The PrEP Up Pharmacies Study: Protocol for integrating and disseminating pre-exposure prophylaxis (PrEP) screening and dispensing in community pharmacies for Black men who have sex with men in Atlanta, Georgia (Preprint)

BACKGROUND Black men who have sex with men (BMSM) suffer from alarmingly high rates of HIV in the United States. Pre-exposure prophylaxis (PrEP) can reduce risk of HIV infection by 99% among MSM, yet profound racial disparities in the uptake of PrEP persist. Low PrEP uptake in BMSM is driven by poor access to PrEP including inconvenient locations of PrEP-prescribing physicians and distrust of physicians and stigma, which limit communication about PrEP and its side effects. Previous work indicates that offering HIV prevention services in pharmacies located in high poverty, racial minority neighborhoods is feasible and can reduce stigma because pharmacies offer a host of less stigmatized health services (e.g. vaccinations). We present a protocol for a pharmacy PrEP model that seeks to address challenges and barriers to pharmacy-based PrEP specifically for BMSM. OBJECTIVE To develop a sustainable pharmacy PrEP delivery model that can be implemented to increase PrEP access in high poverty, racial minority neighborhoods for BMSM. METHODS This study design is a pilot intervention to test a pharmacy PrEP delivery model among pharmacy staff and BMSM. We will examine the PrEP delivery model’s feasibility, acceptability and safety, and gather early evidence of its impact and cost with respect to PrEP uptake. A mixed methods approach will be performed including three study phases: 1) a completed formative phase with qualitative interviews from key stakeholders; 2) a completed transitional pilot phase to assess customer eligibility and willingness to receive PrEP in pharmacies during COVID-19; and 3) a planned pilot intervention phase which will test the delivery model in two Atlanta pharmacies in high poverty, racial minority neighborhoods. RESULTS Data from the formative phase showed strong support of pharmacy-based PrEP delivery among BMSM, pharmacists and pharmacy staff. Important factors were identified to facilitate implementation of PrEP screening and dissemination in pharmacies. During the transitional pilot phase, we identified 81 individuals who would have been eligible for the pilot phase. CONCLUSIONS Pharmacies have proven to be a feasible source for offering PrEP for White MSM, but have failed to reach the most at-risk, vulnerable population – BMSM. Increasing PrEP access and uptake will reduce HIV incidence and racial inequities in HIV. Translational studies are required to build further evidence and scale pharmacy-based PrEP services specifically for populations that are disconnected from HIV prevention resources.

The Association Between Racial Privilege and Ethnocultural Empathy

Racial minorities living in U.S. society hold fewer privileges in day-to-day life than those in the racial majority. Some propose that the shared experience of a lack of racial privilege among minorities may promote increased empathy for people of other ethnicities and cultures, although there is a lack of evidence demonstrating this empirically. In this study, we examine the intersection of racial privilege and ethnocultural empathy in a diverse sample ( N = 404) of U.S. residents recruited using Amazon’s Mechanical Turk. Results indicated statistically significant differences in racial privilege and ethnocultural empathy between racial groups such that White participants had higher levels of racial privilege than racial minority participants and lower levels of ethnocultural empathy than Black participants. Results further suggested that the difference in ethnocultural empathy between White and Black participants remained even after racial privilege was controlled for statistically. These results integrate and advance research on the intersection between racial privilege on ethnocultural empathy.

Care Experiences and Expectations of Older Sexual Minority Adults

Sexual minority (SM) adults have unique care needs and experiences, partially because they receive and give care by and to “chosen family”. This study examines the care experiences and expectations of diverse SM adults. Using data from the 2018 AARP Survey “Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans,” logistic and ordinal regressions were conducted to examine associations with care experiences (i.e., provided caregiving and received caregiving) and care expectations (i.e., likelihood of having to provide care and need care) among SM respondents. Gender was highly associated with care experiences, with female respondents being 70% and 74% more likely to have provided caregiving [OR:1.71, SE=.26; p<0.001] and received caregiving [OR:1.74, SE=.22; p< 0.001]. Relationship status was significantly associated with care expectations, with those who were married/civil union/domestic being 4 times [OR:4.0, SE=.52; p<0.001] and those in a relationship being 3 times [OR:3.3, SE=.51; p<0.001] more likely to expect that they will provide care in the future. Those same respondents had a 64% [OR:1.64, SE=.21, p<0.001] and 55% [OR:1.55, SE=.23, p<0.01] greater odds of reporting being “very likely” that they will need care in the future. Additionally, older age, being a racial minority, having higher education, and being employed were significantly and positively associated with care experiences and expectations. These findings provide a deeper insight into how SM individuals of different backgrounds experience and anticipate different aspects of caregiving. Moreover, we will discuss how our findings compare to non-SM individuals and implications of these findings.

Vaccine Hesitancy Is a Barrier to Achieving Equitable Herd Immunity Among Racial Minorities

Introduction: Racial minority groups have been disproportionately affected by the 2019 novel coronavirus disease (COVID-19). Vaccine hesitancy may be a major barrier to achieving equitable herd immunity and must be addressed to reduce the excess morbidity and mortality of COVID-19 in disproportionately affected communities. This study aimed to determine if COVID-19 vaccine hesitancy, and its factors vaccine complacency and confidence, are more prominent among disproportionately affected racial minority groups.Methods:We collected data from participants aged 18 years or older from the four most populous U.S. states, including New York, California, Florida, and Texas, and Canada. Data were collected using a web-based survey platform. Data are available at http://www.covid19-database.com.Results:Data from 4,434 participants were included [mean (SD) age = 48.7 (17.2) and 50.4% women]. Vaccine hesitancy was higher in Black, Indigenous (Native American and Indigenous People of Canada, including First Nations, Inuit and Métis), and Latinx compared to White participants, while no difference was found between East Asian and White participants. The group differences in vaccine hesitancy for Indigenous and Black compared to White participants remained after controlling for sociodemographic factors. Determinants of vaccine complacency were equivalent between disproportionately affected racial groups and white participants. Vaccine confidence (i.e., trust in vaccine benefit) was generally lower in all racial groups compared to White participants. Differences in vaccine mistrust comparing Black and East Asian to White participants remained after controlling for sociodemographic factors.Discussion:Disproportionately affected racial minorities may have higher vaccine hesitancy and lower confidence in COVID-19 vaccines. Public health and other relevant government services should address vaccine hesitancy among racial minorities using a culturally sensitive, community-centered approach to attain equitable herd immunity.

Presence and Power: Teams with Hierarchical Representation of Underrepresented Minorities are More Attractive

Across four studies (N = 1,555) we find that individuals perceive teams with hierarchical representation (i.e., minority employees represented throughout their hierarchy) as more attractive than equally diverse teams that lack hierarchical representation. Teams with hierarchical representation are perceived as more diverse and as having superior team functioning (Study 1). Furthermore, the effect of hierarchical representation on team attractiveness did not differ between racial minority and majority participants (Studies 2-3), suggesting that attitudes about race among racial majority members might have evolved since a previous study found only racial minorities to be concerned with hierarchical representation. Additionally, diverse teams without hierarchical representation are perceived as no more attractive than hierarchical teams with objectively lower diversity (Study 3) and non-hierarchical teams without diversity (Study 4). These studies highlight the importance of minority representation across every echelon of a hierarchy rather than only at lower levels.

A New Effort to Diversify Faculty: Postdoc-to-Tenure Track Conversion Models

Calls to diversify the professoriate have been ongoing for decades. However, despite increasing numbers of scholars from underrepresented racial minority groups earning doctorates, actual progress in transitioning to faculty has been slow, particularly across STEM disciplines. In recent years, new efforts have emerged to recruit faculty members from underrepresented racial minority groups (i.e., African American/Black, Hispanic/Latinx, and/or Native American/Native Hawaiian/Indigenous) through highly competitive postdoctoral programs that allow fellows the opportunity to transition (or “convert”) into tenure-track roles. These programs hybridize some conventional aspects of the faculty search process (e.g., structured interview processes that facilitate unit buy-in) along with novel evidence-based practices and structural supports (e.g., proactive recruitment, cohort communities, search waivers, professional development, enhanced mentorship, financial incentives). In this policy and practice review, we describe and synthesize key attributes of existing conversion programs at institutional, consortium, and system levels. We discuss commonalities and unique features across models (N = 38) and draw specific insights from postdoctoral conversion models developed within and across institutions in the University System of Maryland (USM). In particular, experience garnered from a 10-year-old postdoc conversion program at UMBC will be highlighted, as well as the development of an additional institutional model aimed at the life sciences, and a state-system model of faculty diversification with support from a NSF Alliances for Graduate Education and the Professoriate (AGEP) grant.