators and barriers to the adoption of LAI-ARVs. Results: In total, 27 participants from 4 provinces were interviewed including 14 (52%) men and 13 (48%) women. Participants median age was 48 years and they had 11.5 years of experience with HIV services and programs. Perceived user-level facilitators included the greater convenience of injectables in comparison to oral regimens, while barriers included the increased frequency of visits, fear of pain and side effects, and cost. Clinic-level facilitators included existing technical capacity to administer injections and physical storage availability in district health centers, while barriers included lack of space and equipment for administering injections for HIV-related services, concerns about cold chain maintenance for LAI-ART, and workload for healthcare workers. Health system-level facilitators included existing mechanisms for medication distribution, while barriers included regulatory approval processes and concerns about supply chain continuity. Conclusion: Overall, participants were optimistic about the potential impact of LAI-ARVs but highlighted important considerations at multiple levels needed to ensure successful implementation in Vietnam. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
33. Oral pre-exposure prophylaxis implementation in South Africa: a case study of USAID-supported programs.
- Author
-
Milimu, Jerome Wendoh, Parmley, Lauren, Matjeng, Mahlodi, Madibane, Mathata, Mabika, Mandisi, Livington, Jacques, Lawrence, Joseph, Motlhaoleng, Orapeleng, Subedar, Hasina, Tsekoa, Rethabile, and Mthembu, Zandile
- Abstract
Since the introduction of oral pre-exposure prophylaxis (PrEP) in 2016, countries have successfully scaled-up PrEP to populations at risk of HIV acquisition, including key populations, serodiscordant couples and pregnant women. Between 2016 and 2023, there were over 5.6 million oral PrEP initiations globally. Of these, over 1.2 million occurred in South Africa, with nearly 700,000 implemented through USAID/South Africa's PEPFAR program. This case study uses WHO's Building Blocks for Health Systems Strengthening to describe USAID's oral PrEP program in South Africa, reporting experiences and lessons learned in 14 districts across 7 provinces. Key lessons include: (i) Substantial donor financial investment was critical for expanding oral PrEP in South Africa, but sustained leadership and investment from government stakeholders, such as the Department of Health and the National Treasury, have been essential for sustainability. Despite fluctuations in USAID funding, annual PrEP initiations have continued to increase in USAID-supported districts largely due to local leadership. (ii) Health information and supply chain systems required agility to monitor oral PrEP introduction and scale-up. When systems lacked agility, temporary solutions like the development of interim reporting tools were necessary. (iii) Integrating community-based and facility-based service delivery supported client-centered care. Nurses and lay health workers contributed to over 80% of the full-time equivalents supporting PrEP under USAID's human resources for health portfolio. (iv) Integrating sexual and reproductive health services with oral PrEP service delivery provided clients with comprehensive, client-centered care. (v) Other client-centered care included differentiated service delivery options, such as mobile and gazebo modalities, and expanded PrEP choice through implementation science activities for new PrEP products. (vi) USAID-supported PrEP initiations have been highest among females of reproductive age in the general population and men who have sex with men among key populations, priority populations in South Africa. As done in this case study, sharing best practices and lessons learned from USAID/South Africa's oral PrEP program can strengthen the implementation evidence base and inform more efficient PrEP service delivery, particularly as new PrEP products become available. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
34. Readiness to implement contingency management to promote PrEP initiation and adherence among people who inject drugs: results from a multi-site implementation survey.
- Author
-
Pickering, Eleanor, Viera, Adam, Sung, Minhee L., Davidson, Daniel, Bailey, Genie, Buchelli, Marianne, Jenkins, Mark, Kolakowski, Jennifer, Maier, Leah, Edelman, E. Jennifer, and Rash, Carla J.
- Subjects
HIV prevention ,DRUG abuse ,PUBLIC health ,COMMUNITY organization ,DIAGNOSIS of HIV infections ,PRE-exposure prophylaxis - Abstract
Background: Contingency management (CM), an incentive-based intervention to encourage target behaviors, effectively promotes medication adherence. However, efforts to extend CM to HIV pre-exposure prophylaxis (PrEP) have been lacking. As part of a randomized clinical trial to promote HIV Prevention among people who inject drugs (PWID), we examined the readiness of staff in community-based organizations serving PWID to implement CM for PrEP uptake and adherence in this population. Methods: From April to August 2022, we conducted a survey of staff from four community-based organizations providing HIV testing, harm reduction, and outreach services in the northeastern United States. We assessed knowledge and attitudes regarding PrEP for PWID on five-point Likert scales (e.g., Poor to Excellent, Not at all to Extremely). Using a modified version of the Contingency Management Beliefs Questionnaire, we assessed the degree to which attitudes about CM for HIV prevention influenced interest in its adoption on a scale from "1-No influence at all" to "5-Very strong influence". We explored endorsement patterns, along with average values of individual items and subscale scores. Results: Among 271 staff invitations, 123 (45.4%) responded. The majority (88.6%) of respondents reported prior PrEP awareness, with a mean self-rated knowledge of 2.98 out of 5 (SD = 1.1). Attitudes towards PrEP, including its relevance to and importance for clients (both means = 4.3), efficacy (mean = 4.5), and safety (mean = 4.2), were positive. Items related to practicality and confidence in providing PrEP-related care had relatively lower ratings. Respondents endorsed influential generalized (mean = 2.1) and training-related (mean = 2.5) CM implementation barriers less frequently than positive attitudes towards CM (mean = 3.6). Staff favored adding CM to existing services (mean = 3.8), and highly endorsed it as "useful for targeting HIV prevention with PrEP" (mean = 3.7). Conclusions: Respondents generally supported the use of CM to promote HIV prevention among PWID and favored adding it to their existing services. Though respondents understood the value of both PrEP and CM to support HIV prevention activities, findings corroborate research citing relative lack of knowledge and confidence regarding PrEP management among clients, potentially detracting from implementation readiness. Trial Registration Number: NCT04738825. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
35. Factor structure of the HIV-SM LMIC self-management questionnaire for people living with HIV in low- and middle-income countries.
- Author
-
Dadi, Tegene Legese, Medhin, Girmay, and Spigt, Mark
- Subjects
- *
HIV prevention , *MIDDLE-income countries , *CROSS-sectional method , *MULTITRAIT multimethod techniques , *HEALTH literacy , *GOODNESS-of-fit tests , *SELF-management (Psychology) , *RESEARCH methodology evaluation , *QUESTIONNAIRES , *DESCRIPTIVE statistics , *SELF-control , *PSYCHOLOGY of HIV-positive persons , *PSYCHOMETRICS , *RESEARCH methodology , *FACTOR analysis , *LOW-income countries , *WELL-being ,RESEARCH evaluation - Abstract
Introduction: Despite the need for reliable questionnaires to monitor self-management in chronic disease patients, such tools are lacking in developing countries. This study aims to pilot and assess the construct validity of the HIV-SM LMIC questionnaire. Method: The validation of the HIV-SM LMIC questionnaire involved two cross-sectional studies in Ethiopia. The first round, for exploratory factor analysis (EFA), included 261 patients, while the second round, for confirmatory factor analysis (CFA), included 300 patients. Data was collected using the Kobo Collect electronic data entry template. Result: The sample adequacy test showed a good value of 0.82. In the first round, 6 of the 32 items were not loaded, forming three factors in the EFA. Four of these items were dropped, but two (PSMB2 and PSMB12) were retained for their content. In the second round, CFA on the remaining 28 items led to dropping 8 more items due to conceptual overlap, resulting in a 20-item questionnaire. The final items were structured into three dimensions: awareness and well-being (4 items), self-regulation (6 items), and self-management practices (10 items). Conclusion: The study refined the original 32-item HIV-SM LMIC questionnaire to a validated 20-item, three-dimensional tool with an acceptable goodness of fit. The authors recommend further cross-cultural and predictive validation and adaptation for newly diagnosed HIV patients, those with poor treatment outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
36. Addressing Pre-exposure Prophylaxis Awareness and Knowledge Gaps Among Lebanese Medical Professionals: A Cross-Sectional Study.
- Author
-
Azzi, Akel, Chartouni, Carine, Sakr, Charlyne, Ibrahim, Racha, Bou Chebel, Zeina, Haddad, Elie, Chehata, Nabil, Choucair, Jacques, Pozniak, Anton, and Saliba, Gebrael
- Subjects
- *
CAREER development , *MEDICAL students , *MEDICAL personnel , *HIV prevention , *PRE-exposure prophylaxis - Abstract
OBJECTIVE: In Lebanon, HIV prevalence among key populations such as men who have sex with men is high at 12%, warranting a need for targeted healthcare efforts. Pre-exposure prophylaxis (PrEP) is an effective prevention measure, yet global challenges persist, including limited awareness of PrEP among healthcare professionals. This study investigates PrEP awareness within the Lebanese medical community. METHODS: A survey targeted 201 participants from the Saint Joseph University of Beirut, Faculty of Medicine, comprising students, residents, and physicians. Analyses, including chi-square tests, mid- P exact test, and point-biserial correlation, assessed PrEP knowledge and perceptions. RESULTS: Significant disparities in PrEP awareness were noted among medical students, residents, and physicians, revealing misconceptions about its purpose, administration, and effectiveness. Positive correlations between age and awareness among medical students suggest evolving awareness during medical education. Residents exhibited higher awareness compared to physicians, emphasizing the impact of recent training. No significant correlation based on specialty was found among physicians, indicating the need for uniform PrEP education across all medical fields. CONCLUSION: Addressing PrEP awareness gaps among medical professionals is crucial for effective HIV prevention in Lebanon, necessitating tailored educational strategies integrated into medical curricula and ongoing professional development. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
37. Developing an ethical framework for the recruitment of people who inject drugs experiencing incarceration in HIV prevention research: a qualitative study.
- Author
-
Murphy, Matthew, Gomes, Nyx, Kane, Kimberly, Rich, Josiah D., Goldsamt, Lloyd, Ahluwalia, Jasjit S., Guthrie, Kate M., Ramsey, Susan E., and Vargas, Sara
- Subjects
- *
HIV prevention , *COMMUNITY health services , *PUBLIC health , *PRISONERS , *MEDICAL sciences , *PRE-exposure prophylaxis - Abstract
Background: HIV disproportionately impacts people who experience incarceration. Incarceration represents an opportunity to engage in HIV prevention care for individuals who often experience a number of barriers accessing health services in the community. The development of evidence-based practices promoting pre-exposure prophylaxis for HIV prevention (PrEP) is crucial for ending the HIV epidemic within this highly marginalized population. However, PrEP research within carceral facilities has been limited and is hampered in part by the lack of ethical guidance on conducting HIV prevention research in this unique setting where incarcerated individuals are categorized as a vulnerable population requiring specific protections. This lack of knowledge is particularly striking when considering the lack of input from incarcerated individuals themselves on the responsible conduct of research, which is critical to understanding ways to ensure participant autonomy while avoiding coercive practices in research activities. Methods: In order to gain a better understanding of ethical approaches to the conduct of HIV prevention research among incarcerated individuals, we conducted qualitative interviews with 21 incarcerated men who reported injecting drugs and met clinical criteria for PrEP use. The interview topics included HIV knowledge, PrEP knowledge, stigma, and perceptions related to ethical research practices. Results: Themes identified included how forced abstinence during incarceration can negatively affect research participation, the importance of participant comfort as it relates to ensuring autonomy in decision making, a desire for person centred approaches in research activities, study staff characteristics impacting participant experience, and perceptions of carceral staff as members of research teams. Conclusions: The results of this study indicate that conducting research focused on improving PrEP use in a carceral environment has support among those experiencing incarceration. However, researchers should place the participant experience at the center of research protocol development. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
38. Brief Communication: Factors associated with willingness to use long-acting injectable Cabotegravir for HIV pre-exposure prophylaxis (PrEP) among female undergraduate students at a Ugandan university.
- Author
-
Atuhaire, Bridget, Muteebwa, Laban, Nabunya, Racheal, Muhindo, Richard, Ngabirano, Tom Denis, Osingada, Charles Peter, and Muwanguzi, Patience A.
- Subjects
- *
HIV infection epidemiology , *HIV prevention , *CROSS-sectional method , *POISSON distribution , *RISK-taking behavior , *HEALTH attitudes , *RESEARCH funding , *UNDERGRADUATES , *HUMAN sexuality , *PSYCHOLOGY of women , *DESCRIPTIVE statistics , *PRE-exposure prophylaxis , *INJECTIONS , *SURVEYS , *SEX customs , *HEALTH behavior , *PYRIDINE , *PSYCHOLOGY of college students , *ANTI-HIV agents , *STUDENT attitudes , *CONFIDENCE intervals , *ALCOHOL drinking , *PREVENTIVE health services , *REGRESSION analysis - Abstract
Background: We assessed the willingness of female students at a Ugandan public university to use long-acting Cabotegravir (CAB-LA) for HIV prevention, given their high prevalence of HIV risk behaviours. Methods: Using an online questionnaire, this cross-sectional study surveyed 346 female undergraduate students aged 18–25. Factors influencing their willingness were analysed with modified Poisson regression and robust standard errors. Results: More than half, 56.7% (95% CI: 51.4 to 61.8), were willing to use CAB-LA. Willingness was significantly associated with being sexually active in the past 3 months, using alcohol in the past 6 months, or being in the 4th year of study compared to the 1st year. Conclusion: Educational initiatives on innovative HIV prevention strategies, such as CAB-LA, should be introduced early in university students' studies to increase awareness and acceptance. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
39. Implementation fidelity and client satisfaction in HIV testing and counseling services: perspectives from facilities and clients in Gondar city, Northwest Ethiopia.
- Author
-
Terefe, Bewuketu, Techane, Masresha Asmare, Assimamaw, Nega Tezera, and Kebede, Adane
- Subjects
- *
CLIENT satisfaction , *DIAGNOSIS of HIV infections , *HEALTH facilities , *HIV prevention , *COUNSELING , *ORPHANS - Abstract
Background: Individuals can learn their HIV status through voluntary HIV counseling and testing (VCT), which also serves as a crucial access point for prevention, treatment, care, and support programs. VCT has grown in significance as a component of HIV prevention and care in Ethiopia because of its viability and convenience for the wider community, as well as its ability to provide access to care, treatment, and support for those in need. However, studies on this topic are limited, particularly because the fidelity of Ethiopia's VCT program has not been evaluated or measured. Therefore, this study aimed to assess the current implementation status of VCT services and client satisfaction in public health facilities in Gondar City. Methods: This cross-sectional study was conducted out from June to July 2022. This study involved 130 counselors and 423 VCT users. Information on physical facilities, client satisfaction, and counselor impressions of the services was gathered using a standardized and pre-tested questionnaire, observation checklists, and resource inventory checklists developed from Ethiopian national VCT guidelines, the World Health Organization, United Nations AIDS, and previous literature. In the bivariate and multiple logistic regression models, variables with p values ≤ 0.2 and < 0.05 were chosen as candidate variables and associated variables, respectively. Results: The overall implementation and facility readiness for VCT services was found to be 67%. The overall client satisfaction rate was 71% (95% CI: 69.7%, 72.7%). Age of participants from 25 to 30 years (AOR = 1.11, 95% CI, 1.02–1.21), 31–35 years (AOR = 2.03, 95% CI, 1.88–2.18), higher educational status (AOR = 1.18, 95% CI, 1.03–2.01), and comprehensive knowledge of HIV/AIDS (AOR = 2.42, 95% CI, 1.53,3.32) were positively associated with client satisfaction, whereas fear of confidentiality (AOR = 0.42, 95% CI, 0.20, 0.63) and longer waiting time (AOR = 0.09, 95% CI, 0.04, 0.15) were negatively associated with the outcome variable. Conclusion: The implementation fidelity was evaluated to be low; however, client satisfaction was somewhat good. Based on the descriptive and analytical findings, providers' adherence to standards, strong communication with leaders, and the preservation of client confidentiality and privacy must be ensured by having VCT centers meet the necessary standards as outlined in the HTC guidelines to increase client uptake and satisfaction. To enhance the quality of the program, it is important to address clients' educational levels, improve participants' understanding of VCT, promote youth participation, and provide training to service providers. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
40. Economic evaluation of short message service intervention for HIV prevention among men who have sex with men in China: a modelling study.
- Author
-
Fan, Rui-Qi, Shu, Jun-Tao, Huang, Hao, Shi, Ling-Yi, Ge, Qi-Wei, Zhuang, Xun, Zou, Mei-Yin, and Qin, Gang
- Subjects
- *
HIV infections , *COST benefit analysis , *HIV prevention , *HEALTH care rationing , *PUBLIC health - Abstract
Background: Men who have sex with men (MSM) globally face a high risk of HIV infection. Previous studies indicate that customized short message service (SMS) interventions could reduce high-risk behaviors that associated with HIV transmission. This study aims to evaluate the health and economic impacts of such interventions among MSM in China. Methods: A decision tree-Markov model was developed for a simulated cohort of 100,000 MSM of 20 years old. We assessed three intervention strategies: (1) routine strategy with standard health information; (2) SMS strategy with customized messages based on individual high-risk behaviors, with 50.1% efficacy and 50% coverage; (3) LEN-LA (lenacapavir long-acting) strategy as pre-exposure prophylaxis (PrEP), with 100% efficacy lasting for 0.5-year and 50% coverage. The study period was 45 years. Primary outcomes included the number of HIV infections and HIV-related deaths. The cost-effectiveness, cost-utility and cost-benefit analyses were conducted along with sensitivity analyses from the healthcare sector perspective. Results: The SMS strategy was more effective, averting 6,191 (22.0%) HIV infections and 2,100 (38.5%) HIV-related deaths when compared with routine strategy. The average cost-effectiveness ratios (ACERs) were US$6,361 (95% CI: 5,959-6,613) per HIV infection averted and US$18,752 (95% CI: 17,274 − 20,530) per HIV-related death averted. It had incremental cost-effectiveness ratios (ICERs) of US$1,743 (95% CI: 1,673-1,799) per QALY, with a benefit cost ratio (BCR) of 1.98 (95% CI: 1.94–2.02), compared with routine strategy. While the LEN-LA strategy may be the most effective, its high cost, coupled with the highest ICER, currently presents a considerable obstacle to its widespread adoption. The ICERs were most affected by the probability of HIV infection, intervention cost and coverage. Conclusions: SMS strategy for preventing HIV among MSM in China is cost-effective and could be a promising strategy for HIV prevention. These findings may have implications for public health policy and resource allocation in HIV prevention efforts targeting high-risk populations. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
41. Public perceptions of HIV/AIDS awareness in the Gulf Council Cooperation countries: a qualitative study.
- Author
-
Alageel, Samah, Alsadhan, Norah M., Alkhaldi, Ghadah, Alkasabi, Rawan, and Alomair, Noura
- Subjects
- *
AIDS prevention , *HIV prevention , *HEALTH literacy , *CULTURAL awareness , *HEALTH attitudes , *QUALITATIVE research , *INTERVIEWING , *PUBLIC opinion , *SOCIAL change , *DESCRIPTIVE statistics , *REFLEXIVITY , *THEMATIC analysis , *RESEARCH methodology , *SAFE sex , *HEALTH education , *HEALTH promotion , *DATA analysis software , *SEXUAL health , *SOCIAL stigma , *ADULTERY - Abstract
Background: Awareness of Human Immunodeficiency Virus (HIV) is limited in Muslim countries, even among high-risk populations. Several factors contribute to the misunderstandings and stigma surrounding HIV, including socio-cultural and religious aspects. This study explored people's experiences and perceptions of HIV awareness campaigns in the Gulf Cooperation Council (GCC) region. Methods: We conducted a qualitative study using semi-structured interviews with participants from the GCC region. The data were analysed using reflexive thematic analysis methods. Results: Twenty-seven participants took part in this study. The data revealed five main themes: The Necessity of HIV/AIDS Awareness, The Contrast Between Traditional and Modern Awareness, Exploring the Balance: Moral vs. Health Messages, HIV/AIDS Awareness in GCC countries, and Key Providers of HIV/AIDS Awareness. All participants emphasised the need to raise awareness about HIV in the GCC, believing that recent societal changes and increased openness justify the need for sexual health education. They stressed the importance of delivering clear and assertive health education to raise awareness while minimising the reliance on fear-based messaging. However, some participants expressed concerns about promoting condom use and HIV treatment, fearing it might encourage extramarital sex. Additionally, the lack of a religious component in the awareness messages raised concerns among some participants, as they believed adhering to religious practices was the best protection against HIV. Conclusions: Muslims in the GCC recognise the importance of spreading awareness about HIV. However, they stress the need to balance religious sensitivity with the delivery of open and transparent health messages. Engaging the target community, including high-risk individuals, in planning health campaigns is crucial for improving the acceptance, reach, inclusivity, and understanding of health awareness programs. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
42. Protocol: the American Women: Assessing Risk Epidemiologically (AWARE) cohort study.
- Author
-
Schnall, Rebecca, Kempf, Mirjam-Colette, Phillips II, Gregory, Dionne, Jodie A., Wingood, Gina, Long, Dustin Marsh, Klitzman, Robert, Hughes, Tonda L., Liu, Jianfang, Nassel, Ariann F., Corcoran, Jessica Lee, and Johnson, Amy K.
- Subjects
- *
HIV seroconversion , *MENTAL illness , *HIV prevention , *MEDICAL sciences , *PUBLIC health - Abstract
Background: While progress has been made in reducing HIV incidence rates among cisgender women, it continues to fall short of reaching the goal of ending the HIV epidemic with no new cases. Objective: This study aims to use innovative electronic methods (e.g., social media with community-informed advertisements) to recruit and retain a large (N = 1,800), diverse national sample of women at higher risk for HIV seroconversion who are 14 years of age and older to better understand the predictors of HIV-related sexual risk and HIV incidence within the context of a theoretically-grounded social-ecological framework. Methods: A US-based national longitudinal cohort study was launched among cisgender women with greater likelihood of HIV seroconversion Participants complete a survey with items related to demographics, substance use, mental health symptoms, interpersonal violence and other social factors. Biospecimens include self-collected vaginal and rectal swabs, and blood in microtainers to test for HIV, syphilis, chlamydia, gonorrhea, and trichomoniasis every 6 months for 2 years. Results: Participant recruitment began in June 2023 and baseline enrollment is scheduled to finish in July 2025. Discussion: Innovative and culturally sensitive strategies to improve access to HIV prevention and treatment services for cisgender women are vital to curb the burden of the HIV epidemic for this key population. Findings from this study will inform future research, intervention strategies, and public policies. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
43. HIV prevention and treatment cascades among female sex workers in Ghana: gaps and priorities that should be addressed by the national programme.
- Author
-
Dery, Samuel, Guure, Chris, Owusu-Ansah, Kwaku, Apreko, Amos, Asamoah-Adu, Comfort, Addo, Stephen Ayisi, and Torpey, Kwasi
- Subjects
- *
DIAGNOSIS of HIV infections , *HIV prevention , *CONDOM use , *MEDICAL sciences , *PUBLIC health - Abstract
Background: There is currently limited knowledge about HIV prevention and treatment cascades among female sex workers (FSW) in Ghana. This study sought to use the 2020 bio-behavioural survey (BBS) among FSWs to identify gaps and priorities in HIV treatment and prevention cascades to help achieve the 95–95-95 fast track targets. Method: The study used a cross-sectional design with Time Location Sampling (TLS) technique in all regions of Ghana. All eligible FSW at the selected venues and stipulated time frame were interviewed and tested for HIV onsite using the national testing algorithm. For condom use and HIV testing cascades, each step of the cascade was calculated as a percentage of all FSW. Analysis of treatment cascade was restricted to HIV positive participants and was presented using both conditional (% eligible PLHIV) and unconditional (% all PLHIV) approaches. Viral suppression level was defined as < 1000 copies/ml. Results: A total of 6,773 participants took part in the behavioral interviews while 6,217 took part in the biological component which involves HIV testing. In all, 33% and 80% of all FSW do not consistently use condoms with their paying clients and non-paying partners respectively. The findings further show that 26.6% of FSW have never tested for HIV, and contrary to the HIV testing policy of every six months for FSW, 70.0% did not test for HIV 6 months preceding the survey and 40.7% of all FSW did not test for HIV 12 months preceding the survey. The conditional treatment cascade was 32%-71%-57% while the unconditional cascade was 32%-23%-49%. The study further shows 68% of the HIV positive FSW were not aware of their HIV positive status, 77% were not on treatment, while nearly 51% were not virally suppressed regardless of treatment status. Conclusion: The results show that both the prevention and treatment cascades are suboptimal. Key gaps identified include low: HIV testing, viral load suppression, condom use with both paying clients and non-paying partners. There is therefore the need to scale prevention and treatment interventions particularly HIV testing, treatment initiation, consistent condoms use with both paying clients and non-paying partners to help achieve the 95–95-95 fast track targets. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
44. Collaborative design of a care pathway for pharmacy-based PrEP delivery in Nigeria: insights from stakeholder consultation.
- Author
-
Ekwunife, Obinna I., Omenoba, Theodora C., Eyong, Ugochi, Okelu, Valentine, Alagbile, Michael, Ume, Ifeanyi, Eze, Ambrose, Fisayo, Aderinola, Aidoo-Frimpong, Gloria, Shroff, Farah, and Anyakora, Chimezie
- Subjects
- *
HEALTH information systems , *HIV prevention , *PUBLIC health , *MEDICAL sciences , *GROUP decision making , *PRE-exposure prophylaxis - Abstract
Background: HIV remains a significant public health problem, particularly in Africa, where two-thirds of global cases occur. Nigeria is among the three countries with the highest burden. Despite free access to pre- and post-exposure prophylaxis (PrEP and PEP) in Nigerian hospitals, stigma, distance, and restrictive clinic hours hinder uptake, especially among vulnerable populations. Building on the successful pilot implementation of pharmacy-based PrEP delivery in Kenya, we engaged Nigerian stakeholders in adapting the model, addressing user and provider concerns to ensure effective implementation in Nigeria. Methods: The stakeholder meeting took place in Abuja, Nigeria, which is selected for its central location and accessibility to various stakeholders, particularly those involved in HIV prevention efforts. The participants were purposefully selected to ensure diverse representations, including youth who are potential PrEP users, pharmacy providers, regulators, and representatives from civil society organizations. The meeting utilized the Nominal Group Technique (NGT)—a structured method for facilitating group decision-making and prioritizing ideas—to adapt the Kenyan pharmacy-delivered PrEP model for implementation in the Nigerian context. Mock role play was conducted to help participants understand the care pathway. The discussions culminated in identifying challenges and viable strategies for implementing the model in Nigeria. Results: The one-day stakeholder meeting on 9 October 2024 was attended by 20 participants from various sectors involved in HIV prevention services. Stakeholders expressed enthusiasm for pharmacy-based PrEP delivery while acknowledging challenges associated with clinic-based services, such as stigma, limited hours, and long wait times. The key recommendations included training pharmacy providers, increasing awareness, ensuring confidentiality, establishing referral linkages, and integrating program data into the Health Management Information System (HMIS) as well as ensuring commodity availability and access. To enhance the success of the pilot study, stakeholders proposed engaging a research assistant, forming a monitoring team, and submitting the results to the Pharmacy Council of Nigeria (PCN) for review. Conclusions: The identified challenges and strategies for implementing the model in Nigeria will inform the development of a refined pharmacy-delivered PrEP framework that is ready for pilot testing and potential scaling across the country. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
45. Expanding the reach of HIV pre-exposure prophylaxis (PrEP) among Kenyan adolescent girls and young women: the acceptability of HIV PrEP integration into post-abortal care services.
- Author
-
Casmir, Edinah, Wairimu, Njeri, Etyang, Lydia, Mogaka, Felix, Oware, Kelvin, Nyerere, Bernard, Nafula, Inviolata, Kimani, Susan, Bukusi, Elizabeth, Heffron, Renee, Mugo, Nelly, and Ngure, Kenneth
- Subjects
- *
TEENAGE girls , *UNPLANNED pregnancy , *YOUNG women , *HIV prevention , *KENYANS , *PRE-exposure prophylaxis - Abstract
Adolescent girls and young women (AGYW) seeking post-abortal care (PAC) remain at risk of unintended pregnancies and HIV due to infrequent condom use. Integrating HIV prevention services, such as PrEP, into PAC services offers an opportunity to enhance reach, uptake, and efficiency, particularly in high-burden settings like Kenya. However, data on acceptability, feasibility, and sustainability of PAC clinics as entry points for PrEP is limited. A cross-sectional qualitative study, part of a cluster-randomized trial in 14 Kenyan public and private facilities, explored the integration of PrEP delivery for AGYW aged 15–30 within PAC clinics. Using in-depth interviews, focus group discussions, and key informant interviews, the study gathered perspectives from AGYW, providers, and implementing partners. Guided by the theoretical framework of acceptability, findings revealed receptiveness for the integration as a timely and effective intervention to expand PrEP reach, enhance access , and reduce stigma. Provider competence, their attitudes towards the integration, and AGYWs’ confidence in using PrEP were identified as critical influencers. Essentail operational considerations were staffing, availability of safe spaces, commodity management, and efficient reporting systems. The study highlights the acceptability and scalability of integrating PrEP services into PAC while emphasizing the need for strategies to enhance operational efficiency. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
46. Projecting the Potential Clinical and Economic Impact of HIV Prevention Resource Reallocation in Tennessee.
- Author
-
Borre, Ethan D, Ahonkhai, Aima A, Chi, Kyu-young Kevin, Osman, Amna, Thayer, Krista, Person, Anna K, Weddle, Andrea, Flanagan, Clare F, Pettit, April C, Closs, David, Cotton, Mia, Agwu, Allison L, Cespedes, Michelle S, Ciaranello, Andrea L, Gonsalves, Gregg, Hyle, Emily P, Paltiel, A David, Freedberg, Kenneth A, and Neilan, Anne M
- Subjects
- *
HIV infection risk factors , *DIAGNOSIS of HIV infections , *HIV prevention , *COMPUTER simulation , *STATISTICAL models , *HEALTH services accessibility , *RISK assessment , *RESEARCH funding , *HEALTH policy , *HIV infections , *PREGNANT women , *DESCRIPTIVE statistics , *COST benefit analysis , *PRE-exposure prophylaxis , *MEN who have sex with men , *BLACK people , *AIDS serodiagnosis , *CONDOMS , *TRANS women , *COMPARATIVE studies , *HEALTH care rationing , *HUMAN trafficking , *MEDICAL care costs - Abstract
Background In 2023, Tennessee replaced $6.2 M in US Centers for Disease Control and Prevention (CDC) human immunodeficiency virus (HIV) prevention funding with state funds to redirect support away from men who have sex with men (MSM), transgender women (TGW), and heterosexual Black women (HSBW) and to prioritize instead first responders (FR), pregnant people (PP), and survivors of sex trafficking (SST). Methods We used a simulation model of HIV disease to compare the clinical impact of Current, the present allocation of condoms, preexposure prophylaxis (PrEP), and HIV testing to CDC priority risk groups (MSM/TGW/HSBW); with Reallocation , funding instead increased HIV testing and linkage of Tennessee-determined priority populations (FR/PP/SST). Key model inputs included baseline condom use (45%–49%), PrEP provision (0.1%–8%), HIV testing frequency (every 2.5–4.8 years), and 30-day HIV care linkage (57%–65%). We assumed Reallocation would reduce condom use (−4%), PrEP provision (−26%), and HIV testing (−47%) in MSM/TGW/HSBW, whereas it would increase HIV testing among FR (+47%) and HIV care linkage (to 100%/90%) among PP/SST. Results Reallocation would lead to 166 additional HIV transmissions, 190 additional deaths, and 843 life-years lost over 10 years. HIV testing reductions were most influential in sensitivity analysis; even a 24% reduction would result in 287 more deaths compared to Current. With pessimistic assumptions, we projected 1359 additional HIV transmissions, 712 additional deaths, and 2778 life-years lost over 10 years. Conclusions Redirecting HIV prevention funding in Tennessee would greatly harm CDC priority populations while conferring minimal benefits to new priority populations. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
47. Definition of Virological Endpoints Improving the Design of HIV Cure Strategies Using Analytical Antiretroviral Treatment Interruption.
- Author
-
Alexandre, Marie, Prague, Mélanie, Lhomme, Edouard, Lelièvre, Jean-Daniel, Wittkop, Linda, Richert, Laura, Lévy, Yves, and Thiébaut, Rodolphe
- Subjects
- *
HIV prevention , *ANTIRETROVIRAL agents , *VIRAL load , *MICROBIAL virulence , *SECONDARY analysis , *DATA analysis , *RECEIVER operating characteristic curves , *HIV , *RESEARCH funding , *HIV infections , *DESCRIPTIVE statistics , *STRUCTURED treatment interruption , *RESEARCH , *STATISTICS , *VIREMIA - Abstract
Background Analytical treatment interruption (ATI) is the gold standard in HIV research for assessing the capability of new therapeutic strategies to control viremia without antiretroviral treatment (ART). The viral setpoint is commonly used as endpoint to evaluate their efficacy. However, in line with recommendations from a consensus meeting, to minimize the risk of increased viremia without ART, trials often implement short ATI phases and stringent virological ART restart criteria. This approach can limit the accurate observation of the setpoint. Methods We analyzed viral dynamics in 235 people with HIV from 3 trials, examining virological criteria during ATI phases. Time-related (eg time to rebound, peak, and setpoint) and viral load magnitude–related criteria (peak, setpoint, and time-averaged AUC [nAUC]) were described. Spearman correlations were analyzed to identify (1) surrogate endpoints for setpoint and (2) optimal virological ART restart criteria mitigating the risks of ART interruption and the evaluation of viral control. Results Comparison of virological criteria between trials showed strong dependencies on ATI design. Similar correlations were found across trials, with nAUC the most strongly correlated with the setpoint, with correlations >0.70. A threshold >100 000 copies/mL for 2 consecutive measures is requested as a virological ART restart criterion. Conclusions Our results are in line with recommendations and emphasize the benefits of an ATI phase >12 weeks, with regular monitoring, and a virological ART restart criterion of 10 000 copies/mL to limit the risk for patients while capturing enough information to keep nAUC as an optimal proxy to the setpoint. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
48. Brief Report:Availability of and Interest in Gender-Affirming Care, PrEP, and HIV Prevention Services in a Global Sample of Transmasculine Persons.
- Author
-
Paine, Emily Allen, Appenroth, Max, Scheim, Ayden, Goldrich, Madison, Giguere, Rebecca, and Sandfort, Theodorus
- Abstract
Background: We assessed access to pre-exposure prophylaxis (PrEP) and interest in integration of PrEP with gender-affirmative care in a global sample of transmasculine persons. Methods: Transmasculine persons (N = 590) aged 18 years and above from 57 countries completed a brief online survey from April to July 2022 about sexual behavior, knowledge, and interest in PrEP, current access to PrEP and gender-affirmative care, and preferred context for accessing PrEP. Descriptive analyses were stratified by country income group. Results: Most participants (54.4%) lived near a health center offering care to trans people. Overall, 1.9% of respondents reported ever receiving a positive HIV test result. Among those who had not (n = 579), more than a third reported engaging in receptive sex in the past year (35.2%) or anticipated doing so in the next year (41.5%), 86.9% had never received information about HIV prevention specific to transmasculine people, and 76.3% had heard of PrEP. Among those who had heard of PrEP (n = 440), only 18.9% had discussed or been offered it by a provider, and only 3.6% were currently taking it—yet 67.9% who had heard of it but were not using it would "definitely" (28.5%) or "maybe" (39.4%) be interested in taking it were it available for free. Out of these participants, the majority (60.5%) preferred the idea of accessing PrEP from the same clinic where they received gender-affirming care. Conclusions: Interventions are needed to improve PrEP access for transmasculine people globally. Clinics already providing gender-affirming care to trans people are acceptable clinical contexts to integrate such interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
49. Site-Based and Digital Cohort Participation Among Transgender Women in the Eastern and Southern United States: Findings From the LITE Study.
- Author
-
Reisner, Sari L., Humes, Elizabeth, Stevenson, Megan, Cooney, Erin E., Adams, Dee, Althoff, Keri N., Radix, Asa, Poteat, Tonia C., Mayer, Kenneth H., Cannon, Christopher M., Malone, Jowanna, Wawrzyniak, Andrew, Rodriguez, Allan E., Schneider, Jason, Haw, J. Sonya, and Wirtz, Andrea L.
- Abstract
Supplemental Digital Content is Available in the Text. Background: Transgender women (TW) are highly burdened by HIV. There is increasing interest in digital (ie, through Internet-based interfaces) HIV research; yet few studies have assessed potential biases of digital compared with site-based data collection. This study examined differences in characteristics between TW participating through site-based versus digital-only modes in an HIV incidence cohort. Methods: Between March 2018 and Aug 2020, a multisite cohort of 1312 adult TW in the eastern and southern United States was enrolled in site-based and exclusively digital modes. We evaluated differences in baseline demographics, sociostructural vulnerabilities, health care access, gender affirmation, mental health, stigma, social support, and HIV acquisition risk comparing site-based vs digital modes using χ2 tests and Poisson regression modeling with robust standard errors. Results: The overall median age was 28 (interquartile range = 23–35) years and more than half identified as people of color (15% Black, 13% Multiracial, 12% Another Race, 18% Latina/e/x). A higher proportion of site-based (vs. digital mode) participants resided in the northeast, were younger, identified as people of color, experienced sociostructural vulnerabilities, had a regular health care provider, received medical gender affirmation, endorsed mental health symptoms and stigma, reported HIV acquisition risk but also greater experience with biomedical HIV prevention (preexposure and postexposure prophylaxis), and had larger social networks (all P < 0.05). Conclusions: Site-based and digital approaches enrolled TW with different demographics, life experiences, and HIV acquisition risks. A hybrid cohort model may achieve a more diverse and potentially representative sample of TW than either site-based or online cohorts alone for HIV research. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
50. Pre-exposure prophylaxis implementation during incarceration: Perspectives of formerly incarcerated men and women.
- Author
-
Banyas, Elizabeth Anna, Castleman, Madelaine F., Rahim, Husnah A., Okumu, Eunice, and White, Becky L.
- Subjects
- *
MEDICALLY underserved persons , *PRE-exposure prophylaxis , *HIV prevention , *RISK-taking behavior , *IMPRISONMENT - Abstract
The HIV prevalence is higher among individuals involved in the United States (U.S.) correctional system than those in general population. Despite this, people in prisons or other closed settings have poor access to the most effective biomedical prevention tool, HIV pre-exposure prophylaxis (PrEP). The purpose of this study was to explore the attitudes and beliefs of PrEP initiation in correctional facilities amongst individuals formerly in prisons or other closed settings. We conducted 13 in-depth qualitative interviews with recently released (from incarceration) clients participating in a formerly incarcerated transition program in the southern United States. We identified several themes from our interviews. These themes were 1) PrEP information during incarceration; 2) Risky behaviors during incarceration and post-release; 3) Anticipated post-release challenges to accessing PrEP. Individuals formerly in prisons or other closed settings desire more education about PrEP during incarceration. They also want to learn more about HIV prevention measures. They believe that initiating PrEP in prison would allow a seamless transition to post-release PrEP programs. In conclusion, initiating PrEP during incarceration is one strategy to increase access to PrEP among the medically underserved criminal-justice population. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.