scholarly journals Structural, Dosing, and Risk Change Factors Affecting Discontinuation of Pre-exposure Prophylaxis (PrEP) in a Large Urban Clinic

2020 ◽  
Vol 32 (4) ◽  
pp. 271-S13
Author(s):  
Chelsea L. Shover ◽  
Michelle A. DeVost ◽  
Nicole J. Cunningham ◽  
Matthew R. Beymer ◽  
David Flores ◽  
...  
Keyword(s):  
Los Angeles ◽  
Hiv Incidence ◽  
Factors Affecting ◽  
Change Factors ◽  
Monogamous Relationship ◽  
Dosing Strategies ◽  
Programmatic Evaluation ◽  
Multifaceted Interventions ◽  
Exposure Prophylaxis ◽  
Urban Clinic

Understanding why clients stop taking pre-exposure prophylaxis (PrEP) is critical to improve PrEP delivery and ultimately reduce HIV incidence. We analyzed data from a programmatic evaluation conducted at the Los Angeles LGBT Center from February to May 2018. Of 180 respondents to the emailed survey, 91 had stopped taking PrEP and 11 never started. Among former PrEP users, most common reasons for stopping were entering a monogamous relationship (43%) and side effects (40%). Ten of 11 who never started PrEP reported access barriers (e.g., cost, insurance problems). A quarter of inactive clients re-engaged with PrEP services following the survey and 15% restarted PrEP by October 2018. Improving PrEP retention may require multifaceted interventions—e.g., tailored discussions about stopping and restarting PrEP safely as HIV risk changes, ensuring consistent access to affordable PrEP, and alternative dosing strategies. An emailed survey may be a simple, effective strategy to reengage some PrEP clients.

scholarly journals Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California

2019 ◽  
Vol 23 (10) ◽  
pp. 2730-2740 ◽  
Author(s):  
Chelsea L. Shover ◽  
Steven Shoptaw ◽  
Marjan Javanbakht ◽  
Sung-Jae Lee ◽  
Robert K. Bolan ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Center ◽  
Hiv Incidence ◽  
Federally Qualified Health Center ◽  
Exposure Prophylaxis

Cultural Factors Affecting the Negotiation of First Sexual Intercourse among Latina Adolescent Mothers

1998 ◽  
Vol 18 (1) ◽  
pp. 121-137 ◽  
Author(s):  
Pamela I. Erickson
Keyword(s):  
Los Angeles ◽  
Sexual Intercourse ◽  
Adolescent Mothers ◽  
Social Factors ◽  
Birth Rate ◽  
Factors Affecting ◽  
First Sexual Intercourse ◽  
Latina Adolescent Mothers ◽  
Adolescent Birth ◽  
First Time

In 1995, the Latina adolescent birth rate surpassed that of African Americans for the first time. This article investigates cultural and social factors affecting the initiation of sexual intercourse among Latina adolescent mothers in Los Angeles. The data are from life history interviews with forty young mothers and their partners conducted in 1994 to 1997. Results suggest that sexual intercourse is initiated within the context of the couple's developing relationship, and that the course of relationships is highly scripted. Men pressure for sex and women resist. Women should be ignorant about sex, but control access to intercourse. Sex is never discussed. Thus, it is unexpected, and contraception other than withdrawal is not used. This script places young Latinas at enormous risk for pregnancy and STDs.

scholarly journals “PrEP”ing for a PrEP demonstration project: understanding PrEP knowledge and attitudes among cisgender women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth C. Pasipanodya ◽  
Jamila Stockman ◽  
Thupten Phuntsog ◽  
Sheldon Morris ◽  
Christina Psaros ◽  
...  
Keyword(s):  
Los Angeles ◽  
Focus Groups ◽  
Knowledge And Attitudes ◽  
Women Living With Hiv ◽  
Effective Interventions ◽  
Hiv Serostatus ◽  
Prep Awareness ◽  
Exposure Prophylaxis ◽  
Competing Priorities ◽  
And Control

Abstract Background Prior to implementing a pre-exposure prophylaxis (PrEP) demonstration study, we sought to explore cisgender women’s experiences with HIV prevention, PrEP knowledge and attitudes, and anticipated barriers and facilitators for PrEP uptake and adherence in Southern California. Methods Three focus groups were held with cisgender women of mixed HIV serostatus in San Diego and Los Angeles between November 2015 and January 2016. Women were recruited through local testing sites, community-based organizations, and social media. Focus groups were audio-recorded and transcripts were analyzed using thematic analysis. Results Twenty-two women participated in focus groups, with median age 44 (IQR 30–53) and 6 identifying as non-Hispanic Black, 7 non-Hispanic White, 8 Latina and 1 mixed race. Despite limited prior PrEP knowledge and no PrEP experience, participants expressed interest in taking PrEP. Anticipated benefits were freedom from worry about HIV and control over sexual health; however, these were tempered by concerns including the possibility of increased HIV risk behaviors and potential side effects. Cisgender women reported potential barriers to PrEP uptake and adherence barriers, like competing priorities and poor PrEP access. Conversely, PrEP facilitators included utilizing practical tools such as phone apps and pill boxes as well as receiving encouragement from loved ones and support from other cisgender women on PrEP, women living with HIV and their medical providers. Conclusions Although PrEP awareness was low, participants recognized the importance of PrEP and ways to facilitate adherence. Exploring perspectives of cisgender women is integral to developing effective interventions to support PrEP uptake and adherence for women at elevated risk for HIV.

scholarly journals PrEP Continuation, HIV and STI Testing Rates, and Delivery of Preventive Care in a Clinic-Based Cohort

2018 ◽  
Vol 30 (5) ◽  
pp. 393-405 ◽  
Author(s):  
Matthew A. Hevey ◽  
Jennifer L. Walsh ◽  
Andrew E. Petroll
Keyword(s):  
Clinical Trials ◽  
Preventive Care ◽  
Retention In Care ◽  
Clinical Settings ◽  
Hiv Incidence ◽  
Sti Testing ◽  
Hiv And Sti Testing ◽  
Study Completion ◽  
Exposure Prophylaxis

HIV pre-exposure prophylaxis (PrEP) has been demonstrated to be a safe and effective method of reducing HIV incidence. Questions remain regarding PrEP's efficacy and outcomes in real-world clinical settings. We conducted a retrospective review to assess PrEP outcomes in an academic clinic setting and focused on retention in care, reasons for discontinuation, and receipt of appropriate preventive care (immunizations, HIV testing, and STI testing). One hundred thirty-four patients were seen between 2010 and 2016 over 309 visits. One hundred sixteen patients (87%) started daily PrEP and of those, 88 (76%) attended at least one 6-month follow-up visit. Over 60% of PrEP patients completed all recommended STI screening after starting PrEP. Only 40% of patients had all appropriate immunizations at baseline; 78% had all appropriate immunizations at study completion. This study demonstrated high rates of both retention and of attaining recommended preventive care in a clinical setting outside of the rigors of clinical trials.

scholarly journals Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa

2018 ◽  
Vol 1 ◽  
pp. 3 ◽  
Author(s):  
Renee Heffron ◽  
Kenneth Ngure ◽  
Josephine Odoyo ◽  
Nulu Bulya ◽  
Edna Tindimwebwa ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Hiv Treatment ◽  
Demonstration Project ◽  
Hiv Incidence ◽  
Serodiscordant Couples ◽  
Treatment Services ◽  
Hiv Serodiscordant Couples ◽  
Exposure Prophylaxis ◽  
Living With Hiv ◽  
Hiv Negative

Background: Pre-exposure prophylaxis (PrEP) can provide high protection against HIV infection and is a recommended intervention for HIV-negative persons with substantial HIV risk.  Demonstration projects conducted in diverse settings worldwide illustrate practical examples of how PrEP can be delivered. This manuscript presents estimates of effectiveness and patterns of PrEP use within a two-year demonstration project of PrEP for HIV-negative members of heterosexual HIV serodiscordant couples in East Africa. Methods: The PrEP delivery model integrated PrEP into HIV treatment services, prioritizing PrEP use for HIV-negative partners within serodiscordant couples before and during the first 6 months after the partner living with HIV initiated antiretroviral therapy (ART).  We measured PrEP uptake through pharmacy records and adherence to PrEP through medication event monitoring system (MEMS) bottle caps and quantification of tenofovir in plasma among a random sample of participants. We estimated HIV infections prevented using a counterfactual cohort simulated from the placebo arm of a previous PrEP clinical trial. Results: We enrolled 1,010 HIV serodiscordant couples that were naïve to ART and PrEP.  Ninety-seven percent of HIV-negative partners initiated PrEP. Objective measures suggest high adherence: 71% of HIV-negative participants took ≥80% of expected doses, as recorded via MEMS, and 81% of plasma samples had tenofovir detected.  Four incident HIV infections were observed (incidence rate=0.24 per 100 person-years), a 95% reduction (95% CI 86-98%, p<0.0001) in HIV incidence, relative to estimated HIV incidence for the population in the absence of PrEP integrated into HIV treatment services.   Conclusions: PrEP uptake and adherence were high and incident HIV was rare in this PrEP demonstration project for African HIV-negative individuals whose partners were known to be living with HIV.  Delivery of PrEP to HIV-negative partners within HIV serodiscordant couples was feasible and should be prioritized for wide-scale implementation.

scholarly journals 1701. Added Benefits of Pre-exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement among Men Who Have Sex with Men

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S833-S833
Author(s):  
Alyson L Singleton ◽  
Brandon D Marshall ◽  
Xiao Zang ◽  
Amy S Nunn ◽  
William C Goedel
Keyword(s):  
African American ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Treatment Engagement ◽  
Hiv Incidence ◽  
Black African ◽  
African American Msm ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
High Treatment

Abstract Background Although there is ongoing debate over the need for substantial increases in PrEP use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use in settings with high treatment engagement across variable sub-epidemics in the United States. Methods We used a previously published agent-based network model to simulate HIV transmission in a dynamic network of 17,440 Black/African American and White MSM in Atlanta, Georgia from 2015 to 2024 to understand how the magnitude of reductions in HIV incidence attributable to varying levels of PrEP use (0–90%) changes in potential futures where high levels of treatment engagement (i.e. the UNAIDS ‘90-90-90’ goals and eventual ‘95-95-95’ goals) are achieved and maintained, as compared to current levels of treatment engagement in Atlanta (Figure 1). Model inputs related to HIV treatment engagement among Black/African American and White men who have sex with men in Atlanta. A comparison of current levels of treatment engagement (Panel A) to treatment engagement at ‘90-90-90’ (Panel B) and ‘95-95-95’ goals (Panel C). Results Even at achievement and maintenance of ‘90-90-90’ goals, 75% PrEP coverage reduced incidence rates by an additional 67.9% and 74.2% to 1.53 (SI: 1.39, 1.70) and 0.355 (SI: 0.316, 0.391) per 100 person-years for Black/African American and White MSM, respectively (Figure 2), compared to the same scenario with no PrEP use. Additionally, an increase from 15% PrEP coverage to 75% under ‘90-90-90’ goals only increased person-years of PrEP use per HIV infection averted, a measure of efficiency of PrEP, by 8.1% and 10.5% to 26.7 (SI: 25.6, 28.0) and 73.3 (SI: 70.6, 75.7) among Black/African American MSM and White MSM, respectively (Figure 3). Overall (Panel A) and race-stratified (Panel B and Panel C) marginal changes in HIV incidence over ten years among Black/African American and White men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: All changes are calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Person-years of pre-exposure prophylaxis use per HIV infection averted among Black/African American (Panel A) and White (Panel B) men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: The number of HIV infections averted is calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Conclusion Even in the context of high treatment engagement, substantial expansion of PrEP use still contributes to meaningful decreases in HIV incidence among MSM with minimal changes in person-years of PrEP use per HIV infection averted, particularly for Black/African American MSM. Disclosures All Authors: No reported disclosures

Remittance Behavior among Salvadoran and Filipino Immigrants in Los Angeles

1998 ◽  
Vol 32 (1) ◽  
pp. 97-126 ◽  
Author(s):  
Cecilia Menjívar ◽  
Julie DaVanzo ◽  
Lisa Greenwell ◽  
R. Burciaga Valdez
Keyword(s):  
United States ◽  
Los Angeles ◽  
Family Income ◽  
Country Of Origin ◽  
The United States ◽  
Individual Characteristics ◽  
Host Countries ◽  
Factors Affecting ◽  
English Classes ◽  
Remittance Behavior

This article analyzes the factors that influence remittance behavior (the decision to remit and the amount sent) in the host country of Filipino and Salvadoran immigrants, two groups with high rates of U.S.-bound migration and of remittances. Data for this study come from a multipurpose survey fielded in Los Angeles in 1991 and are analyzed using logistic regressions and OLS. Individual characteristics and financial ability to remit, motivation to migrate, personal investments in the United States, and family obligations in the home and in the host countries are hypothesized to affect remittance behavior. No differences by country of origin in the proportion who send remittances were found, but there were significant differences in the amount remitted. Some variables affect the two country-of-origin groups differently. The size of remittances sent by Salvadorans tends to be relatively insensitive to their characteristics compared with Filipinos. Filipinos’ remittances are more affected by age, family income, having taken English classes in the United States, and living alone than are the remittances of Salvadorans. For both groups, the most consistent factors affecting remittances are family income and the place of residence of close family members.

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