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1.
Implement Sci Commun ; 4(1): 18, 2023 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-36810099

RESUMO

BACKGROUND: Clinical decision support (CDS) is a promising intervention for improving uptake of HIV testing and pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for HIV prevention in pediatric primary care, a key implementation setting. METHODS: This was a cross-sectional multiple methods study utilizing surveys and in-depth interviews with pediatricians to assess acceptability, appropriateness, and feasibility of CDS for HIV prevention, as well as to identify contextual barriers and facilitators to CDS. Qualitative analysis utilized work domain analysis and a deductive coding approach grounded in the Consolidated Framework of Implementation Research. Quantitative and qualitative data were merged to develop an Implementation Research Logic Model to conceptualize implementation determinants, strategies, mechanisms, and outcomes of potential CDS use. RESULTS: Participants (n = 26) were primarily white (92%), female (88%), and physicians (73%). Using CDS to improve HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4-5]), appropriate (5, IQR [4-5]), and feasible (4, IQR [3.75-4.75]) using a 5-point Likert scale. Providers identified confidentiality and time constraints as two key barriers to HIV prevention care spanning every workflow step. With respect to desired CDS features, providers sought interventions that were integrated into the primary care workflow, standardized to promote universal testing yet adaptable to the level of a patient's HIV risk, and addressed providers' knowledge gaps and bolstered self-efficacy in providing HIV prevention services. CONCLUSIONS: This multiple methods study indicates that clinical decision support in the pediatric primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit workflow and prioritizing standardized but flexible designs.

2.
J Adolesc Health ; 71(5): 545-551, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35963759

RESUMO

PURPOSE: Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. METHODS: We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. RESULTS: Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. DISCUSSION: Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.


Assuntos
Infecções por Chlamydia , Gonorreia , Infecções Sexualmente Transmissíveis , Feminino , Adulto Jovem , Adolescente , Humanos , Masculino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Chlamydia trachomatis , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Neisseria , Neisseria gonorrhoeae , Atenção Primária à Saúde
3.
Transgend Health ; 7(2): 159-164, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35586576

RESUMO

Gender-affirming care (GAC) is critical to the well-being of transgender and gender diverse youth and was limited by COVID-19 stay-at-home orders. Telehealth created opportunities for youth to continue receiving lifesaving care. We examined the attitudes of patients (n=21) and caregivers (n=38) receiving telehealth-delivered GAC (TGAC) from May to July 2020. Participants completed surveys after telehealth visits. Descriptive statistics compared telehealth with in-person visits across key domains. Overall, 86.5% of patients and 95.4% of caregivers were satisfied with medical TGAC and 94.3% and 93.3% were satisfied with behavioral health TGAC. Future research should determine the effectiveness of TGAC and identify areas for improvement.

4.
J Int AIDS Soc ; 25(2): e25867, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35192740

RESUMO

INTRODUCTION: Youth account for a disproportionate number of new HIV infections; however, pre-exposure prophylaxis (PrEP) use is limited. We evaluated PrEP counselling rates among non-Hispanic Black youth in the United States after a bacterial sexually transmitted infection (STI) diagnosis. METHODS: We conducted a retrospective cohort study of Black youth receiving care at two academically affiliated clinics in Philadelphia between June 2014 and June 2019. We compared PrEP counselling for youth who received primary care services versus those who did not receive primary care services, all of whom met PrEP eligibility criteria due to STI diagnosis per U.S. Centers for Disease Control and Prevention clinical practice guidelines. Two logistic regression models for receipt of PrEP counselling were fit: Model 1 focused on sexual and gender minority (SGM) status and Model 2 on rectal STIs with both models adjusted for patient- and healthcare-level factors. RESULTS: Four hundred and sixteen patients met PrEP eligibility criteria due to STI based on sex assigned at birth and sexual partners. Thirty patients (7%) had documentation of PrEP counselling. Receipt of primary care services was not significantly associated with receipt of PrEP counselling in either Model 1 (adjusted OR (aOR) 0.10 [95% CI 0.01, 0.99]) or Model 2 (aOR 0.52 [95% CI 0.10, 2.77]). Receipt of PrEP counselling was significantly associated with later calendar years of STI diagnosis (aOR 6.80 [95% CI 1.64, 29.3]), assigned male sex at birth (aOR 26.2 [95% CI 3.46, 198]) and SGM identity (aOR 317 [95% CI 39.9, 2521]) in Model 1 and later calendar years of diagnosis (aOR 3.46 [95% CI 1.25, 9.58]), assigned male sex at birth (aOR 18.6 [95% CI 3.88, 89.3]) and rectal STI diagnosis (aOR 28.0 [95% CI 8.07, 97.5]) in Model 2. Fourteen patients (3%) started PrEP during the observation period; 12/14 (86%) were SGM primary care patients assigned male sex at birth. CONCLUSIONS: PrEP counselling and uptake among U.S. non-Hispanic Black youth remain disproportionately low despite recent STI diagnosis. These findings support the need for robust investment in PrEP-inclusive sexual health services that are widely implemented and culturally tailored to Black youth, particularly cisgender heterosexual females.


Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Infecções Sexualmente Transmissíveis , Adolescente , Aconselhamento , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Estados Unidos
5.
J Adolesc Health ; 70(3): 435-441, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34887198

RESUMO

PURPOSE: We sought to evaluate sexual history documentation and corresponding Chlamydia trachomatis screening practices across a large pediatric primary care network in the context of patient and clinic characteristics. METHODS: Demographic, chlamydia screening, and provider note data were collected via electronic health record and manual chart audit for females aged 15-19 years attending annual well-adolescent visits, from February 1 to 28, 2019. Inductive qualitative textual analysis evaluated sexual history documentation as informative (containing clear indication of patient as sexually active or not) or noninformative and identified documentation subtypes. We examined patient and clinic characteristics by sexual history documentation type (informative or noninformative) and chlamydia screening status and documentation subtypes across clinic types using chi-square and Fisher's exact tests. A multilevel logistic regression model considering clinic-specific random effects evaluated predictors of informative sexual history documentation. RESULTS: Chart notes were examined for 1,062 patients across 31 unique clinics. Only 34.7% of chart notes were found to have informative sexual history documentation. Older patients (odds ratio: 1.51, 95% confidence interval: 0.99-2.31) and patients seen at clinics receiving U.S. Department of Health and Human Services Title-X funding (odds ratio: 11.05, 95% confidence interval: 1.34-90.86) had higher rates of informative documentation. The overall Chlamydia screening rate was 13.1%. CONCLUSION: Sexual history documentation varied widely across clinics, and the majority of chart notes were found to have noninformative documentation. Understanding and addressing barriers to informative sexual history documentation and comprehensive sexual health care is fundamental to improve adolescent sexual health outcomes, particularly given recently enacted federal electronic health record transparency policies.


Assuntos
Infecções por Chlamydia , Registros Eletrônicos de Saúde , Adolescente , Adulto , Criança , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Documentação , Feminino , Humanos , Programas de Rastreamento , Atenção Primária à Saúde , Comportamento Sexual , Adulto Jovem
6.
Am J Public Health ; 112(1): 135-143, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34936422

RESUMO

Objectives. To identify associations between patient race and annual chlamydia screening among adolescent females. Methods. We performed a retrospective cohort study of females aged 15 to 19 years in a 31-clinic pediatric primary care network in Pennsylvania and New Jersey from 2015 through 2019. Using mixed-effect logistic regressions, we estimated associations between annual chlamydia screening and patient (race/ethnicity, age, previous chlamydia screening and infection, insurance type) and clinic (size, setting) characteristics. We decomposed potential effects of clinician's implicit racial bias and screening, using covariates measuring the proportion of Black patients in each clinician's practice. Results. There were 68 935 well visits among 37 817 females, who were 28.8% Black and 25.8% Medicaid insured. The mean annual chlamydia screening rate was 11.1%. Black females had higher odds of screening (adjusted odds ratio [AOR] = 1.67; 95% confidence interval [CI] = 1.51, 1.84) than did White females. In the clinician characteristics model, individual clinicians were more likely to screen their Black versus non-Black patients (AOR = 1.88; 95% CI = 1.65, 2.15). Conclusions. Racial bias may affect screening practices and should be addressed in future interventions, given the critical need to increase population-level chlamydia screening.(Am J Public Health. 2022;112(1):135-143. https://doi.org/10.2105/AJPH.2021.306498).


Assuntos
População Negra/estatística & dados numéricos , Infecções por Chlamydia/prevenção & controle , Chlamydia trachomatis , Programas de Rastreamento/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adolescente , Estudos de Coortes , Feminino , Humanos , New Jersey , Pennsylvania , Atenção Primária à Saúde , Fatores Raciais , Estudos Retrospectivos , Adulto Jovem
7.
JMIR Pediatr Parent ; 4(4): e32708, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34779782

RESUMO

BACKGROUND: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. OBJECTIVE: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. METHODS: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. RESULTS: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. CONCLUSIONS: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety.

8.
J Adolesc Health ; 69(5): 824-830, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34103237

RESUMO

PURPOSE: HIV pre-exposure prophylaxis (PrEP) reduces HIV transmission and is approved for adolescents aged 12-17 years. Adolescent girls and young women (AGYW) have modest PrEP uptake rates, while many receive reproductive health counseling. We sought to identify opportunities for incorporating PrEP education in contraceptive counseling delivered to AGYW. METHODS: We performed a secondary analysis of data from the Health Coaching for Contraceptive Continuation pilot study, which supported contraceptive use among AGYW. Participants were 14-22 years old, sexually active with males, and not desiring pregnancy within 12 months. Coaches were sexual health educators with ≥5 years' experience providing contraceptive and PrEP counseling to youth. Participants completed a baseline visit within 30 days of contraceptive initiation and completed up to five monthly coaching sessions. Of 33 enrollees, this analysis includes the 21 who completed ≥4 sessions. Two coders deductively coded session transcripts for five themes: opportunities to discuss PrEP; HIV knowledge, risk perception, and testing attitudes; changes in HIV risk status; condom use knowledge and skills; and sexually transmitted infection knowledge and risk perception. RESULTS: Of the 111 transcripts coded, 24 contained opportunities to discuss PrEP and were inductively analyzed. Thematic analysis demonstrated three types of opportunities for PrEP discussions: failure to introduce information, and provision of incomplete information or misinformation. Analysis also revealed four opportunity contexts: sexually transmitted infection prevention strategies, HIV risk reduction, avoidance of adverse sexual health outcomes, and disclosures of condom nonprotected sexual behaviors. Only one transcript mentioned PrEP. CONCLUSIONS: Multiple opportunities to introduce PrEP counseling exist within contraceptive counseling provided to AGYW.


Assuntos
Infecções por HIV , Tutoria , Profilaxia Pré-Exposição , Adolescente , Adulto , Anticoncepcionais , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Projetos Piloto , Gravidez , Comportamento Sexual , Adulto Jovem
9.
Sex Transm Dis ; 48(7): e91-e93, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33783411

RESUMO

ABSTRACT: Disruptions in sexually transmitted infection (STI) testing infrastructure during the COVID-19 pandemic threaten to impact STI service delivery for adolescents. Within a large pediatric primary care network, we compared STI testing encounters between the pandemic period and an analogous prepandemic period. The STI test counts decreased and test positivity increased during the pandemic period.


Assuntos
COVID-19 , Infecções por HIV , Infecções Sexualmente Transmissíveis , Adolescente , Criança , HIV , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Pandemias , Atenção Primária à Saúde , SARS-CoV-2 , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia
10.
J Pediatr Adolesc Gynecol ; 34(5): 732-738, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33571659

RESUMO

STUDY OBJECTIVE: Nonadherence in sexual risk reduction interventions might be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a previous pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation. DESIGN: Secondary data analysis from a feasibility study of a health-coaching intervention to improve contraceptive continuation. SETTING: Three urban pediatric clinics in Philadelphia. PARTICIPANTS: Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method. INTERVENTIONS: At baseline, participants completed a sociodemographic questionnaire and semistructured interview, followed by 5 monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content. MAIN OUTCOME MEASURES: Intervention completion was defined as the number of completed coaching sessions. Secondary outcomes were qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception. RESULTS: Participants with a previous adverse outcome (a previous STI and/or a previous pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs 4; P = .03). Both groups had low HIV/STI knowledge, negative attitudes toward pregnancy, and low HIV/STI risk perception. Those with a previous adverse reproductive outcome held more negative attitudes toward condoms. CONCLUSION: Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome might be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize the intervention's reach for vulnerable youth.


Assuntos
Infecções por HIV , Tutoria , Infecções Sexualmente Transmissíveis , Adolescente , Adulto , Criança , Preservativos , Anticoncepcionais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Saúde Reprodutiva , Comportamento Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto Jovem
11.
AIDS Patient Care STDS ; 35(1): 15-22, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400589

RESUMO

Prior sexually transmitted infections (STIs) are associated with higher rates of subsequent human immunodeficiency virus (HIV) infection, but the influence of prior STIs on perceived vulnerability to HIV remains unclear. We aimed to assess this relationship, hypothesizing that a prior STI diagnosis is associated with higher self-assessed vulnerability to HIV. We performed a cross-sectional study of men and transgender individuals who have sex with men screening for HIV prevention trials in Philadelphia. An unadjusted regression analysis found no significant association between prior STI and HIV risk perception (p = 0.71) or HIV anxiety (p = 0.32). Multivariate logistic regression models that controlled for predetermined potential cofounders known to impact HIV risk-such as condom use, preexposure prophylaxis use, and demographics-also failed to show statistically significant associations between prior STI and HIV risk perception (p = 0.87) or HIV anxiety (p = 0.10). Furthermore, there was no effect modification by HIV preventive behaviors on the relationship between prior STI and HIV vulnerability. These data suggest that a gap exists between how clinicians may attribute individual HIV risk and how individuals view their own vulnerability at a given moment in time. Future research should focus on the dynamic relationship between perceived HIV vulnerability, STI diagnosis, and adoption of preventive behavior to determine better, individualized targets for HIV prevention interventions.


Assuntos
Ansiedade/psicologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Profilaxia Pré-Exposição/métodos , Infecções Sexualmente Transmissíveis/epidemiologia , Pessoas Transgênero , Adulto , Preservativos , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Percepção , Philadelphia/epidemiologia , Comportamento Sexual , Minorias Sexuais e de Gênero
12.
AIDS Behav ; 25(2): 524-531, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32860114

RESUMO

The effects of mental health comorbidities and social support on the HIV pre-exposure prophylaxis (PrEP) care continuum are unknown. We conducted a cross-sectional study of men and transgender individuals, ≥ 18 years-old, with ≥ 2 male or transgender partners, or recent condomless anal intercourse. Surveys assessed demographics, mental health treatment, depressive symptomatology, social support, and PrEP-related social contacts. Logistic regression assessed associations between these factors and PrEP uptake and persistence. Participants (n = 247) were 89% cis-male and 46% African-American. Median age was 27 (IQR:23-33). Thirty-seven percent had ever used PrEP, of whom 18% discontinued use. High depressive symptomology was identified in 11% and 9% were receiving mental health treatment. There were no significant associations between depressive symptoms or mental health treatment on the odds of PrEP uptake or discontinuation. Each additional PrEP contact conferred a greater odds of uptake (aOR:1.24, 95% CI: 1.09-1.42). Network-level targets may produce fruitful interventions to increase PrEP uptake.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Saúde Mental , Profilaxia Pré-Exposição , Pessoas Transgênero , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino
14.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32179661

RESUMO

BACKGROUND AND OBJECTIVES: Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. METHODS: Retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis. RESULTS: The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing. CONCLUSIONS: HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.


Assuntos
Infecções por HIV/diagnóstico , Infecções Sexualmente Transmissíveis , Doença Aguda , Adolescente , Feminino , Gonorreia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Vaginite por Trichomonas/epidemiologia , Adulto Jovem
15.
J Adolesc Health ; 66(3): 268-274, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31672523

RESUMO

PURPOSE: The aim of the study was to characterize perceived social support for young men and transgender women who have sex with men (YM/TWSM) taking HIV pre-exposure prophylaxis (PrEP). METHODS: Mixed-methods study of HIV-negative YM/TWSM of color prescribed oral PrEP. Participants completed egocentric network inventories characterizing their social support networks and identifying PrEP adherence support figures. A subset (n = 31) completed semistructured interviews exploring adherence support and qualities of PrEP support figures. We calculated proportions of role types (e.g., family), individuals disclosed to regarding PrEP use, and PrEP-supportive individuals within each participant network. Interviews were analyzed using an inductive approach. RESULTS: Participants (n = 50) were predominately African American men who have sex with men. Median age was 22 years (interquartile range: 20-23). Biologic family were the most common support figures, reported by 75% of participants (mean family proportion .37 [standard deviation (SD): .31]), followed by 67% reporting friends (mean friend proportion .38 [SD: .36]). Most network members were aware (mean disclosed proportion .74 [SD: .31]) and supportive (mean supportive proportion .87 [SD: .28]) of the participants' PrEP use. Nearly all (98%) participants identified ≥1 figure who provided adherence support; more often friends (48%) than family (36%). Participants characterized support as instrumental (e.g., transportation); emotional (e.g., affection); and social interaction (e.g., taking medication together). Key characteristics of PrEP support figures included closeness, dependability, and homophily (alikeness) with respect to sexual orientation. CONCLUSIONS: Although most YM/TWSM identified family in their support networks, friends were most often cited as PrEP adherence support figures. Interventions to increase PrEP adherence should consider integrated social network and family-based approaches.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Etnicidade/psicologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição , Apoio Social , Pessoas Transgênero/psicologia , Administração Oral , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/psicologia , Homossexualidade Masculina/etnologia , Humanos , Masculino , Adesão à Medicação , Autoeficácia , Minorias Sexuais e de Gênero , Adulto Jovem
16.
AIDS Behav ; 23(10): 2719-2729, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30993479

RESUMO

We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48 h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22 years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility, reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Negro ou Afro-Americano/psicologia , Infecções por HIV/prevenção & controle , Hispânico ou Latino/psicologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Adesão à Medicação/etnologia , Profilaxia Pré-Exposição/métodos , Pessoas Transgênero/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação/psicologia , Philadelphia , Pesquisa Qualitativa , Assunção de Riscos , Minorias Sexuais e de Gênero , Estigma Social , Apoio Social , Tenofovir/administração & dosagem , Tenofovir/uso terapêutico , Pessoas Transgênero/estatística & dados numéricos , Adulto Jovem
17.
J Pediatr Adolesc Gynecol ; 32(1): 32-38, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30394335

RESUMO

STUDY OBJECTIVE: To determine the impact of a multicomponent quality improvement (QI) intervention on Chlamydia trachomatis screening for young women in primary care. DESIGN: Observational cohort analysis. SETTING: Urban primary care site providing adolescent primary and confidential sexual health care. PARTICIPANTS: Female adolescents aged 15-19 years. INTERVENTIONS: From December 2016 to April 2018, we designed and implemented a multiphase QI intervention. The final intervention, beginning March 2017, consisted of the following at all adolescent well visits: (1) dual registration for well and confidential sexual health encounters; (2) urine collection during the rooming process; and (3) electronic health record-based prompts for chlamydia screening. MAIN OUTCOME MEASURES: Annual chlamydia screening rates before and after the intervention, with a goal of achieving a relative increase of 10%. RESULTS: There were 1550 well adolescent encounters from December 2016 to April 2018. The preimplementation chlamydia screening rate among 15- to 19-year-old female adolescents was 312/757 (41.2%) (95% confidence interval, 20.9%-61.5%). Postintervention, this increased to 397/793 (50.0%) (95% confidence interval, 28.6%-71.5%; P < .001). The clinic chlamydia test positivity rate remained stable, at 10.7% and 11.1% in the pre- and postintervention periods, respectively. There was no significant change in median visit length in the pre- (79.2 minutes; interquartile range, 59.5-103.3) and postintervention periods (80.4 minutes; interquartile range, 61.7-102.8; P = .63). CONCLUSION: This practice-based QI intervention resulted in a statistically significant 21% relative increase in annual Chlamydia trachomatis screening rates among female adolescents, without lengthening median visit time.


Assuntos
Infecções por Chlamydia/diagnóstico , Programas de Rastreamento/normas , Serviços Preventivos de Saúde/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade/estatística & dados numéricos , Adolescente , Adulto , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis/isolamento & purificação , Estudos de Coortes , Atenção à Saúde/normas , Feminino , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Comportamento Sexual , Adulto Jovem
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