‘If the Partner Finds Out, then there’s Trouble’: Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV)

Jeffers, Noelene K.; Zemlak, Jessica L.; Celius, Lourdes; Willie, Tiara C.; Kershaw, Trace; Alexander, Kamila A.

doi:10.1007/s10461-021-03565-6

Cited by 15 publications

(8 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An on-demand, prevention product may also be appealing to end users who have infrequent intercourse, or who do not want to be on a daily or long-acting prevention regimen ( Halpern et al., 2014 ; Taylor et al., 2014 ). An on-demand prevention product that women could use pre- or post-coitally, with an extended window of protection, would also be a safe alternative for women who are in less stable relationships, where use of a daily regimen, short acting regimen may decrease their ability to use a product covertly, which may increase their risk of intimate partner violence ( Giovenco et al., 2022 ; Jeffers et al., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

A phase I study to assess safety, pharmacokinetics, and pharmacodynamics of a vaginal insert containing tenofovir alafenamide and elvitegravir

Thurman

Ouattara

Yousefieh

et al. 2023

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

BackgroundNew multi-purpose prevention technology (MPT) products are needed to prevent human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV2). In this study, we evaluated a fast-dissolve insert that may be used vaginally or rectally for prevention of infection.ObjectiveTo describe the safety, acceptability, multi-compartment pharmacokinetics (PK), and in vitro modeled pharmacodynamics (PD) after a single vaginal dose of an insert containing tenofovir alafenamide (TAF) and elvitegravir (EVG) in healthy women.MethodsThis was a Phase I, open-label, study. Women (n=16) applied one TAF (20mg)/EVG (16mg) vaginal insert and were randomized (1:1) to sample collection time groups for up to 7 days post dosing. Safety was assessed by treatment-emergent adverse events (TEAEs). EVG, TAF and tenofovir (TFV) concentrations were measured in plasma, vaginal fluid and tissue, and TFV-diphosphate (TFV-DP) concentration in vaginal tissue. PD was modeled in vitro by quantifying the change in inhibitory activity of vaginal fluid and vaginal tissue against HIV and HSV2 from baseline to after treatment. Acceptability data was collected by a quantitative survey at baseline and post treatment.ResultsThe TAF/EVG insert was safe, with all TEAEs graded as mild, and acceptable to participants. Systemic plasma exposure was low, consistent with topical delivery, while high mucosal levels were detected, with median TFV vaginal fluid concentrations exceeding 200,000 ng/mL and 1,000 ng/mL for up to 24 hours and 7 days post dosing, respectively. All participants had vaginal tissue EVG concentrations of > 1 ng/mg at 4 and 24 hours post dosing. The majority had tissue TFV-DP concentrations exceeding 1000 fmol/mg by 24 – 72 hours post dosing. Vaginal fluid inhibition of HIV-1 and HSV-2 in vitro significantly increased from baseline and was similarly high at 4 and 24 hours post dosing. Consistent with high tissue TFV-DP concentrations, p24 HIV antigen production from ectocervical tissues infected ex vivo with HIV-1 significantly decreased from baseline at 4 hours post dosing. HSV-2 production from tissue also decreased post treatment.ConclusionsA single dose of TAF/EVG inserts met PK benchmarks, with PK data supporting an extended window of high mucosal protection. PD modeling supports mucosal protection against both HIV-1 and HSV-2. The inserts were safe and highly acceptable.Clinical trial registrationClinicalTrials.gov, identifier NCT03762772.

show abstract

Section: Discussionmentioning

confidence: 99%

A phase I study to assess safety, pharmacokinetics, and pharmacodynamics of a vaginal insert containing tenofovir alafenamide and elvitegravir

Thurman

Ouattara

Yousefieh

et al. 2023

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

show abstract

“…On the other hand, some women expressed distrust in healthcare providers, which may limit engagement in PrEP. Prior research has described IPV-related medical mistrust and how it differs by IPV exposure type (25, 27, 28).…”

Section: Discussionmentioning

confidence: 99%

A PrEP Decision Aid for Women Survivors of Intimate Partner Violence: Task-Shifting Implementation to Domestic Violence Service Settings

Meyer,

Lazarus,

Phillips

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundWomen exposed to intimate partner violence (IPV) experience multiple social and structural barriers to accessing HIV pre-exposure prophylaxis (PrEP), despite being at increased risk for HIV. In addition, few existing HIV prevention interventions address IPV. A recently developed PrEP decision aid for women has the potential to reach IPV survivors at risk for HIV if it could be integrated into existing domestic violence agencies that prioritize trust and rapport with female IPV survivors. Leveraging non-traditional service delivery mechanisms in the community could expand reach to women who are IPV survivors for PrEP.MethodsWe conducted qualitative interviews and online qualitative surveys with 33 IPV survivors and 9 domestic violence agency staff at two agencies in Connecticut. We applied the Consolidated Framework for Implementation Research (CFIR) to understand barriers and facilitators to delivering a novel PrEP decision aid to IPV survivors in the context of domestic violence service agencies.ResultsMost IPV survivors and agency staff thought the PrEP decision aid intervention could be compatible with agencies’ existing practices, especially if adapted to be trauma-responsive and delivered by trusted counselors and staff members. PrEP conversations could be packaged into already well-developed safety planning and wellness practices. Agency staff noted some concerns about prioritizing urgent safety needs over longer-term preventive health needs during crisis periods and expressed interest in receiving further training on PrEP to provide resources for their clients.ConclusionsIPV survivors and agency staff identified key intervention characteristics of a PrEP decision aid and inner setting factors of the service agencies that are compatible. Any HIV prevention intervention in this setting would need to be adapted to be trauma-responsive and staff would need to be equipped with proper training to be successful.

show abstract

“…For example, our finding that PrEP‐related stigma was higher among those reporting sex work suggests a need for tailored stigma mitigation interventions among this population. Further, our finding that disclosure concerns were more common than negative self‐image related to PrEP suggests a need for tailored support and safety planning to PrEP users who may conceal their PrEP use [45–47]. This scale also enables researchers to examine the impacts of PrEP‐related stigma on other HIV care continuum outcomes, such as uptake of HIV testing during PrEP services, PrEP initiation, adherence and continuation or other patterns of PrEP use.…”

Section: Discussionmentioning

confidence: 99%

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

Atkins

Kan

Musau³

et al. 2022

J Int AIDS Soc.

View full text Add to dashboard Cite

Introduction As oral pre‐exposure prophylaxis (PrEP) services scale up throughout sub‐Saharan Africa (SSA), clients continue to face challenges with sustained PrEP use. PrEP‐related stigma has been shown to influence engagement throughout the HIV PrEP care continuum throughout SSA. Validated quantitative measures of PrEP‐related stigma in SSA are of critical importance to better understand its impacts at each stage of the HIV PrEP care continuum. This study aimed to psychometrically evaluate a PrEP‐related stigma scale for use among key and vulnerable populations in the context of a Kenya national PrEP programme. Methods As part of a larger prospective cohort study nested within Kenya's Jilinde programme, this study used baseline data collected from 1135 participants between September 2018 and April 2020. We used exploratory factor analysis to evaluate the factor structure of a PrEP‐related stigma scale. We also assessed convergent construct validity of the PrEP‐Related Stigma Scale by testing for expected correlations with depression and uptake of HIV services. Finally, we examined the relationship between PrEP‐related stigma and key demographic, psychosocial and behavioural characteristics. Results We identified four dimensions of PrEP‐related stigma: (1) interpersonal stigma, (2) PrEP norms, (3) negative self‐image and (4) disclosure concerns. The scale demonstrated strong internal consistency (α = 0.84), was positively correlated with depressive symptoms and negatively correlated with uptake of HIV services. Multivariable regression analysis demonstrated associations between PrEP‐related stigma and sex worker identity. Conclusions The adapted and validated PrEP‐Related Stigma Scale can enable programmes to quantify how PrEP‐related stigma and its dimensions may differentially impact outcomes on the HIV PrEP care continuum, evaluate stigma interventions and tailor programmes accordingly. Opportunities exist to validate the scale in other populations and explore further dimensions of PrEP‐related stigma.

show abstract

‘If the Partner Finds Out, then there’s Trouble’: Provider Perspectives on Safety Planning and Partner Interference When Offering HIV Pre-exposure Prophylaxis (PrEP) to Women Experiencing Intimate Partner Violence (IPV)

Cited by 15 publications

References 42 publications

A phase I study to assess safety, pharmacokinetics, and pharmacodynamics of a vaginal insert containing tenofovir alafenamide and elvitegravir

A phase I study to assess safety, pharmacokinetics, and pharmacodynamics of a vaginal insert containing tenofovir alafenamide and elvitegravir

A PrEP Decision Aid for Women Survivors of Intimate Partner Violence: Task-Shifting Implementation to Domestic Violence Service Settings

Adaptation and psychometric evaluation of a scale to measure oral pre‐exposure prophylaxis‐related stigma among key and vulnerable populations in Kenya

Contact Info

Product

Resources

About