A Call for Youth Voice to Support Engagement in Care for 18- to 29-Year Olds Living with HIV in the US South.

Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH.

Nothing About Us Without Us: Involving Youth Living With HIV in a Virtual Advisory Board.

PURPOSE: We adapted a traditional community advisory board to the needs of youth living with HIV (YLWH), resulting in a virtual, asynchronous, and anonymous youth advisory board (YAB). The YAB's evolution fostered participation during the adaptation of an HIV care mobile health application. METHODS: YAB members, comprised of YLWH in South Texas, engaged in the mobile application's formative evaluation, adaptation, and pilot implementation. We collected feedback via surveys and interviews, analyzed and integrated responses, tracked participation and YAB adaptations, and performed content analysis. RESULTS: Driven by feedback, the YAB evolved from in-person group meetings to the current iteration. We administered five surveys, and YAB members provided feedback on communication preferences; mobile app elements; privacy and confidentiality; and virtual support groups. DISCUSSION: Our adaptive process highlights three primary drivers of innovation: COVID-19 risk reduction, asynchrony, anonymity. Our success in maintaining YAB engagement suggests the adapted model could be employed to support youth input in other contexts.

Low Prevalence of COVID-19 Vaccine Hesitancy in Students Across Health Science Disciplines in Texas.

Introduction: Although the development of COVID-19 vaccines represents a triumph of modern medicine, studies suggest vaccine hesitancy exists among key populations, including healthcare professionals. In December 2020, a large academic medical center offered COVID-19 vaccination to 3439 students in medicine, nursing, dentistry, and other health professions. With limited vaccine hesitancy research in this population, this study evaluates the prevalence of COVID-19 vaccine hesitancy among healthcare students, including predictors of hesitancy and top concerns with vaccination. Methods: The authors distributed a cross-sectional survey to all healthcare students (n = 3,439) from 12/17/2020 to 12/23/2020. The survey collected age, sex, perceived risk of contracting SARS-CoV-2 without vaccination, perceived impact on health if infected with SARS-CoV-2, vaccine hesitancy, and vaccine concerns. In 2021, logistic regressions identified risk factors associated with hesitancy. Results: The response rate was 30.0% (n = 1030) with median age of 25.0. Of respondents, 19.4% were hesitant to accept COVID-19 vaccination, while 66.6% reported at least one concern with the vaccine. Medical discipline, history of COVID-19 infection, perceived risk of contracting COVID-19, and perceived severity of illness if infected were predictor variables of COVID-19 vaccine hesitancy (p < 0.05). Age, sex, and exposure to in-person clinical care were not predictive of vaccine hesitancy. Conclusions: Fewer students reported COVID-19 vaccine hesitancy than expected from surveys on the general public and on healthcare workers. Continued research is needed to evaluate shifting attitudes around COVID-19 vaccination among healthcare professionals and students. With COVID-19 vaccine hesitancy a growing concern in young adults, a survey of this size and breadth will be helpful to other academic medical centers interested in vaccinating their students and to persons interested in leveraging predictors of COVID-19 vaccine hesitancy for targeted intervention.