Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

Jenness, Samuel M.; Maloney, Kevin M.; Smith, Dawn K.; Hoover, Karen W.; Goodreau, Steven M.; Rosenberg, Eli S.; Weiss, Kevin M; Liu, Albert Y.; Rao, Darcy White; Sullivan, Patrick S.

doi:10.1101/249540

Cited by 24 publications

(36 citation statements)

References 56 publications

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“…Egocentric data have been successfully used to model the drivers of HIV transmission, racial disparities in disease incidence, and optimal strategies for HIV/STI prevention (26)(27)(28). These empirically grounded network models depend on egocentric network data.…”

Section: Introductionmentioning

confidence: 99%

Egocentric Sexual Networks of Men Who Have Sex with Men in the United States: Results from the ARTnet Study

Weiss

Goodreau

Morris

et al. 2019

Preprint

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In this paper, we present an overview and descriptive results from the first egocentric network study of MSM from across the United States (U.S.): the ARTnet study. ARTnet was designed to support prevention research for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) that are transmitted across partnership networks. ARTnet implemented a population-based egocentric network study design that sampled egos from the target population and asked them to report on the number, attributes, and timing of their sexual partnerships. Such data provide the foundation needed for estimating and simulating stochastic network models that are used for disease projection and intervention planning. ARTnet collected data online from 2017 to 2019, with a final sample of 4904 participants who reported on 16198 sexual partnerships. The analytic aims of the study were to characterize the joint distribution of three network parameters needed for modeling: degree distributions, assortative mixing, and partnership length, with heterogeneity by partnership type (main, casual and one-time), demography, and geography. Participants had an average of 1.19 currently active partnerships ("mean degree"), which was higher for casual partnerships (0.74) than main partnerships (0.45). The mean rate of one-time partnership acquisition was 0.16 per week (8.5 partners per year). Main partnerships lasted 272.5 weeks on average, while casual partnerships lasted 133.0 weeks. There was strong but heterogenous assortative mixing by race/ethnicity for all groups. The mean absolute age difference was 9.5 years, with main partners differing by 6.3 years compared to 10.8 years for casual partners. Our analysis suggests that MSM may be at sustained risk for HIV/STI acquisition and transmission through high network degree of sexual partnerships. The ARTnet network study provides a robust and reproducible foundation for understanding the dynamics of HIV/STI epidemiology among U.S. MSM and supporting the implementation science that seeks to address persistent challenges in HIV/STI prevention.

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Section: Introductionmentioning

confidence: 99%

Egocentric Sexual Networks of Men Who Have Sex with Men in the United States: Results from the ARTnet Study

Weiss

Goodreau

Morris

et al. 2019

Preprint

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“…21 Our findings that bias was higher in casual compared to main partnerships and for MSM with larger baseline degrees suggests empiric models may have overestimated the role of these factors for explaining HIV transmission. 17,28 Intervention models projecting the impact of new prevention strategies (such as HIV PrEP) based on network structure may also overestimate effectiveness if model parameters for degree are inaccurate. 10,19 is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Bias in Estimates of Sexual Network Degree using Prospective Cohort Data

Uong

Rosenberg

Goodreau

et al. 2019

Preprint

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Background: Sexual network degree, a count of ongoing partnerships, plays a critical role in the transmission dynamics of human immunodeficiency virus (HIV) and other sexually transmitted infections (STI). Researchers often quantify degree using self-reported cross-sectional data on the day of survey, which may result in bias because of uncertainty about future sexual activity. Methods: We evaluated the bias of a cross-sectional degree measure with a prospective cohort study of men who have sex with men (MSM). At baseline, we asked men about whether recent sexual partnerships were ongoing. We confirmed the true, ongoing status of those partnerships at baseline at follow-up. With logistic regression, we estimated the partnership-level predictors of baseline measure accuracy. With Poisson regression, we estimated the longitudinally confirmed degree as a function of baseline predicted degree. Results: Across partnership types, the baseline ongoing status measure was 70% accurate, with higher negative predictive value (91%) than positive predictive value (39%). Partnership exclusivity and racial pairing were associated with higher accuracy. Baseline degree generally overestimated confirmed degree. Bias, or number of ongoing partners different than predicted at baseline, was -0.28 overall, ranging from -1.91 to -0.41 for MSM with any ongoing partnerships at baseline. Comparing MSM of the same baseline degree, the level of bias was stronger for black compared to white MSM, and for younger compared to older MSM. Conclusions: Research studies may overestimate degree when it is quantified cross-sectionally. Adjustment and structured sensitivity analyses may account for bias in studies of HIV or STI prevention interventions.

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“…This includes the use of MI to help orient the client toward seeking and initiating care. MyCare (step 1), which is modeled after life steps, a single-session intervention grounded in cognitive-behavioral principles, is at the core of several successful ART adherence interventions [ 12 , 87 , 88 ]. MyCare (step 2) adds to this evidence-based approach by recognizing that adherence to medications is a personal choice grounded in a variety of behavioral and psychosocial domains.…”

Section: Methodsmentioning

confidence: 99%

“…The focus of the Providing Unique Support for Health (PUSH) study is to engage individuals at risk for HIV into prevention and care. The approach is the same as aim 2, modeled after life steps [ 12 , 87 , 88 ] and based on the case management protocol 078 of the HPTN [ 82 ]. It is tailored to the prevention needs of the youth.…”

Section: Methodsmentioning

confidence: 99%

“…Both YBLMSM and YBLTW are less likely than White young men who have sex with men (MSM) or their White cisgender peers to receive, adhere, and obtain HIV viral suppression with antiretroviral therapy (ART) [ 10 , 11 ]. Moreover, YBLMSM and YBLTW at risk for HIV have had disproportionately lower rates of PrEP uptake and adherence [ 3 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial

Arrington‐Sanders¹,

Hailey-Fair²,

Wirtz³

et al. 2020

JMIR Res Protoc

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Background The US National HIV/AIDS Strategy 2020 calls for increasing access to care, improving outcomes of people living with HIV, and targeting biomedical prevention efforts, including access to pre-exposure prophylaxis (PrEP) in communities where HIV is most heavily concentrated. The cities of Baltimore, Maryland (MD); Washington, DC; and Philadelphia, Pennsylvania (PA) are disproportionately burdened by high rates of new cases of HIV infection, with high prevalence among young Black and Latinx men who have sex with men (YBLMSM) and young Black and Latinx transgender women (YBLTW) aged 15-24 years. Objective This study aims (1) to identify and recruit YBLMSM and YBLTW who are at risk or living with HIV in Baltimore, MD; Philadelphia, PA; and Washington, DC, using respondent-driven sampling (RDS) with targeted seed selection, and (2) to assess the efficacy of a coach-based mobile-enhanced intervention (MEI) compared with standard of care (SOC) to increase successful engagement and retention into HIV, PrEP, and substance use treatment care across the HIV care and prevention continua in 3 Mid-Atlantic cities. This paper describes the protocol and progress as of October 20, 2019. Methods This study uses a multiphase mixed methods design. The first phase is a formative, qualitative research with focus group discussions and key informant interviews. The second phase consists of evaluating the ability of RDS with targeted seed selection. The third phase includes 2 embedded randomized controlled trials (RCTs), where participants complete a baseline sociobehavioral survey, rapid HIV testing, and eligible youth enroll in parallel status-dependent RCTs that randomize the participant to 1 of 2 study arms: MEI with coach or SOC. Participants are asked to complete a web-based survey and provide biologic specimens—HIV-1 RNA (viral load) or HIV-1 antibody test and urine drug screen—at baseline and at 3, 6, and 12 months, and an exit interview at 18 months. Results A formative qualitative research was conducted in February 2017 and May 2018, and this led to further refinement of recruitment and study methods. Aim 1 recruitment began in September 2017 with subsequent enrollment into the RCTs. Recruitment is ongoing with 520 participants screened and 402 (77.3%) enrolled in aim 1 by October 2020. Of these, 159 are enrolled in the 2 randomized trials: 36 (22.6%) HIV-positive not virally suppressed (aim 2) and 123 (77.4%) high-risk HIV-negative (aim 3). Conclusions This study has the potential to significantly impact the medical and substance use services provided to YBLMSM and YBLTW in the United States by providing rigorous scientific evidence outlining approaches and strategies that improve the uptake and engagement of YBLMSM and YBLTW in the HIV treatment and prevention continuum. Trial Registration ClinicalTrials.gov NCT03194477; https://clinicaltrials.gov/ct2/show/NCT03194477 International Registered Report Identifier (IRRID) DERR1-10.2196/17269

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Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States

Abstract: Background HIV preexposure prophylaxis (PrEP) could reduce the disparities in HIV incidence among

Cited by 24 publications

References 56 publications

Egocentric Sexual Networks of Men Who Have Sex with Men in the United States: Results from the ARTnet Study

Egocentric Sexual Networks of Men Who Have Sex with Men in the United States: Results from the ARTnet Study

Assessment of Bias in Estimates of Sexual Network Degree using Prospective Cohort Data

Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial

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