Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019

Objective: Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. Methods: We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. Results: PrIDE jurisdictions implemented multiple health equity–focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP ( z = −33.57; P < .001). Conclusions: PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity–focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.

PARTNER-MH, a Peer-Led Patient Navigation Intervention for Racial and Ethnic Minority Veterans in Veterans Health Administration (VHA) Mental Health Services: A Mixed-Methods Randomized Controlled Feasibility Trial Study Protocol

Background: Mental healthcare disparities are persistent and have increased in recent years. Compared to their White counterparts, racial and ethnic minority groups have less access to mental healthcare. Minority groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental healthcare experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental healthcare and treatment decisions may help to reduce mental healthcare disparities. Designed to achieve this goal, PARTNER-MH is a peer-led, patient navigation intervention that aims to engage minority patients in mental health treatment, support them to take a greater role in their care, and facilitate their participation in treatment shared decision-making. Methods: This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a VHA mental health setting using a mixed-methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions, using certified VHA peer support specialists (peers), selected via usual VHA hiring practices and assigned to the mental health service. The peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making, as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. Results: Participants (N=50) were veterans who were mostly male (62%), self-identified as non-Hispanic Black (70%), with a median age in the 45-54 group. Most had at least some college education, and 32% completed 4 or more years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for gender. Discussion and Conclusion: Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally-sensitive system-based intervention to improve patient engagement and patient-provider communication in mental healthcare for racial and ethnic minorities. IRB Protocol #1708628270Trial registration: ClinicalTrials.gov, NCT04515771. Registered 14 August 2020, https://clinicaltrials.gov/ct2/show/NCT04515771

Applying Grounded Theory to Understand Asian Women’s Motivations to Donate Healthy Breast Tissue

Background: The Komen Tissue Bank (KTB) is a clinical trial and the only global biorepository that collects and stores healthy breast tissue to be used as controls in breast cancer (BC) research. Due to a variety of barriers, there is a lack of participation by racial and ethnic minority women in tissue donation. In order to increase this participation, it is necessary to understand why or why not these populations choose to participate in clinical trials such as the KTB. This study used grounded theory methodology to explore the motivations behind Asian women’s decisions to donate their breast tissue. Methods: Guided by grounded theory, we conducted interviews with previous breast tissue donors who self-identified as Asian (n=20). We then transcribed and coded the interviews to discover common attitudes and motivations for participating in breast tissue donation. Findings: Preliminary findings were obtained from 11 interviews. We identified three common themes that influenced these women’s donations: altruistic behavior, comfort with science, and Asian identity. Identified sub-themes include factors such as personal ties to BC and background in research and clinical trials. It is of note that over half of the women expressed Asian identity and comfort with science as important factors, and all mentioned altruistic tendencies, either towards family or towards research and others. Conclusion and Future Work: We identified common factors for donating healthy breast tissue from using grounded theory to interview previous donors of Asian descent. We will transcribe and code 9 more interviews, as well as use those interviews to confirm theoretical saturation. The findings from this study will be used in the future to inform a framework for developing recruitment strategies to increase overall participation of historically excluded individuals in the KTB. Future work will include exploring the motivations of Latinas regarding donating their healthy breast tissue.

Unsupervised Machine Learning to Detect and Characterize Barriers to PrEP Therapy: A Multiplatform Social Media Study (Preprint)

BACKGROUND Among racial and ethnic minority groups, the risk of HIV infection is an ongoing public health challenge. PrEP (pre-exposure prophylaxis) is highly effective for preventing HIV when taken as prescribed. However, there is a need to understand experiences, attitudes, and barriers of PrEP for racial and ethnic minority populations, and sexual minority groups. OBJECTIVE This infodemiology study aimed to leverage big data and unsupervised machine learning to identify, characterize, and elucidate on experiences and attitudes regarding perceived barriers associated with uptake and adherence to PrEP therapy. The study also specifically examined self-reported experiences from racial or ethnic populations and sexual minority users. METHODS The study used data mining approaches to collect posts from popular social media platforms Twitter, YouTube, Tumblr, Instagram, and Reddit. Posts were selected by filtering for keywords associated with PrEP, HIV, and approved PrEP therapies. We analyzed data using unsupervised machine learning followed by manual annotation using a deductive coding approach to characterize PrEP and other HIV prevention-related themes discussed by users. RESULTS We collected a total of 522,430 posts over a 60-day period, including 408,637 (78.22%) Tweets, 13,768 (2.63%) YouTube comments, 8,728 (1.67%) Tumblr posts, 88,177 (16.88%) Instagram posts, and 3,120 (0.60%) Reddit posts. After applying unsupervised machine learning and content analysis, a total of 785 posts were identified that specifically related to barriers to PrEP and were grouped into three major thematic domains including the: (a) provider level (n=13 posts, 1.66%); (b) patient-level (n=570, 72.61%), and (c) community level (n=166, 21.15%). The main barriers identified in these categories included those associated with knowledge (lack of knowledge about PrEP); access issues (lack of insurance coverage, no prescription, and impact of COVID-19 pandemic); and adherence (subjective reasons for why users terminated PrEP or decided not to start PrEP, including side effects, alternative HIV prevention measures, and social stigma). Among all PrEP posts, we identified 320 (40.76%) posts where users self-identified as racial or ethnic minority, or as a sexual minority population with their own specific PrEP barriers and concerns. CONCLUSIONS Both objective and subjective reasons were identified as barriers reported by social media users when initiating, accessing, and adhering to PrEP. Though ample evidence supports PrEP as an effective HIV prevention strategy, user-generated posts nevertheless provide insights into what barriers are preventing people from broader adoption of PrEP, including topics that are specific to two different groups of sexual minorities and racial and ethnic minority populations. Results have the potential to inform future health promotion and regulatory science approaches that can reach these HIV/AIDS communities who may benefit from PrEP.