Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study.

BACKGROUND: Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. OBJECTIVE: To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations' HIV service providers. METHODS: We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. RESULTS: Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5% to 3.6% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7% to 1.5% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9% to 2.8%, and the proportion of MSM decreased from 1.5% to 0.75%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6% to 4.0% in regions with high prevalence and decreased the proportion from 1.4% to 1.2% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1% to 3.4%) and decreased the proportion of MSM in all regions. CONCLUSIONS: Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response.

A decade of PrEP: the evolution of HIV pre-exposure prophylaxis content and sentiments in South African print news media, 2012-2021.

After nearly a decade of HIV pre-exposure prophylaxis (PrEP) rollout in sub-Saharan Africa, there has been limited study of PrEP messaging in news media. We selected twenty South African newspapers with the highest circulation volumes to retrieve articles published in 2012-2021 mentioning PrEP (N = 249). Using inductive content analysis, we developed a structured codebook to characterise PrEP-related content and sentiments, as well as their evolution over time, in the South African press. Many articles espoused favourable attitudes towards PrEP (52%), but a sizeable fraction espoused unfavourable attitudes (11%). Relative to PrEP-favourable articles, PrEP-unfavourable articles were significantly more likely to emphasise the drawbacks/consequences of PrEP use, including adherence/persistence requirements (52% vs. 24%, p = .007), cost (48% vs. 11%, p < .001), and risk compensation (52% vs. 5%, p < .001). Nevertheless, the presence of these drawbacks/consequences in print media largely declined over time. Key populations (e.g. adolescents, female sex workers) were frequently mentioned potential PrEP candidates. Despite message variations over time, prevention effectiveness and adherence/persistence requirements were the most widely cited PrEP benefits and drawbacks, respectively. Study findings demonstrate the dynamic nature of PrEP coverage in the South African press, likely in response to PrEP scale-up and real-world PrEP implementation during the study period.

Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework.

While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.

Maintaining Community-engaged Research with Young People in A Virtual setting.

BACKGROUND: Partnering with young people to conduct research is fundamental to community mobilization. Recent restrictions on in-person interactions and engagement presented limitations for continued partnership with young people. OBJECTIVE: To present a practical strategy and lessons learned to facilitate community-engaged research with youth in a virtual setting. METHODS: Based on youth engagement tenets, the TEAM (tailor the compensation package, ensure meetings are accessible, accommodate personal needs, and maintain the structure of in-person meetings) strategy was used to adapt the partnership to a virtual setting. LESSONS LEARNED: Three lessons are discussed 1) the importance of maintaining social connectedness, 2) maximizing flexibility, and 3) focusing on creativity and competency building. CONCLUSIONS: The COVID pandemic forced researchers to rethink previous engagement practices that relied heavily on in-person interactions to be sustainable. The TEAM strategy is one way to successfully adapt practices and engage young people in virtual settings.

"It's on every corner": assessing risk environments in Baltimore, MD using a racialized risk environment model.

Physical, social, economic, and political environments can increase harm and risk among people who use drugs. These factors may be exacerbated in urban environments with a history of systemic inequality toward African Americans. However, racialized risk environment models have rarely been used within substance use research. To fill this gap, the current qualitative study sought to describe the racialized risk environment of an African American sample of 21 adults with a history of illicit drug use living in Baltimore, MD. Semi-structured interviews were conducted. Data were analyzed using qualitative content analysis to identify themes related to illicit drug use, neighborhood context, violence, social interactions, and income generation. Themes related to the physical (e.g., the increased visibility of drug markets), social (e.g., normalization of drug use within social networks), and economic (e.g., financial hardships) risk environments emerged from this sample. These perceptions and themes can aid in developing and refining substance use programming within racialized settings.

Health Beliefs and Preventive Behaviors Among Adults During the Early COVID-19 Pandemic in the United States: a Latent Class Analysis.

The objectives of this study are to (1) characterize patterns of preventive behaviors 3 months after the COVID-19 pandemic was declared a national emergency in the USA and (2) identify how health beliefs (e.g., perceived risk of infection, perceived risk of death upon infection, and perceived effectiveness of CDC-recommended preventive behaviors) and sociodemographic characteristics are associated with preventive behaviors. Data were obtained from two waves of the Understanding America Study (UAS) conducted in March (wave 1) and May to June of 2020 (wave 2) (n = 4445); UAS is a nationally representative panel of US adults. We conducted a latent class analysis (LCA) using wave 2 data to identify our outcome, patterns of 10 COVID-preventive behaviors (e.g., wearing a facemask, handwashing, social distancing), and then used a three-step regression (R3STEP) to test associations between the likelihood of class membership with (1) health beliefs and sociodemographic characteristics (age, sex, race/ethnicity, and educational attainment) in bivariate models and (2) health beliefs adjusted for sociodemographic characteristics in multivariate models. The LCA identified a three-class model of preventive behaviors characterized by high likelihood of engagement in the set of preventive behaviors ("high"), low likelihood of the preventive behaviors ("low"), or engagement in some behaviors ("mixed"). Respondents of older age (i.e., age 50 or older) and those with higher levels of educational attainment (i.e., a 4-year college degree or higher) were less likely to be in the low engagement versus the mixed engagement class compared to those who are younger (18-29) and have lower levels of educational attainment (i.e., high school), respectively. Women (compared to men) and respondents who were Black and/or Hispanic/Latinx (compared to White) were more likely to be in the high (vs. mixed) engagement class. In separate models adjusted for sociodemographic characteristics, respondents with a high perceived risk of infection, high perceived risk of death, and high perceived effectiveness of COVID-preventive behaviors were statistically significantly less likely to be in the low engagement relative to the mixed engagement class. Engagement in COVID-preventive behaviors varies by sociodemographic characteristics (i.e., age, sex, race/ethnicity and educational attainment) and health beliefs (i.e., perceived risk of infection, perceived risk of death, and perceived effectiveness of CDC-recommended behaviors). Our findings highlight the potential utility of using health beliefs to inform targeted prevention efforts to help reduce the spread of COVID-19 and future pandemics.

"Don't Close the Door on Them": Recruiting and retaining vulnerable Black adolescents in prevention research.

There is a need to understand why some strategies work better than others for engaging vulnerable Black adolescents in prevention research, especially those who are affected by parental drug use. The current study sought to fill this gap. Thirty in-depth interviews were conducted with parents who reported a history of illicit drug use (N = 11), young adults who had a biological parent with a history of illicit drug use (N = 14), and service providers who work with families affected by illicit drug use (N = 5). Nearly all participants were Black and lived or worked in Baltimore, Maryland. Over half of the participants were female (62%). Interviews were recorded and ranged from 30 to 92 minutes in length. Data were analyzed using an inductive, content analysis approach. Four themes emerged (coined STAR): SAFE people and places minimize retraumatization; TEAMING UP with community partners increases acceptability; ADDRESSING a range of needs helps adolescents survive; and RELATABLE facilitators understand and listen to adolescents. Findings build onto and extend previous research that highlights strategies to recruit and retain vulnerable Black adolescents in prevention research.