Ending the HIV epidemic PrEP equity recommendations from a rapid ethnographic assessment of multilevel PrEP use determinants among young Black gay and bisexual men in Atlanta, GA

Hill, Miranda; Smith, Justin C.; Elimam, Dena; Mustafaa, Genetha; Wortley, Pascale M.; Taylor, Brittany; Harris, Orlando

doi:10.1371/journal.pone.0283764

Cited by 8 publications

(8 citation statements)

References 33 publications

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“…43 Recent advances in treatment, particularly long-acting injectable ART formulations, also hold promise to improve virologic suppression but must be implemented using care models that ensure needed access to priority populations despite structural barriers. 45 The gap in life expectancy is also likely due to inequities in non-HIV-related mortality. Black men experience higher rates of chronic health conditions than White men.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is in part, but not entirely, due to the earlier mean age at which Black MSM acquire HIV than White MSM. Improving uptake of HIV prevention strategies, such as PrEP, is of critical importance to ending the HIV epidemic and reducing inequities, and equity-centered interventions must also include prevention services for people without HIV, including equitable access to PrEP and harm reduction services . The gap in life expectancy is also likely due to inequities in non–HIV-related mortality.…”

Section: Discussionmentioning

confidence: 99%

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Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men

Rich,

Pandya,

Chiosi

et al. 2023

JAMA Netw Open

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ImportanceSubstantial racial inequities exist across the HIV care continuum between non-Hispanic Black and White men who have sex with men (MSM) in the US.ObjectivesTo project years of life gained (YLG) with improving the HIV care continuum among Black MSM and White MSM in the US and to determine the outcomes of achieving health equity goals.Design, Setting, and ParticipantsThe Cost-Effectiveness of Preventing AIDS Complications microsimulation model was used and populated with 2021 race-specific data to simulate HIV care among Black MSM and White MSM in the US who have acquired HIV. Analyses were completed from July 2021 to October 2023.InterventionThe study simulated status quo care using race-specific estimates: age at infection, time to diagnosis, receipt of care, and virologic suppression. The study next projected the outcomes of attaining equity-centered vs non–equity-centered goals by simulating 2 equal improvements in care goals: (10-point increased receipt of care and 5-point increased virologic suppression), 3 equity-centered goals (annual HIV testing, 95% receiving HIV care, and 95% virologic suppression) and lastly, an equitable care continuum that achieves annual HIV testing, 95% receiving care, and 95% virologic suppression in Black MSM and White MSM. One-way and multiway sensitivity and scenario analyses were conducted.Main Outcomes and MeasuresMean age at death and YLG.ResultsIn the simulated cohort, the mean (SD) age at HIV infection was 27.0 (10.8) years for Black MSM and 35.5 (13.6) years for White MSM. In status quo, mean age at death would be 68.8 years for Black MSM and 75.6 years for White MSM. The equal improvements in care goals would result in 0.5 YLG for Black MSM and 0.5 to 0.9 YLG for White MSM. Achieving any 1 equity-centered goal would result in 0.5 to 1.7 YLG for Black MSM and 0.4 to 1.3 YLG for White MSM. With an equitable care continuum compared with the nationally reported status quo, Black MSM and White MSM would gain 3.5 and 2.1 life-years, respectively. If the status quo HIV testing was every 6 years with 75% retained in care and 75% virologically suppressed, Black MSM would gain 4.2 life-years with an equitable care continuum.Conclusions and RelevanceIn this simulation modeling study of HIV care goals, equal improvements in HIV care for Black and White MSM maintained or worsened inequities. These results suggest that equity-centered goals for the HIV care continuum are critical to mitigate long-standing inequities in HIV outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men

Rich,

Pandya,

Chiosi

et al. 2023

JAMA Netw Open

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“…While peer navigation and patient navigation are often used interchangeably in some literature [25,40], peers often refer to who have received some STI-related or health intervention training and who can reach to a broad population within and beyond clinical settings. Lastly, interventions that utilize social networks (usually refers to one's social circle of friends, families, neighbors, and other significant others) to leverage the power of social relationships can also promote awareness of STI prevention and healthy behavioral patterns while strengthening community cohesion [12,26 ▪ ,27].…”

Section: Engagement Efforts At Interpersonal Levelmentioning

confidence: 99%

“…Additionally, digital tools are also instrumental in collaborating with community partners to co-develop intervention strategies, evident by the thriving of crowdsourcing contests and virtual co-creation in digital health research landscape [38 ▪ ,40]. Such remote engagement became particularly relevant in times of pandemic such as COVID-19 [12], enable the gathering of insights without geographical constraints. The application of digital methodologies extends beyond development to intervention delivery.…”

Section: Virtual Engagement: Digital Approachesmentioning

confidence: 99%

“…The main actors include but not limited to individuals from the target community, community leaders, religious leaders, community workers, policymakers, healthcare providers, researchers and many others involved in the decision-making process. These approaches can be roughly categorized into in-depth interviews or focus group discussions for formative research [12,13], short-term consultation with community members (often referred as community advisory board) for study design, implementation and results dissemination [14,15], and cocreation of intervention strategies or components with a small number of community members [16 & ]. While this type of community engagement may involve a wide range of stakeholders in the research decision-making process, the main difference between individual-level and community-level engagement is the duration and extent of such engaging efforts.…”

Section: Engagement Efforts At Individual Levelmentioning

confidence: 99%

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Community engagement tools in HIV/STI prevention research

Li,

Zhao,

Tan

et al. 2023

Current Opinion in Infectious Diseases

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Purpose of review Community engagement is key to the success of sustainable public health interventions. This review highlights recent published studies that describe the use of community-engaged methods in sexually transmitted infection (STI) prevention research. Recent findings We organized the findings using a socio-ecological model. At the individual level, communities were engaged through participation in formative research, short-term consultations and community advisory board participation, as well as co-creation activities. At the interpersonal level, studies reviewed described peer-led interventions that leverage the influence and guidance of peers, patient-led interventions in the form of patient navigation and notification, as well as those that mobilize social networks and the power of social relationships to promote health. At the organizational and community level, multisectoral, multifacility collaborations between community, government, and academic stakeholders were highlighted. At the policy and population level, communities were engaged through community dialogues to disseminate research findings, as well as in developing strategic frameworks and clinical guidelines. Digital tools have also been leveraged for effective community engagement. Summary Communities have an effective role to play in STI prevention and can be engaged at multiple levels. Future efforts may consider the use of community engagement tools highlighted in this review, including digital technologies that have the potential to reach more diverse end-users.

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