Abstract

Barriers and facilitators of antiretroviral therapy and pre-exposure prophylaxis uptake within Black/African American communities: A systematic review

Plangkat Milaham, B.Pharm, MPH (in progress), Page Dobbs, PhD, Alex Russell, PhD, Philip Massey, PhD Department of Health, Human Performance and Recreation, University of Arkansas

APHA 2022 Annual Meeting and Expo

Background: While Black/African Americans comprise only 13% of the U.S. population, they account for over 40% of current HIV cases, cumulative AIDS deaths, and new HIV diagnoses. The uptake of effective biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) is suboptimal within Black/African American communities.

Methods: We conducted a systematic review guided by the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to synthesize the literature published over the last decade (2011-2021) related to barriers and facilitators of ART and PrEP uptake within Black/African American communities. Our search was conducted on February 27, 2022, across four databases (Pubmed, CINAHL, PsychInfo, Medline complete). Search strings employed were (((antiretroviral therapy or anti-retroviral therapy or antiretroviral) AND (barriers or facilitators or barriers and facilitators) AND (Black or African American or African-American or Black American)) OR ((pre-exposure prophylaxis or prep or preexposure prophylaxis) AND (barriers or facilitators or barriers and facilitators) AND (black or African American or African-American or black American))). Inclusion criteria included: qualitative and quantitative studies, Black/African American populations, biomedical interventions of interest (ART and PrEP), and articles that described barriers to and facilitators of these interventions. Studies that covered other racial groups, were conducted outside the U.S., examined other biomedical interventions, or did not report original data were excluded from the review.

Results: A total of 13 studies met inclusion criteria. The sample size of study participants ranged from 8 to 855, and participant ages ranged from 18 to 65 years. Facilitators and barriers were noted across three levels of the ecological framework: individual, interpersonal, and structural. The most prevalent barriers identified were limited knowledge about biomedical interventions (individual), stigma from family and community members (interpersonal), and inequalities due to race and sexuality (structural), while facilitators included feeling of safety (individual), relational support (interpersonal), as well as positive experience with providers (structural).

Conclusions: This review highlights important factors that should be considered in HIV eradication strategies, and buttresses the need to recognize the roles of structural and interpersonal factors that might influence linkage to care, enrollment in care, medication adherence, and retention in care in the context of PrEP and ART. Strategies that seek to reduce barriers and strengthen facilitators to PrEP and ART among Black and African American communities need to be explored.

Abstract

Relationship between Access and Use of Community Resources and PrEP Adoption

Hue Mai, Erin Benton, Liesl Nydegger The University of Texas at Austin

APHA 2022 Annual Meeting and Expo

Literature suggests the importance of leveraging community resources to address disparities in HIV and PrEP use among Black and Latinx communities, yet little is known about how they utilize these resources. We conducted a secondary analysis to explore the use of community resources and PrEP among Black and Latinx women who are at high risk for HIV. We conducted semi-structured interviews with 18 Black and Latinx women. Inclusion criteria included: being at least 18 years old, Identifying as a cisgender Latinx or Black women, having at least one child under 18 years old, having unprotected sex with a cisgender male in the past 30 days, having unknown or HIV negative status, speaking fluent English or Spanish, and at least two of following factors – IPV in the past 3 months, substance misuse in the past 30 days, transactional sex in the past 3 months, multiple sex partners in the past 3 months, or their partner(s) had multiple sex partners in the past 3 months. Interviews were transcribed verbatim and analyzed using thematic content analysis. We found that the majority of participants used community resources, including shelters, domestic violence resources, counseling, and education/workplace resources. Several barriers to the use of community resources were intimate partner violence, financial and employment issues, and stigma. The majority of women were interested in PrEP use, and those who use community resources were more open to PrEP use than those who did not. Future work should focus on promoting PrEP use at community resources.

Abstract

A Crowdsourcing Open Call to Design Pre-Exposure Prophylaxis (PrEP) Services for Youth in Nigeria

Titilola Gbaja-Biamila¹, Oliver Ezechi, MD,PhD², Chisom Obiezu-Umeh, MSc¹, Ucheoma Nwaozuru, PhD³, Hong Xian , PhD¹, David Oladele, MD¹, Adesola Z Musa, PhD², Kathryn E. Muessig, PhD⁴, Joseph Tucker, MD,PhD,AM⁵, Juliet Iwelunmor, PhD¹ (1)College for Public Health & Social Justice, Saint Louis University, Saint Louis, MO, USA, (2)Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria, (3)Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA, (4)Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, (5)Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA , Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

APHA 2022 Annual Meeting and Expo

Background
Youth (ages 14-24 years) in Nigeria have disproportionately high HIV incidence, increasing the importance of pre-exposure prophylaxis (PrEP) for HIV prevention. Effective PrEP service delivery models and strategies for broadening access among youth are not fully known.

Methods
A crowdsourcing open call was conducted to solicit ideas on ways to design services or programs that promote PrEP use among youth in Nigeria. Crowdsourcing open calls involve a group of people collaborating to solve a common problem and sharing solutions with the public. Digital approaches (social media and email) were used to disseminate the crowdsourcing open call, and submissions were collected online for 4 weeks. Eligible submissions were scored on a 3-point scale by an expert panel for Desirability, Innovation, Feasibility, and Potential Impact. Demographic data were collected, and thematic analysis was used to identify emergent themes from the youth submissions.

Results
The open call received 150 submissions, among which 90 were eligible. Most participants were Male (56%), had a mean age of 20, had at least secondary education (50%), and were from the southwestern part of Nigeria. Thematic analysis identified five PrEP delivery models: (1) digital health services (i.e., mobile health apps, telemedicine) (2) peer mobilization (i.e., involving youth peer mobilizers) (3) integration into youth-friendly sexual and reproductive health services (i.e., Prep services offered at the youth-friendly clinics); (4) peer support groups (i.e., creating youth support groups in schools and clinics); (5) De-medicalized and community-based venues (i.e., community outreach activities involving youth activists).


Conclusion
Our findings suggest that crowdsourcing open calls are a feasible strategy for identifying promising service delivery models to promote uptake of PrEP among young people. These themes can inform PrEP messaging and services for youth in Nigeria.

Abstract

Perceptions and attitudes about long-acting injectable pre-exposure prophylaxis (PrEP) among transgender and gender-diverse young adults in the US

Samantha Haiken, BA¹, Kimberly M. Nelson, PhD, MPH¹, Madina Agénor, ScD, MPH², Jaclyn M. W. Hughto, PhD, MPH², Gabriel R. Murchison, PhD, MPH³, Allyson Cogan, BA¹, Allegra R. Gordon, ScD, MPH¹ (1)Boston University School of Public Health, (2)Brown University School of Public Health, (3)Yale University School of Public Health

APHA 2022 Annual Meeting and Expo

Purpose: Transgender and gender-diverse young adults (TGD YA) are disproportionately impacted by HIV and experience significant barriers to accessing pre-exposure prophylaxis (PrEP) for HIV prevention. Long-acting injectable (LAI) PrEP has been newly approved for use in the US, yet little is known about perceptions of LAI PrEP among TGD YA.

Methods: Semi-structured interviews were conducted August 2021-February 2022 with US TGD YA who reported PrEP use or recent HIV risk behavior (n=31). Participants were: ages 18-31 years; 48% nonbinary, 26% transgender men, 26% transgender women; 32% white, 29% multiple races/ethnicities, 16% Latinx/e, 13% Asian, 10% Black. Just under one-third (n=9) had ever used PreP. Two interview questions asked about perceptions of and attitudes toward LAI PrEP; these narratives were analyzed using the Rigorous and Accelerated Data Reduction technique.

Results: All participants who had taken PreP and most participants who had never taken PrEP indicated interest in LAI PrEP, citing drawbacks of once-daily oral medication including adherence challenges and medication side effects. The most widely cited potential barrier to LAI PrEP use was discomfort with needles, followed by concerns about medication side effects and preference for self-administered medications. Some participants associated LAI PrEP with their experiences using injectable gender-affirming hormones, which increased favorability toward LAI PrEP use.

Conclusions: This study identified several potential facilitators of and barriers to LAI PrEP uptake among TGD YA. HIV prevention programs should build on the expertise and experiences of TGD YA to ensure that emerging HIV prevention technologies are accessible to people of all genders.