Community-Based, Rapid HIV Screening and Pre-Exposure Prophylaxis Initiation: Findings From a Pilot Program

Abstract Background HIV incidence among South African adolescent girls and young women (AGYW) remains high, but could be reduced by highly effective pre-exposure prophylaxis (PrEP). Unfortunately, AGYW report significant barriers to clinic-based sexual and reproductive health services. Even when AGYW access PrEP as an HIV prevention method, poor prevention-effective use was a serious barrier to achieving its optimal HIV prevention benefits. Determining the acceptability and feasibility of community-based platforms to increase AGYW’s access to PrEP, and evaluating behavioural interventions to improve prevention-effective use of PrEP are needed. Methods We propose a mixed-methods study among AGYW aged 16–25 years in Eastern Cape Province, South Africa. In the first component, a cross-sectional study will assess the acceptability and feasibility of leveraging community-based HIV counselling and testing (CBCT) platforms to refer HIV-negative, at-risk AGYW to non-clinic-based, same-day PrEP initiation services. In the second component, we will enrol 480 AGYW initiating PrEP via our CBCT platforms into a three-armed (1:1:1) randomized control trial (RCT) that will evaluate the effectiveness of adherence support interventions to improve the prevention-effective use of PrEP. Adherence will be measured over 24 months via tenofovir-diphosphate blood concentration levels. Qualitative investigations will explore participant, staff, and community experiences associated with community-based PrEP services, adherence support activities, study implementation, and community awareness. Costs and scalability of service platforms and interventions will be evaluated. Discussion This will be the first study to assess the acceptability and feasibility of leveraging CBCT platforms to identify and refer at-risk AGYW to community-based, same-day PrEP initiation services. It will also provide quantitative and qualitative results to inform adherence support activities and services that promote the prevention-effective use of PrEP among AGYW. By applying principles of implementation science, behavioural science, and health economics research, we aim to inform strategies to improve access to and prevention-effective use of PrEP by AGYW. Trial registration ClinicalTrials.govNCT03977181. Registered on 6 June 2019—retrospectively registered.

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Prevalence and Correlates of Transactional Sex Among Women of Low Socioeconomic Status in Portland, Oregon

10.21203/rs.3.rs-30004/v1 ◽

2020 ◽

Author(s):

Timothy W Menza ◽

Lauren Lipira ◽

Amisha Bhattarai ◽

Victoria Cali-DeLeon ◽

Roberto Orellana

Keyword(s):

Socioeconomic Status ◽

Hiv Prevention ◽

Sexual Violence ◽

Childhood Trauma ◽

Low Socioeconomic Status ◽

Transactional Sex ◽

Hiv Screening ◽

Low Socioeconomic ◽

Biomedical Hiv Prevention ◽

Exposure Prophylaxis

Abstract Background: Women who report transactional sex are at increased risk for HIV and other sexually transmitted infections (STIs). However,in the United States, social, behavioral, and trauma-related vulnerabilities associated with transactional sex are understudied and data on access to biomedical HIV prevention among women who report transactional sex is limited. Methods: In 2016, we conducted a population-based, cross-sectional survey of women of low socioeconomic status recruited via respondent-driven sampling in Portland, Oregon. We calculated the prevalence and,assessed the correlates of, transactional sex using generalized linear models accounting for sampling design. We also compared health outcomes,HIV screening, and knowledge and uptake of HIV pre-exposure prophylaxis (PrEP) between women who did and did not report transactional sex.Results: Of 334 women, 13.6% reported transactional sex (95% confidence interval [CI]: 6.8%, 20.5%). Women who reported transactional sex were older, more likely to identify as black, to identify as lesbian or bisexual, to experience childhood trauma and recent sexual violence, and to have been homeless. Six percent(95%CI: 1.8%, 10.5%) of women with no adverse childhood experiences (ACEs) reported transactional sex compared to 23.8%(95%CI: 13.0%, 34.6%)of women who reported eleven ACEs (P<0.001). Transactional sex was strongly associated withcombination methamphetamine and opiate use as well ascondomless sex. Women who reported transactional sex were more likely to report being diagnosed with a bacterial STI and hepatitis C; however, HIV screening and pre-exposure prophylaxis knowledge and use were low. Conclusions:In a sample ofwomen of low socioeconomic status in Portland, Oregon, transactional sex was characterized by marginalized identities, homelessness, childhood trauma, sexual violence, substance use, and sexual vulnerability to HIV/STI. Multi-level interventions that address these social, behavioral, and trauma-related factors and increase access to biomedical HIV prevention are critical to the sexual health of women who engage in transactional sex.

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Pleasure and PrEP: Pleasure-Seeking Plays a Role in Prevention Choices and Could Lead to PrEP Initiation

American Journal of Men s Health ◽

10.1177/1557988319827396 ◽

2019 ◽

Vol 13 (1) ◽

pp. 155798831982739 ◽

Cited By ~ 12

Author(s):

Xavier Mabire ◽

Costanza Puppo ◽

Stéphane Morel ◽

Marion Mora ◽

Daniela Rojas Castro ◽

...

Keyword(s):

Quality Of Life ◽

Essential Element ◽

Community Based ◽

Sexual Quality Of Life ◽

Major Threat ◽

On Demand ◽

Community Based Design ◽

Sex With Men ◽

Exposure Prophylaxis

Pleasure-seeking plays a role in prevention (means choices and use), and in the sexual quality of life of men who have sex with men (MSM). Since HIV is a major threat to MSM health, new means of prevention, like pre-exposure prophylaxis (PrEP), must meet the needs of MSM to be fully efficient. Using a psychosocial approach, we examined how pleasure-seeking plays a role in participation of MSM in “ANRS-IPERGAY,” a community-based trial on sexual health which included sexual on-demand PrEP. Thirteen semistructured collective interviews were conducted with 45 participants. First, we analyzed participants’ search for new prevention means due to previous failures in condom use. We found that participants perceived condoms as a barrier—both materially and symbolically—to pleasure and desire, causing anxiety and stress considering sexual intercourse. Second, we explored representations and attitudes concerning pleasure within the context of PrEP. We found that PrEP allowed participants to freely choose their desired sexual positions and to better enjoy intimacy. Third, we studied the sexual quality of life for PrEP users in ANRS-IPERGAY and found an improvement. Thanks to the community-based design of the trial, this new prevention tool became a means to develop agency and empowerment for participants, not only in negotiating individual prevention but also in opposing the normative and stigmatizing discourse on sexuality and HIV. In conclusion, pleasure-seeking appears to be an essential element of sexual fulfillment that needs to be integrated as a positive notion in the study of HIV prevention.

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Community-Based Care in the ANRS-IPERGAY Trial: The Challenges of Combination Prevention

AIDS Education and Prevention ◽

10.1521/aeap.2019.31.3.259 ◽

2019 ◽

Vol 31 (3) ◽

pp. 259-272 ◽

Cited By ~ 1

Author(s):

Costanza Puppo ◽

Xavier Mabire ◽

Laurent Cotte ◽

Daniela Rojas Castro ◽

Bruno Spire ◽

...

Keyword(s):

High Risk ◽

Health Workers ◽

Open Label ◽

Community Based ◽

Double Blind ◽

Combination Prevention ◽

Open Label Extension ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The Relationship

ANRS-IPERGAY was a community-based randomized trial investigating the efficacy of sexual activity-based HIV pre-exposure prophylaxis (PrEP) in a population of males and transgender females who had sex with men and were at high risk of HIV infection. We qualitatively analyzed the support provided to participants by community-based health workers (CBHW) throughout the trial's double-blind and open-label extension phases. In particular, we showed that the relationship between participants and CBHW strongly influenced self-managed pill intake. The delicate construction of this relationship, balanced between trust and dependence, played an important role in PrEP adherence. CBHW had to deal with various issues surrounding participants' feelings of empowerment regarding their role in the trial, as well as related tensions between various logics and rationalities. They were essential to participants' continued involvement.

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Linking women experiencing incarceration to community-based HIV pre-exposure prophylaxis care: protocol of a pilot trial

Addiction Science & Clinical Practice ◽

10.1186/s13722-019-0137-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 4

Author(s):

Susan E. Ramsey ◽

Evan G. Ames ◽

Lauren Brinkley-Rubinstein ◽

Anne M. Teitelman ◽

Jennifer Clarke ◽

...

Keyword(s):

Pilot Trial ◽

Community Based ◽

Care Protocol ◽

Exposure Prophylaxis

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Community-Based Cardiovascular Disease Prevention to Reduce Cardiometabolic Risk in Latina Women: A Pilot Program

Journal of Women s Health ◽

10.1089/jwh.2013.4570 ◽

2014 ◽

Vol 23 (4) ◽

pp. 350-357 ◽

Cited By ~ 17

Author(s):

Robin Altman ◽

Jessica Nunez de Ybarra ◽

Amparo C. Villablanca

Keyword(s):

Cardiovascular Disease ◽

Disease Prevention ◽

Cardiometabolic Risk ◽

Cardiovascular Disease Prevention ◽

Pilot Program ◽

Latina Women ◽

Community Based

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Pre-exposure prophylaxis prescribing and retention in care among heterosexual women at a community-based comprehensive sexual health clinic

AIDS Care ◽

10.1080/09540121.2017.1286287 ◽

2017 ◽

Vol 29 (7) ◽

pp. 866-869 ◽

Cited By ~ 17

Author(s):

Oni J. Blackstock ◽

Viraj V. Patel ◽

Uriel Felsen ◽

Connie Park ◽

Sachin Jain

Keyword(s):

Sexual Health ◽

Retention In Care ◽

Health Clinic ◽

Community Based ◽

Heterosexual Women ◽

Exposure Prophylaxis

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HIV Pre-exposure Prophylaxis (PrEP) Uptake and Retention Among Men Who Have Sex with Men in a Community-Based Sexual Health Clinic

AIDS and Behavior ◽

10.1007/s10461-017-2009-x ◽

2017 ◽

Vol 22 (4) ◽

pp. 1096-1099 ◽

Cited By ~ 57

Author(s):

J. Carlo Hojilla ◽

David Vlahov ◽

Pierre-Cedric Crouch ◽

Carol Dawson-Rose ◽

Kellie Freeborn ◽

...

Keyword(s):

Sexual Health ◽

Health Clinic ◽

Community Based ◽

Sex With Men ◽

Exposure Prophylaxis

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Suboptimal uptake, retention, and adherence of daily oral PrEP among people with OUD receiving HCV treatment

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab658 ◽

2021 ◽

Author(s):

C Brokus ◽

S Kattakuzhy ◽

B Gayle ◽

S Narayanan ◽

A Davis ◽

...

Keyword(s):

Opioid Use Disorder ◽

Self Report ◽

Washington Dc ◽

Opioid Use ◽

Hcv Treatment ◽

Community Based ◽

Treatment Medication ◽

Long Acting ◽

Exposure Prophylaxis ◽

Hiv Negative

Abstract Introduction Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC) prevents HIV among people who inject drugs (PWID). Despite rising HIV incidence and injection drug use, PrEP use remains low and there is limited research about uptake, adherence, and retention among PWID. Methods The ANCHOR investigation evaluated a community-based care model collocating hepatitis C (HCV) treatment, medication for opioid use disorder (OUD), and PrEP in individuals in Washington, DC-Baltimore. PrEP counseling was conducted from HCV treatment Day 0 until Week 24. Subjects could start any time during this window, were followed for 48 weeks, and were assessed for adherence by self-report and dried bloodspot TDF analysis. Results 198 participants were enrolled, of whom 185 (93%) were HIV-negative. Twenty-nine individuals (15.7% of HIV-negative cohort) initiated PrEP. 116 participants (62.7%) met 2014 CDC PrEP criteria due to IDU (82, 44.3%), sex (9, 4.9%), or both practices (25, 13.5%). Providers recommended PrEP to 94 individuals (50.8%), and recommendation was associated with PrEP uptake. Median treatment duration was 104 days (IQR 28, 276), with 8 participants retained through Week 48. Adherence was variable over time by self-report and declined by TDF analysis. No HIV seroconversions occurred. Conclusions This cohort of people with HCV and OUD experienced low uptake of PrEP despite the majority meeting CDC criteria. High rates of disruption and discontinuation, compounded by variable adherence, made TDF/FTC a suboptimal prevention strategy. Emerging modalities like long-acting formulations may address these barriers, but PWID have been excluded from their development to date.

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