Prep Program Research Articles

Awareness, willingness and barriers to HIV Self-testing (HIVST) among Men who Have Sex with Men (MSM) in Brazil, Mexico, and Peru: A web-based cross-sectional study.

HIV self-testing (HIVST) is an essential tool within the combined HIV prevention package and has been available in Latin America since 2015. However, HIVST use among key populations remains low. This study describes awareness, willingness, and barriers to HIVST among MSM in Brazil, Mexico, and Peru. A cross-sectional web-based survey was advertised in two geosocial networking apps (Grindr and Hornet) and Facebook in 2018. We included cisgender men ≥18 years old who self-reported HIV-negative status. We used multivariable Poisson regression models to calculate adjusted prevalence ratios (aPR) to assess the factors associated with willingness to use HIVST for each country. A total of 18,916 completed the survey, 59% from Brazil, 30% from Mexico, and 11% from Peru. Overall, 20% of MSM had never tested for HIV. Awareness and willingness to use HIVST were higher in Brazil than in Peru and Mexico (p < .001). Across the countries, the patterns of association of willingness with HIVST barriers were similar. Most participants think post-test counseling is essential and that dealing with a positive result would be difficult (aPR 1.13 to 1.37, range of aPRs across the three countries). Having the knowledge to deal with a positive HIVST resulted in increased willingness to use HIVST (aPR range: 1.11 to 1.22), while a lack of trust in HIVST compared to HIV testing in clinics was inversely associated (aPR range: 0.80 to 0.90). In general, willingness to use HIVST was associated with higher income (aPR range: 1.49 to 1.97), higher education (aPR range: 1.13 to 1.42), and willingness to use PrEP (aPR range: 1.19 to 1.72). Efforts to increase HIVST knowledge and resolve perceived barriers are warranted, especially among MSM with lower income and education from Brazil, Mexico, and Peru. Personalized virtual counseling could be crucial among this population. In addition, those willing to use HIVST are also willing to use PrEP. It indicates that HIVST delivery could be incorporated into PrEP programs within the Brazilian Public Health System and eventually in Mexico and Peru.

Texting Lost-to-follow-up PrEP Patients from a San Francisco Sexual Health Clinic

It is critical to understand what happens when PrEP patients are lost-to-follow-up (LTFU) and, where appropriate, attempt to re-engage them in care with the goal of preventing future human immunodeficiency virus (HIV) acquisition. We evaluated the benefits and limitations of using text-based outreach to re-engage with LTFU PrEP patients and offer re-initiation of PrEP care. Using text-messaging, we surveyed San Francisco City Clinic patients who started PrEP from January 2015 to October 2019 and were LTFU by October 1, 2020. Our goals were to better understand (1) whether our patients remained on PrEP through another provider or source, (2) why patients choose to discontinue PrEP, and (3) whether text-based outreach could successfully re-engage such patients in care. Multiple-choice survey questions were analyzed quantitatively to determine the proportion of respondents selecting each option; free-text responses were analyzed qualitatively using an inductive approach to identify any additional recurring themes. Of 846 eligible survey recipients, 130 responded (overall response rate 15.4%). Forty-two respondents (32.3%) were still on PrEP through another provider while 88 (67.7%) were not. Common reasons for stopping PrEP included: COVID-19–related changes in sex life (32.3% of responses), concerns regarding side effects (17.7%), and the need to take a daily pill (8.3%). Free text responses revealed additional concerns regarding risk compensation. While 32 participants agreed to be contacted by City clinic staff for PrEP counseling, only 6 were reached by phone and none of the six subsequently restarted PrEP. We learned that text messaging is a possible approach to survey certain PrEP program participants to determine who is truly LTFU and off PrEP, and to better understand reasons for PrEP discontinuation. While such information could prove valuable as programs seek to address barriers to PrEP retention, efforts to improve acceptability and increase response rates would be necessary. We were less successful in re-engaging LTFU patients in PrEP care, suggesting that text-messaging may not be the optimal strategy for this purpose.

PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement

IntroductionPre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health. ObjectiveTo present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort. Materials and methodsRetrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use. Results190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% “slamming”. Half expressed concern about consumption and/or sexual practices and 25% the need for help. ConclusionsThe PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people.

Changes in sexual behavior, PrEP use, and COVID-19 experience among men who have sex with men in Mexico.

This study aimed to explore the impact of COVID-19 lockdown on sexual behavior and PrEP use among a sample of men who have sex with men (MSM) in Mexico. Between April 20th and 27th, 2020 – well into Mexico’s lockdown – we conducted a virtual survey among 637 MSM exploring sexual behavior during the first month of the COVID-19 epidemic in Mexico and the impact of lockdown on PrEP use. We applied logistic regression models to assess predictors of PrEP use continuation. Over half the participants (52%) reported having a sexual encounter in the last two weeks. 75% of participants reported a decrease in the number of sexual partners because of COVID-19. The use of PrEP dropped from 90% to 64% during the first month of lockdown. Multivariate logistic regression models showed that younger participants were less likely to continue using PrEP than those 25 + years. Also, those who perceived themselves as not likely to acquire COVID-19 and those who reported using a condom in their last sexual encounter were more likely to continue using PrEP during the lockdown. This study provides evidence of the impact of COVID-19 on sexual behavior and PrEP use among MSM in Mexico during the lockdown. Sexual and reproductive health services will need to consider the risk of COVID-19 in providing HIV and PrEP programs to guarantee participants’ and health care providers’ safety.Supplementary informationThe online version contains supplementary material available at 10.1007/s10461-022-03688-4.

A Network Approach to Determine Optimization of PrEP Uptake in Athens, Greece.

Although the HIV epidemic in Athens, Greece has reemerged and spread in men who have sex with men (MSM), state-supported PrEP programs have not been instituted. A PrEP intervention was implemented building upon an existing network cohort of MSM (308 participants; 1212 network members). A PrEP intervention cohort of 106 participants was selected based upon sex behaviors. Individual, partner, and network characteristics were compared between the cohorts. The PrEP cohort members were more highly connected and in more influential positions in the network than their peers. Further, their sexual network connections' behaviors increased their vulnerability to HIV infection relative to the rest of the network's sex partners. This included greater stimulant use (24.2% vs 7.0%; χ2 = 28.2; p < 0.001), greater rates of at least weekly condomless sex (OR = 2.7; 95% CI 2.1-3.5; χ2 = 59.2; p < 0.001) and at least weekly use of drugs or alcohol during sex (OR = 3.4; 95% CI 2.6-4.3; χ2 = 89.7; p < 0.001). Finally the PrEP cohort's social networks showed similarly increased vulnerability to seroconversion, including greater rates of injection drug use (4.1% vs 0.5%; χ2 = 3.9; p = 0.04), greater stimulant use (33.6% vs 14.6%; χ2 = 16.9, p < 0.001), and higher rates of recent STIs (21.6% vs 13.1%; χ2 = 4.4; p = 0.04). Thus, this PrEP intervention engaged individuals in vulnerable positions with vulnerable connections within an MSM community.

The PrEP Laboratory Service Gap: Applying Implementation Science Strategies to Bring PrEP Coverage to Scale in the United States.

Using an implementation science framework, we detail how a national system for covering both standard and telemedicine laboratory testing would support a national PrEP program. Implementation strategies that will facilitate success include minimizing provider burden through uncomplicated billing systems and minimizing patient burden through centralized, online access systems. We anticipate that providing telemedicine and in-person laboratory testing options will optimize PrEP care by making it less burdensome, leading to cost-effective healthcare and improved population health.

From COVID Vaccines to HIV Prevention: Pharmaceutical Financing and Distribution for the Public's Health.

The complexity and inefficiency of the U.S. health care system complicates the distribution of life-saving medical technologies. When the public health is at stake, however, there are alternatives. The proposal for a national PrEP program published in this issue of the Journal applies some of the lessons of the national COVID vaccine campaign to HIV prevention. In doing so, it draws on other examples of public health approaches to the financing of medical technology, from vaccines for children to hepatitis C treatment.

Navigating the Intersection of PrEP and Medicaid.

The proposed national PrEP program would serve people who are uninsured as well as those enrolled in Medicaid. In this article, the authors propose a set of recommendations for the proposed program's implementers as well as state Medicaid agencies and Medicaid managed care organizations to ensure PrEP access for people enrolled in Medicaid, addressing gaps without undermining the important role of the Medicaid program in covering and promoting PrEP.

Building Racial and Gender Equity into a National PrEP Access Program.

Transgender and gender diverse (TGD), Black, and Latinx communities have long borne a disproportionate share of the U.S. HIV epidemic, yet these same key demographics are continually underrepresented in national PrEP prescriptions. Black, Latinx, and TGD individuals are also more likely to be uninsured, meaning that a proposed federal program to cover PrEP for people without insurance could provide significant benefit to potential PrEP users from these populations. However, coverage of PrEP costs alone will not end disparities in uptake. This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.

52. PrEP Adherence and Discontinuation at a Pharmacy-Supported PrEP Program in Atlanta, GA

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective biomedical strategy to decrease Human Immunodeficiency Virus (HIV) acquisition. Effectiveness of oral PrEP is linked to medication adherence. In 2018, Grady Health System (GHS) launched a PrEP program to increase PrEP access among un- and underinsured individuals living in metro Atlanta, Georgia. The purpose of this study is to determine PrEP medication adherence, PrEP discontinuation rates, and associated individual factors of patients enrolled during the first 18 months of the program’s implementation. MethodsA single-center, retrospective chart review was conducted on patients enrolled in the GHS PrEP program between June 1, 2018 and February 29, 2020 who received more than one monthly PrEP prescription. Adherence was estimated using the medication possession ratio (MPR). The primary outcome was mean adherence to PrEP. Secondary outcomes include rate of high percent adherence (MPR > 80%), median time of engagement in care, PrEP discontinuation rates, rates of PrEP re-engagement, and individual factors associated with PrEP discontinuation and low adherence. ResultsThis study included 154 patients, 70.8% of them were Black, 62.3% were cisgender men, 59.1% were uninsured, and the mean age was 34. The majority of patients identified as men who have sex with men (51.9%). Mean PrEP adherence was 89.2%; 77.3% of patients demonstrated a high rate of adherence. No individual or social factors were associated with low adherence, but younger age was associated with higher rates of PrEP discontinuation (p< 0.0061). At the end of the follow up period on October 30, 2020, 53.8% of patients were active in the program and 12.7% of those who discontinued had re-engaged with the program. The average length of program engagement was 9.8 months.Table 1. Baseline socio-demographic characteristics (N=154) Table 2. PrEP Adherence and Discontinuation at the GHS PrEP Program from 2018 to 2020 (N=154) Table 4. Multivariate analysis of individual factors associated with PrEP discontinuation and low adherence ConclusionMean PrEP adherence at a safety net PrEP program in Atlanta was high and PrEP discontinuation rates were comparable to other PrEP clinics nationwide. We found no association with individual factors previously linked to lower adherence, including Black race, younger age, and insurance status. Program-related factors that may have impacted these findings need to be investigated. Other future areas of research include strategies to optimize engagement in care in younger patients. Disclosures Bradley L. Smith, Pharm.D., AAHIVP, Gilead Sciences, Inc (Advisor or Review Panel member)

Self-regulated Learning Strategies of Learners of English in a Turkish State University to Improve their Language Proficiency

In today’s world, it is recognized that learners should be in charge of their own learning. Therefore, language learners are expected to regulate their language learning process. This study aimed at investigating the self-regulation process a group of language learners at A1 level went through during a one-year English prep program they attended at a state university in Turkey. The students were to get English medium instruction (EMI) in their departments if they passed the English proficiency exam at the end of the year. Ten participants were selected based on the results of Strategy Inventory for language learning (SILL) (Oxford, &amp; Burry-Stock, 1995), which was applied on 169 English language students who started their language learning with A1 level. On the basis of the questionnaire results, three students were selected from the higher average learners, three students were selected from below average learners and four students were chosen from average learners. These ten participants were interviewed twice: at the end of the first term and the second term. It was found that learners who were highly self-regulated had both self-study time and evaluated their development in terms of linguistic competence. Based on the findings, it can be suggested that learners must monitor their language development and plan their own learnings accordingly.

"I had Made the Decision, and No One was Going to Stop Me" -Facilitators of PrEP Adherence During Pregnancy and Postpartum in Cape Town, South Africa.

PrEP is safe and effective but requires adherence during potential HIV exposure, yet the facilitators of long-term maternal adherence are not well understood. We conducted semi-structured interviews with 25 postpartum women who reported high adherence (PrEP use ≥ 25 days in last 30-days and never missed a PrEP prescription in pregnancy/postpartum period) within a PrEP service for pregnant and postpartum women. A thematic approach guided an iterative process of coding and analysis. Themes identified as drivers of optimal PrEP use were HIV risk perception, mainly because of partner’s behaviors and unknown serostatus, and a strong desire to have a baby free of HIV. Reported disclosure of PrEP use facilitated PrEP adherence. Women discussed having partner and family support, which included reminders to take PrEP daily. Primary barriers were anticipated or experienced stigma, overcome through education of partners and family about PrEP. Pregnant women experienced transient side-effects, but found ways to continue, including taking PrEP at night. PrEP programs for pregnant and postpartum women should integrate strategies to assist women with realistic appraisals of risk and teach skills for disclosure and securing support from significant others.

Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study

BackgroundPre-exposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) infection, but its use remains low among U.S. military men who have sex with men (MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population.MethodsHIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered (LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue. Relative importance and part-worth utility scores were generated using hierarchical bayes (HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios.ResultsA total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health.ConclusionA PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Long-acting implants and injections are also desired.

Üniversite hazırlık sınıfı a1 kuru öğrencilerinin lisedeki dil öğrenme deneyimleri

İngilizcenin küresel boyuttaki öneminden dolayı, Türkiye’de İngilizce ders olarak müfredatta yer almaktadır ve okul öncesinden liseye, her eğitim seviyesinde yıllardır öğretilmektedir. Harcanan zamana, paraya ve enerjiye rağmen öğrenciler üniversitelerdeki dil yeterlik sınavlarını geçememektedir ve bir yıllık üniversite hazırlık programlarına bölümlerine başlamadan önce devam etmek zorunda kalmaktadır. Bu çalışmanın amacı, hazırlık öğrencilerinin gözünden lisede gördükleri yabancı dil öğretiminin/öğreniminin bir resmini çekmek ve lisede anlamlı bir dil öğrenme ortamı yaşayıp yaşamadıklarını anlamak, mevcut durumu ve lisedeki müfredatı iyileştirmek için önerilerini almaktır. 2018-2019 güz döneminde bir devlet üniversitesi hazırlık okulundaki 521 A1 başlangıç düzeyindeki öğrenciden kısa cevap gerektiren ve bir açık uçlu sorudan oluşan 19 soruluk bir anketle veri toplanmıştır. Nicel verileri analiz ederken sıklıkları ve yüzdeleri alınmış, açık uçlu soruya verilen nitel cevapları incelemek için de içerik analizi yapılmıştır. Bulgular, lisedeki İngilizce derslerinin iletişim becerilerine ve gerçek bir öğrenme ortamına odaklanmadığını ortaya koymaktadır.

Mixed-Methods Evaluation of the Incorporation of Home Specimen Self-Collection Kits for Laboratory Testing in a Telehealth Program for HIV Pre-exposure Prophylaxis.

Home specimen self-collection kits with central laboratory testing may improve persistence with PrEP and enhance telehealth programs. We offered Iowa TelePrEP clients the choice of using a home kit or visiting a laboratory site for routine monitoring. Mixed-methods evaluation determined the proportion of clients who chose a kit, factors influencing choice, associations between kit use and completion of indicated laboratory monitoring, and user experience. About 46% (35/77) chose to use a kit. Compared to laboratory site use, kit use was associated with higher completion of extra-genital swabs (OR 6.33, 95% CI 1.20–33.51, for anorectal swabs), but lower completion of blood tests (OR 0.21, 95% CI 0.06–0.73 for creatinine). Factors influencing choice included self-efficacy to use kits, time/convenience, and privacy/confidentiality. Clients reported kit use was straight-forward but described challenges with finger prick blood collection. Telehealth PrEP programs should offer clients home kits and support clients with blood collection and kit completion.

Negative symptom configuration in patients with first episode affective psychosis: findings from the 1-year follow-up of the "Parma Early Psychosis" program.

Background and aim:Evidence on discrete dimensions underlining negative symptoms in First Episode Affective Psychosis (FEAP) may be useful for their treatment strategy, but is still relatively scarce. Aim of this study was to examine the negative symptom configuration in patients with FEAP using both exploratory and confirmatory factor analysis methods on the Positive And Negative Syndrome Scale (PANSS).Methods:Seventy-eight participants, aged 13-35 years, completed the PANSS within the “Parma Early Psychosis” (Pr-EP) program, a specialized protocol of early detection and intervention in psychosis implemented since January 2013 in all public adolescent and adult mental health services of the Parma Department of Mental Health (Northern Italy).Results:A 3-factor model (i.e. “Alogia”, “Social Withdrawal” and “Motor/Affective Expression Poverty” domains) was identified. As an alternative, a 2-factor solution previously proposed in patients with first episode schizophrenia (always within the Pr-EP program) also showed good fit indices in our FEAP sample.Conclusions:Our results suggest the crucial importance of identifying discrete negative symptom domains already at the onset of affective psychosis in order to implement specific early intervention strategies aiming to improve prognosis and long-term outcomes also in this young FEAP help-seeking population.

The Effectiveness of Preparation for Marriage Education with PREP in Iran

Premarital education can benefit couples from many socioeconomic levels. This study aimed to validate the PREP questionnaire and then explore the effectiveness of PREP education for Iranian couples. This study has been done in two phases. In the first phase, the PREP questionnaire was validated. In the second phase, quasi-experimental research was conducted in a pretest-post-test control group design to examine the effectiveness of the PREP education for 15 participants in the experimental group and 15 participants in the control group. The results of factor analysis in the first phase of the study revealed that the PREP questionnaire consists of four factors of Friendship and Emotional Safety; Communication Danger Signs; Social Integration, and Communication Skills. In the second phase of PREP education, there was a significant difference between the experimental and control groups in the post-test on all four factors. Also, there was a significant difference between the experimental and control group on all factors except Social Integration. We can conclude that by utilizing PREP, the researchers found that interpersonal relationships are highly valued for participants and utilizing PREP and other educational programs can successfully help Iranian couples navigate through the complexity of relational dynamics with more knowledge and skills.

“You can’t have a PrEP program without a PrEP Coordinator”: Implementation of a PrEP panel management intervention

Lack of healthcare provider knowledge, capacity, and willingness to prescribe PrEP are barriers to PrEP delivery in clinical settings. We implemented the PrEP Optimization Intervention (PrEP-OI) combining a PrEP Coordinator with an online panel management tool to assist providers with PrEP uptake, persistence, and management in 12 San Francisco Department of Public Health Primary Care Clinics. Medical directors (N = 10) identified important factors to consider prior to implementation, including shortage of clinical space for coordinators, medical mistrust, language barriers, and limited lab hours, along with the need for education of providers and staff and patient outreach. Among 110 providers who completed a baseline survey, the majority had reservations in asking about sexual practices and having conversations about PrEP. Providers reported PrEP-OI increased their efficiency and capacity to manage PrEP patients, and served as a gateway to additional services. These results highlight the promise of a provider-based intervention to improve the PrEP continuum and maximize the impact of PrEP.

Dorn-Severini Historic Photography Collection Donated to Monmouth University

In December 2019, Kathy Dorn Severini and George Severini, residents of Fair Haven, NJ, donated a collection of photographic images to Monmouth University, a private, comprehensive 4-year institution in West Long Branch, NJ, located about a mile from the Atlantic Ocean. With a 2019 enrollment of 6,167, the University offers undergraduate and graduate programs across all traditional disciplines, as well as a Doctorate in Nursing Practice and an Ed. D. program. Monmouth University is a Grammy Museum affiliate, offers a Peace Corps Prep program that is unique in New Jersey, and is the home to the Monmouth Polling Institute.

Disrupting Norms to Increase Diversity of Teacher Candidates: Restraining Forces for Junior Faculty

Research in teacher preparation programs in Institutes of Higher Education (IHE) suggests that diverse and non-traditional students face barriers and challenges within teacher preparation programs (Widiputers et al., 2017). Diverse students include non-traditional students, first-generation students, students who have work responsibilities, who may have family or other care-giving responsibilities, students with disabilities, students living in poverty, and may also include culturally and linguistically diverse students. Issues such as unpaid practicum hours (similar to an internship), conflicting course and work schedules, attendance policies, due dates/late work policies, course expectations that value verbal participation, office hours not available when students are available, and how often courses are offered (e.g., yearly vs every semester) negatively impact diverse student populations. Many of these decisions are made at the preference of administration and tenured and established faculty while others are left-over from a time when students did not have to balance the work and family requirements many students face today.&#x0D; As we attempt to increase representation of students in teacher prep programs, the policies and practices to meet their unique situations have not been equitably incorporated into the daily practices in higher education. This continues to maintain of the status quo rather than increasing the diversity of teachers in the workforce as the diversity of teacher candidates has not increased to represent the diversifying population despite efforts (United States Department of Education, 2016). Many junior faculty may engage or attempt to engage in disrupting the status quo to create and implement policies that respond to students' needs that result in increased support for students from backgrounds that are disproportionately impacted by traditional practices. Junior faculty can serve as change agents if IHE can recognize the tremendous time and effort that goes into making sustainable change within the college and surrounding educational systems. Recognizing the barriers to junior faculty and providing support to do this challenging work and remain on target for promotion and tenure is critical. Tenure protections ensure faculty can be leaders in sustained change and establishes them as leaders within IHE and in their professional fields and disciplines. Establishing support systems, especially from administration, within the university and community can support junior faculty and accelerate the timeline or target systems open and more responsive to change.