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ABSTRACT: Long-acting injectable cabotegravir (CAB-LA) was US Food and Drug Administration-approved in 2021. However, little is known about providers' CAB-LA knowledge, attitudes, challenges, and prescribing preferences for transgender women patients. Understanding this is critical to developing new pre-exposure prophylaxis (PrEP) interventions tailored to transgender women. We conducted 45-min, in-depth Zoom interviews (IDIs) with United States-based health care providers who prescribe PrEP to transgender women. IDIs focused on providers' CAB-LA knowledge/acceptability, willingness to prescribe CAB-LA to transgender women, potential challenges, and solutions to mitigate challenges. Providers ( N = 17) had a mean age of 43 years, and 35.4% ( n = 6) identified as people of color. Most ( n = 12) had basic knowledge of CAB-LA but wanted additional training. All participants found CAB-LA acceptable and were willing to prescribe. Most ( n = 11) anticipated minimal challenges to implementation. Others ( n = 4) reported potential issues, including logistical/scheduling concerns that impede CAB-LA integration and staffing concerns. Many providers expressed support for self-injection ( n = 13) and injections at "drop-in" clinics ( n = 8) to overcome challenges.
Subject(s)
Anti-HIV Agents , HIV Infections , Health Personnel , Pre-Exposure Prophylaxis , Pyridones , Qualitative Research , Transgender Persons , Humans , Transgender Persons/psychology , Transgender Persons/statistics & numerical data , Female , Adult , United States , Male , Pre-Exposure Prophylaxis/methods , HIV Infections/drug therapy , HIV Infections/prevention & control , Health Personnel/psychology , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/therapeutic use , Pyridones/administration & dosage , Pyridones/therapeutic use , Middle Aged , Health Knowledge, Attitudes, Practice , Injections , Health Services Accessibility , Delayed-Action Preparations , Attitude of Health Personnel , Interviews as Topic , DiketopiperazinesABSTRACT
Transgender women are disproportionately burdened by HIV. Though there is a substantial body of research exploring barriers and facilitators of HIV prevention among transgender women, many barriers remain unaddressed. This study identifies strategies to make HIV prevention trials more congruent with transgender women's preferences and needs to boost trial participation and ultimately enhance initiation and uptake of pre-exposure prophylaxis (PrEP). We conducted in-depth interviews with 15 sexually active, HIV-negative transgender women in New York City to understand: (1) preferences concerning long-acting injectable cabotegravir for PrEP and (2) ideas on how to make HIV prevention trial environments more comfortable. We identified five themes related to increasing transgender women's appeal to trials: (1) creating a more inclusive/welcoming environment, (2) providing compensation that is responsive to transgender women and community needs, (3) centering transgender women in recruitment and informational materials, (4) training study staff on gender-affirming practices, and (5) hiring transgender people as study staff. Participants wanted to see more gender diversity, representation, correct pronouns, gender-affirming practices, and compensation or reimbursements. Together, these practices may improve recruitment and retention of transgender women in HIV prevention trials.
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Peer-to-peer chain recruitment has been used for descriptive studies, but few intervention studies have employed it. We used this method to enroll sexually active women ages 18 to 25 into an online Pre-Exposure Prophylaxis (PrEP) information and motivation intervention pilot in eThekwini (Durban), South Africa. Seeds (N = 16) were recruited by study staff and randomized to Masibambane, Ladies Chat, a Gender-Enhanced group-based WhatsApp Workshop (GE), or Individual-Access (IA), a control condition that provided participants with online information/motivation materials only. Each seed could recruit up to three women to participate in the same study condition, with an incentive for each enrolled woman; participants in subsequent waves could choose to recruit or not. We evaluated if peer-to-peer recruitment was self-sustaining and resulted in enrolling women who, in subsequent waves, had less contact with the health care system and less knowledge about PrEP than the initial seeds. Over three recruitment waves beyond the seeds, 84 women were recruited. Almost 90% of women became recruiters, with each recruiting on average 1.90 women and 1.26 eligible enrolled women. The approach was successful at reaching women with less education but not women with less health system contact and PrEP knowledge across waves. IA participants had a slightly higher, though non-significantly different, percentage of individuals who became Peer Health Advocates (PHAs) than GE participants and, on average, they recruited slightly more women who enrolled. Our findings demonstrated that peer-to-peer recruitment is a feasible and self-sustaining way to recruit SA young women into a PrEP intervention study.
Subject(s)
HIV Infections , Patient Selection , Peer Group , Pre-Exposure Prophylaxis , Humans , Female , Pre-Exposure Prophylaxis/methods , South Africa , HIV Infections/prevention & control , Adult , Young Adult , Adolescent , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/therapeutic use , Motivation , Health Knowledge, Attitudes, Practice , Pilot ProjectsABSTRACT
BACKGROUND: With few psychometrically evaluated HIV-related stigma measures for adolescents and young adults living with HIV, we examined the developmental applicability (ie, validity) of 2 subscales of the commonly used stigma measure, the Social Impact Scale, among a cohort of adolescents and young adults with perinatally acquired HIV. SETTING: Data were obtained from a New York City longitudinal study (N = 340). This study primarily comprised Black and Latinx adolescents and young adults with either perinatally acquired HIV or those with perinatal exposure but who are uninfected. Data for this analysis were obtained from the population with perinatally acquired HIV and spanned approximately a 15-year survey period (2003-2018). METHODS: A confirmatory factor analysis was used at 7 time points to assess whether the Social Rejection and Internalized Shame subscales were consistent in this cohort over time. Overall and individual Cronbach alphas were reported to show the strength of the internal consistency. RESULTS: The mean age from baseline to follow-up 6 ranged from 12 to 23 years over the study period. The Social Rejection subscale was acceptably valid across follow-up periods with strong factor loadings and Cronbach alphas higher than 0.70. However, the Internalized Shame subscale was less valid among younger adolescents. Starting at follow-up 2, we observed better validity with the Internalized Shame subscale performance. CONCLUSION: Future research must consider mechanisms for developing and adapting measures from a developmental perspective to best measure the experiences of HIV-related stigma among younger populations.
Subject(s)
HIV Infections , Pregnancy , Female , Humans , Adolescent , Young Adult , Child , Adult , HIV Infections/epidemiology , Longitudinal Studies , Social Change , Social Stigma , ShameABSTRACT
INTRODUCTION: Because of privacy and ethical concerns, the data cannot be made available because of the sensitivity of the HIV data and the relatively small sample and ease of identifying people if a few demographics are known.Few studies have examined intimate partner violence (IPV) victimization among adolescents and young adults (AYAs) with perinatally acquired HIV-infection (PHIV) or perinatal HIV exposure without infection (PHEU) in the United States. The purpose of this study was to (1) estimate lifetime and past-year prevalence of IPV victimization and (2) examine correlates of IPV victimization by subtype (physical, psychological, and sexual) and severity (low, moderate, and severe). METHODS: Data came from the sixth interview of an ongoing New York City-based longitudinal study of primarily Black and Latinx AYAPHIV and AYAPHEU. We examined 232 participants (142 PHIV; 90 PHEU) who had reported having been in at least 1 romantic relationship. We used logistic regression models to explore the association between IPV victimization outcomes and select sociodemographic, psychiatric, and environmental factors. Models were adjusted for age, gender, race, ethnicity, and HIV status. RESULTS: IPV victimization prevalence was 84% for lifetime and 65% for the past year. There were no differences in IPV victimization prevalence by PHIV status. Having a recent substance use disorder, reporting higher levels of neighborhood stress, and being male were all positively associated with at least 1 IPV outcome; stronger familial relationships exhibited a protective effect. CONCLUSIONS: The present study suggests that the prevalence of IPV victimization among AYAPHIV and AYAPHEU is exceedingly high that warrants targeted IPV screening and programming for this population.
Subject(s)
Crime Victims , HIV Infections , Intimate Partner Violence , Female , Pregnancy , Humans , Male , Adolescent , Young Adult , United States , HIV Infections/epidemiology , HIV Infections/prevention & control , Prevalence , Longitudinal Studies , Sexual Partners/psychologyABSTRACT
INTRODUCTION: Traumatic events (TEs) in early life can precede adult psychopathology. Limited research exists on this relationship in young adults with perinatally acquired HIV-infection (PHIV) or perinatal HIV-exposure without infection (PHEU), who often experience social and health disparities. This study examined TEs experienced in childhood/adolescence and their association with psychiatric and substance use disorders in young adults with PHIV and PHEU. METHODS: Participants in a New York City-based longitudinal cohort study were assessed for TE exposure at enrollment (mean age = 12 years) and the first 2 follow-up interviews. Past-year psychiatric and substance use disorders were evaluated via psychiatric interview (DISC-IV) at the fifth follow-up interview (mean age = 22 years). Unadjusted and adjusted logistic regression models assessed associations between cumulative childhood/adolescence TEs and young adult psychiatric and substance use outcomes. Group differences were tested for PHIV and PHEU subgroups. RESULTS: Among 236 participants (60% Black, 51% Latinx), mean cumulative traumatic event count was 3.09 (SD = 1.77); 26% had a past-year psychiatric diagnosis, and 28% had a past-year substance use diagnosis. Increased TEs were associated with past-year psychiatric diagnoses in young adulthood [average marginal effects (AME) 4.21, 95% confidence interval (CI): 0.83 to 7.58]; for PHEU participants, increased TEs were associated with a past-year substance use disorder (AME 15.67, 95% CI: 8.08 to 23.25). CONCLUSIONS: High levels of TEs in childhood/adolescence may contribute to psychiatric and substance use disorders in young adults with PHIV or PHEU. Research exploring relationships between TE exposure and later psychiatric problems is needed to inform interventions for HIV-affected youth.
Subject(s)
HIV Infections , Substance-Related Disorders , Pregnancy , Female , Young Adult , Humans , Adolescent , Adult , Child , Mental Health , Longitudinal Studies , Cohort Studies , Substance-Related Disorders/complications , Infectious Disease Transmission, VerticalABSTRACT
We present experiences of transgender women (TW) who have sex with men with SMARTtest, a smartphone app to accompany the INSTI Multiplex®, a one-minute, dual blood-based HIV/syphilis rapid test. TW participants (N = 11) received 10 INSTI Multiplex® tests to take home for self- and/or partner-testing and installed the SMARTtest app on their phones. The SMARTtest app aimed to support INSTI Multiplex users in correctly performing the test, interpreting the results, and connecting with care following a positive HIV or syphilis screening. After 3 months, users completed in-depth interviews on their experiences. A total of 9 TW used SMARTtest with partners. App feedback was positive, but refining is necessary. Specifically, TW reported that SMARTtest is easy to use and convenient; instructions on how to use the INSTI Multiplex presented on the app were helpful to complete procedures correctly; the most frequently used feature on SMARTtest was the information on clinics that offered confirmatory testing; and participants and their partners were not concerned about app privacy but reported that this could change if INSTI Multiplex detected an HIV-positive result. Further, participants provided recommendations on how to improve SMARTtest, and changes were mostly related to features, content, functionality, navigation, and overall "look" of the app. SMARTtest is promising to facilitate INSTI Multiplex® use in TW. User feedback should be integrated in future versions.
Subject(s)
HIV Infections , Mobile Applications , Syphilis , Transgender Persons , Male , Humans , Female , Syphilis/diagnosis , Smartphone , HIV Infections/diagnosis , HIV Infections/prevention & control , Homosexuality, MaleABSTRACT
Tenofovir diphosphate (TFV-DP) concentrations in dried blood spots (DBS) predict viral breakthrough, but their use remains understudied in real-world clinic settings. This pilot study examined acceptability, feasibility, and initial adherence outcomes of providing adherence feedback using TFV-DP concentrations on patient- and provider-levels in Cape Town, South Africa. We enrolled 60 persons with HIV (PWH) receiving tenofovir-containing ART attending a primary health clinic. They were randomized 1:1 to an intervention receiving TFV-DP concentration feedback by research staff vs. no feedback at monthly visits for 4 months. Acceptability among medical providers and level of clinical follow-up of TFV-DP results was examined. Patient acceptability was assessed descriptively. Mean electronic adherence (EA), as measured by WisePill device, and TFV-DP in DBS were compared between the two arms. All participants in the intervention group (100%) reported finding TFV-DP feedback helpful and 86% reported changing adherence behaviors. Medical providers indicated high acceptability of incorporating TFV-DP concentration feedback into the clinic, yet among 29 results < 1000 fmol/punch, only 2 were reviewed with no follow-up actions performed. In the intervention arm, mean TFV-DP concentrations were significantly higher (t = 2.5, p < .01) during follow-up and EA in upper quartile (96-100%) was greater compared to controls (x2 = 7.8, p ≤ .05). This study found high acceptability among patients for receiving adherence feedback based on TFV-DP concentrations. TFV-DP and EA data demonstrated greater adherence in the intervention group. Providers indicated high acceptability of incorporating TFV-DP feedback into the clinic, but few providers reviewed results, which could impact clinic-level feasibility.
Subject(s)
Anti-HIV Agents , HIV Infections , Humans , Anti-HIV Agents/therapeutic use , Feasibility Studies , HIV Infections/drug therapy , Pilot Projects , South Africa/epidemiologyABSTRACT
Hope for the future has been found protective against suicidal ideation (SI) in adolescents and young adults (AYA) yet has not been examined in AYA with perinatal HIV-infection (PHIV) or AYA who were perinatally HIV-exposed but uninfected (PHEU), who are at higher risk for SI than general populations. Using data from a New York City-based longitudinal study of AYAPHIV and AYAPHEU enrolled when 9-16 years old, we examined associations between hope for the future, psychiatric disorders, and SI over time using validated measures. Generalized estimating equations were used to estimate differences in mean hope for the future scores by PHIV-status and to estimate adjusted odds ratios for associations between hope for the future and SI. AYA reported high hope for the future scores and low SI across visits, irrespective of PHIV-status. Higher hope for the future scores were associated with lower odds of SI (AOR = 0.48, 95% CI: 0.23, 0.996). Mood disorder was associated with increased odds of SI (AOR = 13.57, 95% CI: 5.11, 36.05) in a model including age, sex, follow-up, PHIV-status, mood disorder, and hope for the future. Understanding how hope can be cultivated and how it protects against SI can help to inform preventive interventions for HIV-affected AYA.
Subject(s)
HIV Infections , Pregnancy , Female , Humans , Adolescent , Young Adult , Child , HIV Infections/psychology , Suicidal Ideation , Longitudinal Studies , Mood Disorders , HIV Testing , Infectious Disease Transmission, Vertical/prevention & controlABSTRACT
BACKGROUND: Electronic adherence (EA) and tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) are objective measures of antiretroviral therapy (ART) adherence. We characterized the association between these measures in a prospective cohort of persons with HIV (PWH) on ART. SETTING: Four primary health clinics in Cape Town, South Africa. METHODS: We enrolled 250 virally suppressed PWH receiving tenofovir-based ART. We collected EA data, monthly viral load, and TFV-DP in DBS for 12 months. We used logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) for future viral breakthrough (VB) (>400 copies/mL) for each adherence measure. Receiver operating characteristics (ROCs) provided the predictive power of these measures. RESULTS: Participants had a median (IQR) age of 34 (27-42); 78% were women. Twenty-one (8%) developed VB. Logistic regression showed that when percent EA and TFV-DP concentrations increased, the odds of VB decreased. This relationship was consistent at the time of VB (aOR of 0.41 [95% CI: 0.25 to 0.66] for TFV-DP and aOR of 0.64 [95% CI: 0.54 to 0.76] for EA) and for up to 2 months before VB. Both adherence measures predicted future VB at both 1 month and 2 months before viral load measurement. CONCLUSION: We established that 2 objective adherence measures, EA and TFV-DP in DBS, have a positive association with, and are both strongly predictive of, VB in a community-based South African cohort on ART. Future research is needed to determine the feasibility of implementing these adherence measures in resource-limited settings to facilitate adherence interventions.
Subject(s)
Anti-HIV Agents , HIV Infections , Humans , Female , Male , HIV Infections/drug therapy , South Africa , Anti-HIV Agents/therapeutic use , Prospective Studies , Anti-Retroviral Agents/therapeutic use , Medication AdherenceABSTRACT
Given poor adherence to treatment and prevention techniques, condomless sex jeopardizes adolescents and young adults (AYA) with perinatally-acquired HIV-infection (PHIV) or perinatal HIV-exposure who are uninfected (PHEU). We examined condomless sex and its association with PHIV-status, psychiatric disorder, and sociodemographics. Data come from a US-based study of primarily Black and Latinx AYAPHIV and AYAPHEU (N = 340). Linear regression models examined condomless sex longitudinally by PHIV-status, psychiatric trajectories, and sociodemographics. Rates of viremia (AYAPHIV) and PrEP use (AYAPHEU) were assessed. 56% of participants reported recent condomless sex, with higher prevalence among: AYAPHEU vs. AYAPHIV (24% vs. 19%, p = 0.017); Latinx vs. non-Latinx AYA (25% vs. 17%, p = 0.014); and AYA with increasing psychiatric comorbidity (44%) and consistent anxiety (23%) vs. low-level disorder (17%; p < 0.05). AYAPHIV had high rates of unsuppressed viral load and AYAPHEU limited PrEP use. Preventing condomless sex is challenging within AYAPHIV and AYAPHEU. Developing accessible combination HIV/mental health interventions is much-needed.
Subject(s)
Anti-HIV Agents , HIV Infections , Pre-Exposure Prophylaxis , Female , Pregnancy , Adolescent , Young Adult , Humans , HIV Infections/epidemiology , HIV Infections/prevention & control , HIV Infections/drug therapy , Unsafe Sex , Anxiety Disorders , Anti-HIV Agents/therapeutic useABSTRACT
This article describes the processes of transforming an in-person group-based intervention to promote uptake of PrEP among young woman in South Africa to an online interactive "workshop" during the COVID-19 pandemic. Beginning in person and continuing virtually, we used a step-by-step participatory approach with multiple stakeholder groups to develop nine activities to increase knowledge about, as well as motivation and intention to take PrEP, and to address gender-based barriers to PrEP. Activities were informed by our theoretical framework and formative work with young women ages 18-25. We demonstrate how we developed a gender-enhanced online PrEP workshop that was interactive, group-based, and in accordance with elements of established successful intervention design; why WhatsApp emerged as the most accessible application for the young women in our workshop; and how an intervention with a hybrid approach-alternating between chat box and live sessions-combined with verbal, written, and emoji-based communication enabled interaction among participants.
Subject(s)
Anti-HIV Agents , COVID-19 , HIV Infections , Pre-Exposure Prophylaxis , Humans , Female , Adolescent , Young Adult , Adult , HIV Infections/prevention & control , South Africa , Motivation , Anti-HIV Agents/therapeutic use , Pandemics , COVID-19/prevention & controlABSTRACT
We assessed pathways between sexual minority stigma and condomless anal intercourse (CAI) among two samples of Black South African men who have sex with other men (MSM). Two cross-sectional surveys were conducted in Tshwane, South Africa; one among 199 Black MSM and another among 480 Black MSM. Men reported on external and internalized experiences of sexual minority stigma, mental health, alcohol use, information-motivation-behavioral skills (IMB) model constructs, and CAI. Structural equation modeling was used to test whether external and internalized stigma were directly and indirectly associated with CAI. In both studies, external stigma and internalized stigma were associated with CAI through IMB model constructs. These results suggest a pathway through which stigma contributes to HIV risk. For HIV prevention efforts to be effective, strengthening safer sex motivation and thus decreasing sexual risk behavior likely requires reducing sexual minority stigma that MSM experience and internalize.
Subject(s)
HIV Infections , Sexual and Gender Minorities , Male , Humans , Homosexuality, Male/psychology , South Africa/epidemiology , Motivation , Cross-Sectional Studies , HIV Infections/prevention & control , HIV Infections/psychology , Sexual BehaviorABSTRACT
INTRODUCTION: As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV-exposed but uninfected (AYAPHEU). METHODS: Data come from an ongoing longitudinal New York City-based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12-18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first-reported suicide attempt. Generalized estimating equations were used to examine associations between first-reported suicide attempt and socio-demographic, contextual and psychosocial correlates measured concurrently across six timepoints. RESULTS: At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21-33%) compared to AYAPHEU (16%, CI 10-22%), with an OR of 1.74 (CI 1.04-2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46-4.85), mood (OR 3.62, CI 1.49-8.81) and behaviour disorders (OR 5.05, CI 2.15-11.87) and past-year arrest (OR 3.05, CI 1.26-7.4), negative life events (OR 1.27, CI 1.11-1.46), city stress (OR 2.28, CI 1.46-3.57), pregnancy (OR 2.28, CI 1.08-4.81) and HIV stigma (OR 2.46, CI 1.27-4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14-0.52), higher personal (OR 0.45, CI 0.26-0.80) and family self-concept (OR 0.36, CI 0.22-0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years. CONCLUSIONS: AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.
Subject(s)
HIV Infections , Substance-Related Disorders , Adolescent , Adult , Child , Demography , Female , HIV Infections/complications , HIV Infections/epidemiology , HIV Infections/psychology , Humans , Male , New York City/epidemiology , Risk Factors , Substance-Related Disorders/complications , Suicide, Attempted/prevention & control , Suicide, Attempted/psychology , Young AdultABSTRACT
Introduction: Readiness to change is a key component of substance use behavioral change; yet little is known about readiness to change among justice-involved young adults. This study 1) describes readiness to change alcohol and drug use and 2) examines predictors of readiness to change alcohol and drug use among justice-involved young adults. Method: Justice-involved young adults (18-24 years; n = 137) who were positive on a validated alcohol and/or drug screening tool completed an interview assessing substance use, readiness to change, and reasons to quit. A multivariable linear regression model examined whether reasons to change and substance use severity, and interactions between these, predicted readiness. Results: More than half of participants were contemplating or had decided to quit/cut down substance use. Personal reasons to quit were positively related to readiness to change; interpersonal reasons were negatively associated. Conclusions: This study contributes information needed to design motivational interventions for substance use among justice-involved young adults. Personal reasons to quit using drugs are a potential intervention target.
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OBJECTIVE: Deficits in neurocognitive functioning are common among adolescents and young adults (AYA) with perinatally acquired HIV (PHIV). Limitations of traditional neuropsychological tests hinder assessment of neurocognition in low- and middle-income countries where most AYA with PHIV reside. Computerized testing could make assessment of neurocognition more accessible in these countries. This study examined a culturally modified NeuroScreen, a tablet-based neurocognitive testing app, for use in Thailand. Construct validity was examined among Thai AYA (13-23 years) with and without PHIV. METHOD: NeuroScreen underwent adaptation including language, content, and usability review by Thai psychologists, AYA, and clinical staff. One hundred Thai AYA (50 PHIV; 50 HIV-uninfected, matched controls) were administered the adapted NeuroScreen and a battery of traditional paper-and-pencil neuropsychological tests. Correlations, mean differences, and proportions with impaired performance were examined across NeuroScreen and the traditional tests. RESULTS: The Thai version of NeuroScreen was deemed understandable and culturally appropriate. A large correlation (.82) between overall performance on the NeuroScreen and traditional batteries was observed. Small-to-large correlations were found between conceptually similar NeuroScreen and traditional tests of processing speed, working memory, motor speed, and executive functioning. Mean test performance differences between AYA with PHIV and controls were similar between test batteries. Both sets of tests identified similar rates of impaired participants. CONCLUSIONS: Results provide support for the acceptability and construct validity of the Thai NeuroScreen tests to assess neurocognition in Thai AYA with PHIV. An easy-to-use tool to assess neurocognition can help Thai providers provide better care for AYA with PHIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Subject(s)
HIV Infections , Adolescent , Young Adult , Humans , Thailand , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/psychology , Neuropsychological Tests , Executive Function , CognitionABSTRACT
Cisgender men who have sex with men (cMSM) and transgender women (TGW) are disproportionally burdened by HIV. Among these populations, HIV partner-testing is a highly acceptable harm reduction tool. Particularly, cMSM and TGW report a stronger preference for blood-based tests that include assays for multiple STIs. However, no existing research has explored how these populations negotiate blood-based testing with sexual partners. In the SMARTtest study, 48 sexually active cMSM and TGW took home dual, blood-based HIV/Syphilis kits for self- and partner-testing. After 3 months, they completed a follow-up assessment and in-depth interviews about their experiences initiating testing. Of the 42 responding participants, 27 (64%) reported that it had been "fairly" or "very easy" to raise the idea of testing with partners. Participants predominantly employed partner-conscious communication strategies, including framing the testing proposal as a mandatory, non-personal component of their participation in a research study, gradually incorporating testing mentions into discussions about sexual health, and using the kits to facilitate joint testing. Yet, 21 (44%) participants reported having sex with at least one partner they did not ask to test. Concern regarding partner reactions emerged as a significant barrier to discussing test use; similarly, many partners were averse to taking a blood-based test in the context of a casual sexual encounter. Nonetheless, these findings suggest that dual, blood-based HIV/STI rapid tests may represent acceptable harm reduction tools among similar populations of cMSM and TGW, particularly if future partner-testing research is broadened to consider key couples' dynamics that may impact test usage.
Subject(s)
HIV Infections , Sexual and Gender Minorities , Sexually Transmitted Diseases , Syphilis , Transgender Persons , Female , HIV Infections/diagnosis , Homosexuality, Male , Humans , Male , Negotiating , New York City , Sexual Behavior , Sexual Partners , Syphilis/diagnosisABSTRACT
PURPOSE: Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals. METHODS: Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income. RESULTS: Our sample was diverse in age (M = 34.4, range 16-87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = - 0.61, p < 0.001) and transgender pride (b = - 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = - 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride. CONCLUSIONS: Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.
Subject(s)
Transgender Persons , Cohort Studies , Female , Gender Identity , Humans , Infant, Newborn , Male , Mental Health , Prospective Studies , Social Stigma , Transgender Persons/psychology , United States/epidemiologyABSTRACT
OBJECTIVES: Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is used as a biomarker of antiretroviral therapy (ART) adherence. Recent treatment studies have shown that TFV-DP predicts future viremia in persons with HIV (PWH) but there are few data from high-burden settings. We investigated whether TFV-DP in DBS predicts future viral breakthrough in South African PWH. DESIGN: Prospective observational cohort. METHODS: We enrolled 250 adults receiving tenofovir-containing regimens, currently virally suppressed (<50âcopies/ml) but at risk of future viral breakthrough, from four primary health clinics in Cape Town. Paired viral load and DBS for TFV-DP were collected monthly for 12âmonths. Viral breakthrough was the first confirmed viral load greater than 400âcopies/ml. Logistic regression estimated the odds ratio (OR) and 95% confidence intervals for future viral breakthrough at the next visit. RESULTS: Participants provided 2944 paired DBS and viral load samples. Median (IQR) age was 34 (27-42) years; median duration on ART at study entry was 11 (4-12) months;78% were women. Twenty-one (8%) participants developed viral breakthrough. Participants with TFV-DP 400âfmol/punch or less had an adjusted OR of 16.1 (95% CI: 3.9-67.4; Pâ<â0.001) for developing viral breakthrough 1âmonth later compared with participants with TFV-DP greater 800âfmol/punch. CONCLUSION: TFV-DP in DBS strongly predicted future viral breakthrough in a clinical cohort of South African PWH. A biomarker able to identify PWH at risk for future viral breakthrough has the potential to improve health outcomes through timely intervention. Future studies exploring the clinical use of TFV-DP in DBS in conjunction with viral load in ART monitoring are warranted.