Adolescents and young adults account for a large proportion of new HIV cases, and this age subgroup has worse outcomes across the HIV care continuum than adults. The lack of harmonization of data elements from implementation science trials is an important barrier that limits the learning across settings and the ability to accelerate adoption of effective implementation strategies. We aim to close this gap by assessing the ability to harmonize data elements across seven studies in the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium. The PATC3H team initiated a collaborative process to prospectively develop harmonized measures and then retrospectively implement additional harmonization based on data collected. We harmonized items on socio-demographic characteristics (12 items), economic stress (8 items), social support (12 items), sexual behaviors (20 items), mental health (24 items), substance use (33 items), HIV care continuum (11 items), and implementation science (126 items) for two or more of the studies. We present analysis of selected harmonized measures that revealed similarities and differences across studies which will be important to consider in future comparative assessments. Key lessons learned are that flexibility is required to collect measures across multiple settings, specifying minimum sample sizes will support meaningful analysis and identifying core measures can help prioritize data elements that can be consistently collected. The PATC3H consortium collaboration has shown that it is feasible to collect harmonized data across implementation science trials and future studies can build on these harmonization efforts.

Justice-involved youth report increased mental health concerns, substance misuse, and risky sexual behavior compared to non-justice-involved youth. Supporting Youth Navigating Choices (SYNC) is a manualized evidence-based practice for justice-involved youth that has demonstrated success in reducing sexual risk behaviors, aggression, and recidivism. Dissemination and scale-up are necessary for SYNC to reach more justice-involved youth. This study examined barriers and facilitators of implementing SYNC using the Consolidated Framework for Implementation Research to strengthen SYNC's future implementation. Participants (n = 18) were individuals who work with justice-involved youth and received training to deliver SYNC. Structured interviews were deductively coded using Consolidated Framework for Implementation Research domains and subdomains, and data were examined to identify patterns. As facilitators, participants expressed that SYNC provides necessary skills to youth, and they highlighted the strong training, curriculum, and manual. As barriers, participants noted program length, instructor discomfort, lack of leadership support, and staffing concerns. Applying recommendations may facilitate improved dissemination, implementation, and scalability.

Family-based interventions may reduce the risk of acquiring HIV and other sexually transmitted infections (STIs) among Black girls in the United States, but few have engaged Black male caregivers. We examined key implementation outcomes of IMAGE, IMARA for Black Male Caregivers, and Girls Empowerment, an adapted evidence-based intervention for Black girls (13-18 years old) and their male caregivers. We conducted a pilot test of IMAGE with 40 girl-male caregiver dyads, using a pre-post-test design at baseline and 1-month follow-up. We assessed four implementation outcomes: feasibility, acceptability, appropriateness, and fidelity. Descriptive statistics were used to evaluate the change from baseline to 1-month follow-up for girls and their male caregivers. Feasibility was strong; 87% of those approached agreed to participate, and 93% completed the intervention. Acceptability was also high, with more than 75% of girls and male caregivers reporting being extremely satisfied with IMAGE, and 76% of participants feeling there was an appropriate amount of time spent on the topics. Intervention fidelity, as rated by observers, was 98%. At 1-month follow-up, girls and male caregivers endorsed improvements in their relationship, namely closeness and communication. IMAGE is a promising program designed to protect and reduce transmission of HIV and STIs among Black girls. We found strong evidence of feasibility, acceptability, appropriateness, and fidelity; therefore, a fully powered randomized controlled trial is warranted.

Trauma is common among young men who have sex with men (YMSM) and young transgender women (YTW) and is linked to increased substance use and HIV risk. However, it remains unclear whether alcohol and other drug (AOD) use influences the relationship between trauma exposure and condomless sex in these populations. This study examined whether substance use amplifies or attenuates the association between trauma and condomless sexual behaviors among YMSM and YTW. This was a secondary analysis of data from a randomized controlled trial evaluating an electronic screening and intervention to reduce AODs among YMSM and YTW. Participants (N = 450) aged 16–26 completed validated assessments of trauma exposure, polysubstance use, binge drinking, and sexual risk behaviors between December 2016 and October 2020. The primary outcome was the number of condomless sex acts while under the influence of AODs in the past 3 months. Negative binomial regressions assessed whether AODs moderated the relationship between trauma and condomless sex while under the influence of AODs. Higher trauma exposure was independently associated with increased condomless sex while under the influence of AODs (p =0.008). Binge drinking significantly moderated this relationship, associating trauma and sexual risk (p <.001). Conversely, cannabis use attenuated the trauma–risk relationship (p =0.002). Stimulant use was associated with increased sexual risk but did not moderate the trauma-risk relationship. Binge drinking may exacerbate trauma-related sexual risk behaviors among YMSM and YTW, whereas cannabis use may buffer these effects. Trauma-informed, substance-specific, and culturally tailored interventions are needed to reduce Human Immunodeficiency Virus risk among sexual and gender minoritized youth.

Reducing new HIV infections is crucial. Sex workers continue to face disparities in both HIV infection rates and inadequate prevention care. Stigma, criminalization, and financial instability hinder access to vital HIV prevention methods, including Pre-exposure Prophylaxis (PrEP). Evidence-based, community-centered PrEP care may help address these issues. An evidence-based group PrEP care model, Centering PrEP (C-PrEP +), could empower communities and reduce healthcare burdens. This study explored care professionals’ perspectives on barriers and facilitators of C-PrEP + for sex workers. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we aimed to develop a pilot implementation plan for C-PrEP + . Individual interviews were held with care professionals at a U.S. Midwestern Community Health Center serving sex workers. To reflect the diverse roles and backgrounds of participants, we interviewed 14 healthcare professionals, including care providers, patient navigators, and billing specialists. Guided by a semi-structured interview guide, we sought care providers’ views on obstacles and enablers related to prescribing PrEP and implementing group PrEP care for sex workers. Using Dedoose, we used directed content analysis to systematically explore their perspectives about C-PrEP + using predefined constructs from the EPIS framework to guide coding and interpretation. Major themes included healthcare for sex workers, challenges in standard PrEP care, perceptions of Centering PrEP, and barriers and facilitators for implementing C-PrEP + . Participants viewed group PrEP care as a means to foster patient-centered approaches and strengthen community ties, while addressing the demands of care. Thoughtful integration of C-PrEP + into clinics may be a promising strategy to improve HIV prevention for sex workers.

Black girls are disproportionately impacted by HIV and STIs in the United States. Black male caregivers are underutilized in family-based HIV/STI prevention programming and offer a novel opportunity to protect Black girls. This study will evaluate the efficacy and implementation of an HIV/STI prevention program delivered to Black girls and male caregivers in community settings. IMAGE: IMARA for the Male Caregivers and Girls Empowerment was adapted from IMARA, an evidence-based mother-daughter intervention to decrease HIV/STI infection and increase communication and healthy relationships among girls and their male caregivers. Using an efficacy implementation design, we will test the effectiveness of IMAGE compared to a time-matched general health promotion program across six community-based organizations. Aim one will evaluate IMAGE in a 2-arm randomized controlled trial with 300 14-18-year-old Black girls and their male caregiver dyads in Chicago, IL. We hypothesize that girls who receive IMAGE will have lower STI incidence (primary outcome), fewer sexual partners, and more consistent condom use (secondary outcomes) at 6- and 12-months compared to girls in the health promotion program. Guided by the 3-Step Implementation Model, our second aim is to identify and describe factors (barriers, facilitators) and processes affecting implementation in community settings. HIV and STI disparities go beyond individual-level factors, and male caregivers may protect girls by being a sexual health resource. This study will facilitate rapid CBO uptake and ownership of IMAGE if effective. Trial Registration: ClinicalTrials.gov NCT06266416.

Background: IMARA-South Africa (SA) is an HIV/STI prevention program for adolescent girls and young women (AGYW) and their female caregivers (FC). We examined six implementation outcomes of IMARA-SA (acceptability, appropriateness, feasibility, reach, adoption, and sustainability) from the perspectives of study staff, investigators, and collaborators.Methods: We used a sequential explanatory mixed-methods design. We administered surveys, hosted three focus group discussions with study staff/facilitators (n = 5), clinic staff (n = 3), and community advisory board members (n = 5), and conducted seven key informant interviews with investigators and study staff. We used descriptive statistics and rapid qualitative analyses, merging quantitative and qualitative data by implementation outcome to achieve triangulation.Results: On 27 surveys analyzed, mean scores were highest for acceptability (2.8/3, SD = 0.6), appropriateness (2.7/3, SD = 0.5), and reach (2.7/3, SD = 0.5), followed by feasibility (2.1/3, SD = 0.5), adoption (3.8/5, SD = 0.3), and sustainability (5.9/7, SD = 0.8). All perceived the AGYW and FC to love the program, which fit well with South African culture and addressed AGYW's needs. The delivery site was deemed highly appropriate for reaching vulnerable populations. The lowest scoring items concerned time constraints (2.2/3, SD = 0.9), safety concerns (1.4/3, SD = 0.7), complexity (2.9/5, SD = 1.3), and cost (2.8/5, SD = 0.9). Qualitative participants attributed complexity and cost challenges to the research procedures, not the intervention. Participants proposed potential avenues for future implementation (e.g., schools, clinics) and interest in engaging males.Conclusion: IMARA-SA is implementable. Findings reveal challenges with navigating trade-offs between implementation outcomes and surveys distinguishing between intervention and research activities. Findings can inform future delivery of IMARA-SA and similar programs regionally.

BackgroundAdaptation is widely recognized as important when interventions are to be delivered in new settings or with new populations. However, there are gaps in the literature on how adaptations are carried out and documented. IMARA is a 12-h evidence-based sexual health intervention for Black teens and their mothers, designed for delivery over two days. We present our systematic process of adapting IMARA for Latinas to produce the Floreciendo (“Blooming”) program for Latina teens (14–18 years old) and their female caregivers (e.g., mothers, sisters).MethodsUsing a community-based participatory research (CBPR) approach, we carried out a qualitative study that included 7 focus groups: 4 with staff from community partner organizations (n = 29), 2 with Latina teens (14–18 years) (n = 11), and 1 with female caregivers (n = 5). We also conducted seven key informant interviews with experts in sexual health and Latina health. We used Escoffery’s recommended steps to guide our adaptation process. Data were thematically coded and adaptations documented using the FRAME for reporting modifications to evidence-based interventions.ResultsInformed by the data, we grouped IMARA content into four sessions for Floreciendo, each with unique curricular content and designed to be delivered in two hours (eight hours total): (1) Foundations in Sexual Risk Prevention; (2) Condoms and Contraception; (3) Family Strengthening; and (4) Gender and Relationships. We documented adaptations made for each session. For example, participants emphasized unplanned pregnancy as an important issue facing Latina teens. In response, we added an activity providing hands-on experience with contraceptive methods. Participants also highlighted how gender norms and family expectations in Latine culture shape Latina teens’ sexual and reproductive health practices. We therefore developed activities and opportunities for discussion addressing these cultural influences. We removed IMARA activities considered of lower priority (e.g., portrayal of women in the media).ConclusionThis study addresses gaps in the literature by reporting in detail the adaptations we made to an evidence-based intervention using qualitative methods. The four curriculum sessions we generated through our adaptation process will form the basis of the intervention components we will test in future work using the multiphase optimization strategy (MOST) framework.

Adolescence is a critical period for the emergence of mental health disorders, particularly among adolescent girls and young women (AGYW) in resource-limited settings like sub-Saharan Africa. Despite increasing awareness of mental health challenges in this population, evidence remains limited on the psychometric properties of common tools. This study evaluates the psychometric properties of the PHQ-9, GAD-7, and PC-PTSD-5 scales in South African AGYW to measure depression, anxiety, and post-traumatic stress disorder (PTSD) among 642 South African AGYW (ages 15-19). Results demonstrate that the GAD-7 showed robust psychometric properties, including configural, metric, and scalar invariance across English and IsiXhosa speakers, indicating its reliability across linguistic groups. The PHQ-9 displayed adequate factor structure and construct validity but showed lower item-level scalability for certain items (e.g., "little interest," "poor appetite") in Mokken analysis, suggesting potential cultural or contextual influences on item performance. The PC-PTSD-5 demonstrated challenges with scalar invariance, particularly for the "avoidance" item, indicating potential linguistic or cultural differences in interpretation. Despite this, the scale exhibited acceptable overall scalability. Correlations among scales and with parenting and intimate partner violence provided evidence of construct validity, showing expected associations between mental health symptoms. These findings highlight the GAD-7's utility as a screening tool for anxiety in this population while underscoring the need for further adaptation or testing of the PHQ-9 and PC-PTSD-5. This study emphasizes the importance of culturally sensitive, linguistically appropriate tools for mental health assessment in diverse settings.

Sexual and reproductive health (SRH) interventions have demonstrated effectiveness among Latine youth, but less is known about the content and delivery features of effective programs. This scoping review aimed to identify characteristics of effective SRH programs for Latine teens and their families in the U.S. to inform the adaptation of the Floreciendo SRH program. Records were searched since 2002 in Pubmed, Embase, and PsychInfo. Eligible studies enrolled participants aged 10–24 years (≥ 50

Parenting has been implicated in a range of youth health outcomes. Positive parenting during adolescence, a critical period of developmental change, may equip youth with the necessary tools for their transition into adulthood and, for youth living with HIV, their transition from pediatric HIV care into adult HIV care. Yet, because few studies have carefully assessed the psychometric properties of parenting instruments applied cross-culturally, the validity of parenting research derived in these contexts remains unclear. This study tested the factor structure of the Children's Report of Parenting Behavior Inventory (CRPBI) in a novel setting (e.g., Rwanda), context (e.g., youth with HIV), and considering multiple informants (caregivers and youth). Youth (N = 330) were on average 16.78 years of age; 51% self-identified as female. Caregivers (N = 330) were on average 44.40 years of age; 80% self-identified as female. The factor structures for youth and caregiver CRPBIs appeared to be indicative of two dimensions: (a) acceptance and positive involvement, and (b) hostile detachment and rejection. The CRPBI worked well for youth reports and showed predictive validity. The CRPBI worked less well for caregivers, necessitating the removal of 10 items, seven of which were related to hostile detachment and rejection. The reliability of both CRPBIs was supported. The CRPBI appears to function well for youth, but not as well for caregivers, in this novel context with this unique population of youth with HIV. The findings support careful assessment of instruments developed in high-resource settings and then used in resource-constrained contexts. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

OBJECTIVE:Black girls disproportionately face adverse sexual and reproductive health outcomes in their lifetime. In healthcare, Black girls experience racism and misogyny, which manifest as a combination of discriminatory practices and biases that result in their symptoms being dismissed or neglected, their voices silenced, inadequate treatment, and higher mortality rates. Pediatric providers are in an ideal position to influence, advocate, and strengthen Black girls' sexual and reproductive health. The purpose of this topical review is to discuss current guidelines and provide recommendations to improve pediatric sexual and reproductive care for Black girls. METHODS:We examine current pediatric guidelines and recommendations for adolescent sexual and reproductive health. RESULTS:Current guidelines recommended by organizations and professional societies such as the Centers for Disease Control and Prevention, World Health Organization, Society of Adolescent Health Medicine, and American Academy of Pediatrics are inconsistent and insufficient for the unique needs of Black girls. CONCLUSIONS:We offer three recommendations for pediatric providers to ensure the optimal sexual and reproductive health care for Black girls. These provider recommendations will aid in the protection of Black girls' sexual and reproductive health.

ImportancePediatric emergency department (ED) visits for substance use (SU) increased during COVID-19. Better understanding of trends associated with SU ED visits among youths with a chronic medical condition (CMC) is needed to target SU screening, prevention, and intervention efforts in this population.ObjectiveTo describe trends in pediatric SU ED visits before and during COVID-19 among youths in the US with and without CMCs and by race and ethnicity.Design, Setting, and ParticipantsIn this cohort study, data were obtained from 47 US children’s hospital EDs in the Pediatric Health Information System (PHIS) between March 1, 2018, and March 1, 2022. The cohort included patients aged 10 to 18 years. Data analysis occurred from November 2022 to February 2023.ExposuresED visit occurrence before or during the COVID-19 pandemic and with or without the presence of a CMC. CMCs included chronic conditions (CCs) and complex CCs (CCCs).Main Outcomes and MeasuresThe primary outcome was the number of visits for an SU diagnosis based on diagnostic codes for youths with and without CMCs. Trends were assessed using logistic regression, adjusting for covariates and center effect.ResultsThe sample included 3 722 553 ED visits from March 1, 2018, to March 1, 2022 (1 932 258 aged 14-18 years [51.9%]; 1 969 718 female [52.9%]; 961 121 Hispanic [25.8%]; 977 097 non-Hispanic Black [26.2%]; 1 473 656 non-Hispanic White [39.6%]). Of all visits, 1 016 913 (27.3%) were youths with CCs and 367 934 (9.9%) were youths with CCCs. Youth SU ED visits increased for all groups during COVID-19. The SU ED visits increased by 23% for youths with CCs (21 357 visits [4.0%] to 23 606 visits [4.9%]), by 26% for youths with CCCs (3594 visits [1.9%] to 4244 visits [2.4%]), and by 50% for youths without CCs (4997 visits [0.4%] to 5607 visits [0.6%]). Furthermore, compared with youths without CCs, youths with CCs had consistently larger odds of SU than the other groups before COVID-19 (adjusted odds ratio, 9.74; 99% CI, 9.35-10.15) and during COVID-19 (adjusted odds ratio, 8.58; 99% CI, 8.25-8.92). The interaction between race and ethnicity and CMCs was significant (P for interaction < .001).Conclusions and RelevanceThe findings of this cohort study suggest that providing SU services to all youths during times of societal crises is critical, but particularly for youths with CMCs who experience higher potential health impacts from SU given their medical concerns.

Background The translation of evidence-based interventions into practice settings remains challenging. Implementation science aims to bridge the evidence-to-practice gap by understanding multilevel contexts and tailoring evidence-based interventions accordingly. Engaging community partners who possess timely, local knowledge is crucial for this process to be successful. The Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance aims to address cardiopulmonary health disparities by engaging diverse community partners to improve the implementation of evidence-based interventions. The goal of the Community Engagement Subcommittee is to strengthen community engagement practice across DECIPHeR. This paper presents the subcommittee’s “Why We Engage Communities” statement that outlines why community engagement is critical for implementation science. The paper also provides case examples of DECIPHeR community engagement activities. Methods To develop the “Why We Engage Communities” statement, we conducted a literature review, surveyed subcommittee members to assess the importance of community engagement in their work, and integrated community partner feedback. We synthesize the findings into three key themes and present examples of community engagement activities and their impact across DECIPHeR projects. Results The statement presents three themes that illustrate why community engagement increases the impact of implementation and health equity research. Community engagement (1) engages local knowledge and expertise, (2) promotes authentic relationships, and (3) builds community and researcher capacity. The statement provides a guiding framework for strengthening DECIPHeR research and enhancing community partnerships. Conclusion Community engagement can improve the implementation of evidence-based interventions across diverse settings, improving intervention effectiveness in underserved communities and furthering health equity.

Purpose To conduct a randomized controlled trial to compare 3 implementation strategies and the impact of facilitated referrals on linkage of Federally Qualified Health Center patients to the Illinois Tobacco Quitline (ITQL). Methods This study will be a hybrid type 3 implementation-effectiveness trial guided by 2 implementation science frameworks: reach, effectiveness, adoption, implementation, and maintenance and exploration preparation implementation sustainment. We will evaluate whether sending provider messages through the patient electronic health portal increases patient linkage to the ITQL. We will (1) randomly assign all eligible patients to receive 1 of 3 messages (information about quitting, advice to quit, and advice to quit or cut down), and (2) we will offer a facilitated linkage to the ITQL. For patients who opt into a facilitated referral, we will share their contact information with the ITQL, who will contact them. Four weeks after the initial message, patients who expressed interest in services but were not reached by the ITQL will be rerandomized to 1 of 2 arms, an offer to reconnect to the ITQL or an offer to engage a peer navigator who can help them reconnect to the ITQL. We will assess the implementation strategies’ reach, adoption, linkage, and sustainability with the ITQL. Discussion This study will provide a new cost-effective and efficient model to link low-income smokers to state tobacco quitlines. Message delivery via patient health portals has important implications for addressing other tobacco-related morbidities.

Federally qualified health centers (FQHC) aim to improve cancer prevention by providing screening options and efforts to prevent harmful behavior. Patient portals are increasingly being used to deliver health promotion initiatives. However, little is known about patient portal activation rates in FQHC settings and the factors associated with activation. This study examined patient portal activation among FQHC patients and assessed correlations with demographic, clinical, and health service use variables. We analyzed electronic health record data from adults >18 years old with at least one appointment. Data were accessed from the electronic health records for patients seen between 1 September 2018 and 31 August 2022 (n = 40,852 patients). We used multivariate logistic regression models to examine the correlates of having an activated EPIC-supported MyChart patient portal account. One-third of patients had an activated MyChart portal account. Overall, 35% of patients with an activated account had read at least one portal message, 69% used the portal to schedule an appointment, and 90% viewed lab results. Demographic and clinical factors associated with activation included younger age, female sex, white race, English language, being partnered, privately insured, non-smoking, and diagnosed with a chronic disease. More frequent healthcare visits were also associated with an activated account. Whether or not a patient had an email address in the EHR yielded the strongest association with patient portal activation. Overall, 39% of patients did not have an email address; only 2% of those patients had activated their accounts, compared to 54% of those with an email address. Patient portal activation rates were modest and associated with demographic, clinical, and healthcare utilization factors. Patient portal usage to manage one’s healthcare needs is increasing nationally. As such, FQHC clinics should enhance efforts to improve the uptake and usage of patient portals, including educational campaigns and eliminating email requirements for portal activation, to reinforce cancer prevention efforts.

Purpose To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system–supported and electronic health record–linked patient portal. Methods Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Results Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Conclusion Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.