A Qualitative Study of Barriers and Facilitators to Integrating Medications for Opioid Use Disorder and HIV Preexposure Prophylaxis for Adolescents and Young Adults.

BACKGROUND: The syndemic of substance use and human immunodeficiency virus (HIV) is a well-recognized global phenomenon that threatens to undermine the priorities outlined by the National Institutes of Health "Ending the HIV Epidemic" initiative. There are few published studies on preexposure prophylaxis (PrEP) for adolescents and young adults (AYAs) with opioid use disorder (OUD) despite increasing availability of biomedical prevention options and Centers for Disease Control and Prevention recommendations to offer PrEP to this group. METHODS: Healthcare providers who previously prescribed medications for OUD (MOUDs) and/or PrEP for AYA were purposively sampled. Audio-recorded in-depth individual interviews were conducted using chart-stimulated recall to explore barriers and facilitators to integrated MOUD and HIV prevention services. Interviews were double-coded, and qualitative analysis was performed using a modified grounded theory. RESULTS: Of 19 providers sampled, most were physicians (63%). All recommended HIV screening at varying intervals; however, few counseled on (19%) or prescribed (11%) PrEP to patients on MOUD. Barriers to PrEP prescriptions included patient-level (ie, stigma surrounding PrEP use, adherence challenges, and competing social or mental healthcare needs), provider (perception of low risk, lack of training/experience), and system-level factors (including restricted visit types). Facilitators of PrEP prescriptions included patient-initiated requests, electronic health record system reminders, and the availability of consistent support staff (ie, navigators, certified recovery specialists). CONCLUSIONS: Our study confirms that discussions about HIV prevention and PrEP prescriptions may be rare for AYA patients receiving MOUD. Further research is needed to develop interventions that increase the integration of PrEP delivery within the context of OUD care among this key AYA population.

A Multimodal Qualitative Approach to Understanding Menstrual Health Equity among Adolescents and Young Adults.

STUDY OBJECTIVE: Menstrual inequity-unequal access to menstrual health care or products-negatively affects well-being in relation to the menstrual cycle, a construct known as menstrual health. Few studies have explored menstrual inequities among adolescent and young adult populations in the United States. This multimodal qualitative research aimed to explore factors that influence the lived experience of menstruation among this population. METHODS: This qualitative study consisted of individual interviews among menstruators ages 13-24, recruited from an urban academic medical center. Participants (N = 20) were a mean age of 19 years; 25% previously endorsed period poverty, and 90% were publicly insured. We conducted semi-structured interviews using participant video diaries in a video elicitation exercise. Data were coded by 2 investigators using thematic analysis driven by grounded theory. RESULTS: Emergent themes included the need to normalize menstruation, the need for comprehensive menstrual health education, and the need for menstrual products to be more accessible. Twelve youth prepared video diaries, and all reported positive experiences with the video process. CONCLUSIONS: This youth-centered, multimodal study is one of the first to qualitatively explore the lived experiences of menstruation among adolescents in the United States and identified key inequities in menstrual health from their own perspectives. Thematic findings were mapped onto a proposed framework for menstrual equity that can be applied to future research and efforts around policy change. More research is needed to assess the impacts of these policies.

Health Information From Web Search Engines and Virtual Assistants About Pre-Exposure Prophylaxis for HIV Prevention in Adolescents and Young Adults: Content Analysis.

BACKGROUND: Adolescents and young adults are disproportionately affected by HIV, suggesting that HIV prevention methods such as pre-exposure prophylaxis (PrEP) should focus on this group as a priority. As digital natives, youth likely turn to internet resources regarding health topics they may not feel comfortable discussing with their medical providers. To optimize informed decision-making by adolescents and young adults most impacted by HIV, the information from internet searches should be educational, accurate, and readable. OBJECTIVE: The aims of this study were to compare the accuracy of web-based PrEP information found using web search engines and virtual assistants, and to assess the readability of the resulting information. METHODS: Adolescent HIV prevention clinical experts developed a list of 23 prevention-related questions that were posed to search engines (Ask.com, Bing, Google, and Yahoo) and virtual assistants (Amazon Alexa, Microsoft Cortana, Google Assistant, and Apple Siri). The first three results from search engines and virtual assistant web references, as well as virtual assistant verbal responses, were recorded and coded using a six-tier scale to assess the quality of information produced. The results were also entered in a web-based tool determining readability using the Flesch-Kincaid Grade Level scale. RESULTS: Google web search engine and Google Assistant more frequently produced PrEP information of higher quality than the other search engines and virtual assistants with scores ranging from 3.4 to 3.7 and 2.8 to 3.3, respectively. Additionally, the resulting information generally was presented in language at a seventh and 10th grade reading level according to the Flesch-Kincaid Grade Level scale. CONCLUSIONS: Adolescents and young adults are large consumers of technology and may experience discomfort discussing their sexual health with providers. It is important that efforts are made to ensure the information they receive about HIV prevention methods, and PrEP in particular, is comprehensive, comprehensible, and widely available.