BACKGROUND:Community Network-Driven COVID-19 Testing and Vaccination of Vulnerable Populations in the Central United States (C3) evaluates the use of Social Network Strategy (SNS) with educational messaging to improve COVID-19 testing and vaccination among people most impacted by the pandemic. METHODS:We enrolled individuals with low-income who identify as Hispanic/Latino or a history of criminal legal involvement (CLI) through social network referral and randomized participants 1:1 to SNS vs. SNS plus messaging (SNS+), which included a self-affirmation activity and educational video. We assessed for COVID-19 testing and, among baseline unvaccinated participants, vaccination at 21 days, and used mixed effects logistic regression to examine outcomes. RESULTS:Of 1328 participants (SNS+: 667, SNS: 661), 46.6% identified as Black/African American, 33.4% as Hispanic/Latino, and 43.8% reported history of CLI. Majority (66.3%) reported testing and, of unvaccinated participants, 11.9% reported vaccination at follow-up. There were no differences in testing (aOR 0.89, 95% CI 0.71, 1.11, P = .49) or vaccination (aOR 1.46, 95% CI 0.78, 2.76, P = .30) among participants who received SNS+ compared to SNS after adjusting for recruitment wave and clustering within sites and referral chains. CONCLUSIONS:Social network referral successfully engaged communities disproportionately impacted by COVID-19 in testing and vaccination. Compared to SNS alone, adding educational messaging did not increase testing or vaccination. Additional work is needed to implement SNS to increase vaccination rates among vulnerable populations.

BACKGROUND:Black cisgender women are disproportionately affected by HIV, yet have a low uptake of pre-exposure prophylaxis (PrEP). Barriers to HIV prevention exist on the individual, provider, and system level. This qualitative study aimed to explore factors associated with accessing culturally-appropriate PrEP educational materials and advertisements and receiving PrEP information from providers for Black women. METHODS:Focus groups were conducted at three federally qualified health centers in Illinois, Florida, and North Carolina with Black female patients from August 2022 to February 2023. Women were asked about their awareness and knowledge of PrEP, thoughts on patient-facing PrEP materials, and ideas for improving PrEP uptake among Black women. Transcripts were analyzed thematically using the Stanford Lightning Report Method. RESULTS:Twenty-five women participated across nine focus groups. Barriers and facilitators to patient education to increase PrEP uptake among Black women were identified across the individual, provider, and system level. Barriers included low awareness and knowledge of PrEP, inaccurate self-perceived risk of HIV, and stigma and medical mistrust. Facilitators included positive attitudes toward PrEP, better representation in educational materials and advertisements, improved provider-patient relationship, and additional support via mental wellness resources and community (social networks). CONCLUSIONS:Women reported minimal representation and knowledge regarding PrEP, yet demonstrated high interest in learning more about PrEP and sharing that information with others. Black women must be featured prominently in mainstream PrEP advertisements and PrEP educational materials and included by providers in discussions about PrEP. Increasing funding and support for these efforts will be instrumental to promote PrEP uptake among Black women and to reduce HIV transmission within this population.

BACKGROUND:Better understanding of how deliverers use research and select interventions can further reduce the gap between developing and delivering effective intervention and implementation strategies, especially in the field of HIV. METHODS:We interviewed a convenience sample of Midwest health organizations and health departments who are involved with HIV treatment and/or prevention services. Using an iterative, rapid qualitative analysis, we identified key steps in the process of prioritizing health needs, selecting interventions, and disseminating or receiving information about interventions. RESULTS:In order to prioritize areas for interventions, organizations used community assessments, developing leaderships buy-in, considered staff capacity, accessed funding, and created partnerships. Once a priority areas was developed, interventions were usually developed by the organization or adapted from pre-existing interventions to meet local needs. Organizations preferred to receive information from trusted broker agencies or from peer organizations. There was a strong desire to evaluate and share results from home-grown interventions but evaluation capacity and funding were limiting factors. CONCLUSIONS:There are several ways to improve dissemination and knowledge sharing between researchers and practitioners. Researchers can design flexible and adaptable interventions, with a range of dissemination materials available to broker agencies. Deliverers can partner with researchers for evaluation, while funders can specifically support evaluation and dissemination, including peer-to-peer learning.

Five years into the US national Ending the HIV Epidemic (EHE) plan, it is a critical time to examine what has been learned and what still needs to be studied to achieve its 2030 goals of reducing new HIV infections by 90%. While much has already been gained from the 250+ individual National Institutes of Health-funded implementation research projects and the capacity building provided by the Implementation Science Coordination Initiative (ISCI) and 9 regional consultation hubs (RCHs), identifying generalizable implementation science lessons requires the synthesis of findings across multiple sites, studies, and/or contexts. This supplemental issue of JAIDS emphasizes collaborative papers that summarize shared HIV implementation knowledge from multiple EHE-funded research projects. The 24 papers herein represent work from 111 EHE supplement projects and 7 R01s happening in 40 EHE priority jurisdictions, as well as from ISCI, all RCHs, and federal partners. We identified the following 4 overarching themes: infrastructure for HIV implementation research, methods for conducting HIV implementation research with specific communities, implementation strategies to help deliver HIV-related interventions, and training in implementation science for the HIV workforce. Insights shared in this issue provide a clear pathway for the next phase of EHE, in which research infrastructure must remain robust, workforce investments must prioritize sustainability, and partnerships must continue to bridge local innovation with systemic change.

ABSTRACT: BACKGROUND:Preexposure prophylaxis (PrEP) is a medication that prevents HIV infection. However, PrEP is not equally used by all who would benefit. We examined PrEP disparities by comparing the number of sexually transmitted infections (STIs) and PrEP prescriptions across sex, race, and ethnic groups from 2 federally qualified health centers (FQHCs) in Pinellas County, Florida, and Chicago, Illinois. METHODS:We obtained limited electronic medical record data from January 1, 2023, to December 31, 2023, and identified STI diagnoses (gonorrhea, chlamydia, or syphilis) and PrEP initiation prescriptions. We calculated the PrEP initiation rate for different sex, race, and ethnicity groups; the rate difference in PrEP initiations for each demographic group compared with that in White men; and the ratio of PrEP initiations to STI diagnoses in each group. RESULTS:Out of a total of 63,591 patients, 1208 (1.9%) were diagnosed with an STI and 88 (0.1%) had PrEP initiation prescriptions. There was no rate difference per 100 people in PrEP initiation among Black and White men, but Hispanic men (-0.11), Black women (-0.14), White women (-0.24), and Hispanic women (-0.25) demonstrated PrEP disparities. When examining the ratio of PrEP initiations to STI diagnoses in each group, White men had (0.42) PrEP initiations per STI diagnosis, with much lower ratios seen for Hispanic men (0.2), Black men (0.13), Black women (0.04), White women (0.03), and Hispanic women (0.02). CONCLUSIONS:White men had the highest rate of initial PrEP prescriptions. Men overall received PrEP between 3 and 21 times more frequently per STI diagnosis than women.

BACKGROUND:Ending the HIV Epidemic strategies include rapid ART Initiation (R-ART), rapid pre-exposure prophylaxis (R-PrEP), and status neutral approaches (status neutral), but implementation across heterogeneous settings in the United States is not well characterized. SETTING:Ryan White (RW)-funded HIV treatment clinics located in select Ending the HIV Epidemic priority areas in the United States. METHODS:Clinics were sent a survey to assess experiences offering R-ART, R-PrEP, and status neutral (collectively called "rapid START"). Primary outcomes were rapid START adoption and characteristics of implementing vs. nonimplementing clinics. Secondary outcomes included perceptions, barriers, and facilitators of R-ART and R-PrEP. RESULTS:The response rate was 48% (40 of 83). The 40 respondents represented 57 clinics who reported providing HIV-related services to more than 70,000 individuals annually. R-ART uptake was 85% (range 43%-100%), status neutral 65% (range 57%-75%), and R-PrEP 60% (range 0%-88%). No rural-identifying organizations reported offering R-ART or R-PrEP compared with 96% and 76% of urban-identifying organizations, respectively. Positive perceptions of acceptability, appropriateness, and feasibility for R-ART and R-PrEP were high among all levels of implementation and strongest among those offering R-ART and R-PrEP. The most frequent barriers to R-ART were provider- and clinic-level and for R-PrEP were system-level (lack of insurance coverage) followed by patient-, provider-, and clinic-level issues. CONCLUSION:This survey of diverse RW-funded clinics shows high uptake of R-ART and significant if less consistent uptake of R-PrEP and status neutral. Future research should focus on identifying broadly implementable strategies to expand adoption along with tailored approaches, especially in areas with lower health care access.

BACKGROUND:Community-engaged research (CEnR) is fundamental to effective HIV prevention and treatment implementation, although limited in practice. We describe CEnR lessons learned by researchers in HIV-related implementation science to improve future CEnR. SETTING:Academic-community research partnerships funded by the 2019-2021 National Institutes of Health Ending the HIV Epidemic (EHE) supplement awards. METHODS:Seven individual awardees representing 8 EHE awards documented partnership characteristics and key CEnR experiences in an online form. Three semi-structured reflection sessions subsequently discussed experiences, identifying opportunities and barriers using qualitative thematic analysis, iterative dialogue, and illustrative case studies. RESULTS:Awardees identified both partnerships newly established for the grant (60%) and preexisting collaborations (40%). Key perceived CEnR benefits included: new and better project ideas; improved project implementation; and priorities to guide future research. Prominent barriers included: administrative burdens resulting in delayed funding access that constrained partner engagement; limited grant timelines and funding for essential preimplementation partnership building; and limited recognition of key CEnR activities in academic success metrics. Adaptive responses to barriers included focusing short award periods on exploratory aims and building on extant community activities. CONCLUSIONS:Systems-level redesign at the funder and university levels could improve CEnR equity, including accepting financial risk between grant award and funding receipt to facilitate completion of essential prework such as Institutional Review Board approvals and prevent the exclusion of the more financially constrained community partners or forcing unfunded effort provision and establishing appropriate support and promotion criteria for CEnR-engaged faculty. Thus, enabling CEnR good practices can improve future HIV-related implementation research and EHE goal achievement.

Background: Awareness and uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) remains low among Black/African American cisgender women, partly due to low self-reported PrEP knowledge and comfort among primary care providers. Ensuring providers are trained on PrEP is crucial, as increased PrEP knowledge is associated with higher rates of PrEP prescription. Objective: We aimed to develop a PrEP training for providers to improve their self-efficacy in discussing and prescribing PrEP for Black women, with the ultimate goal of increasing PrEP awareness and utilization among Black women. Design: In this qualitative study, we conducted focus groups with medical providers at three federally qualified health centers in the Southern and Midwestern United States to identify themes informing the development of a provider PrEP training. Methods: Providers were asked for input on content/design of PrEP training. Transcripts underwent rapid qualitative analysis using the Stanford Lightning Report Method. Themes were identified and presented under the domains of the Consolidated Framework for Implementation Research. Results: Ten providers completed four focus groups. Themes included the individual characteristics of providers (low comfort initiating PrEP discussions, particularly among White providers) and the outer setting of client attitudes (perceptions of potential provider bias/racism, varying levels of concern about HIV acquisition). Opportunities were identified to maximize the benefit of training design (e.g., developing case scenarios to enhance providers’ cultural competency with Black women and PrEP knowledge). Conclusion: This comprehensive PrEP training features both didactic material and interactive role-plays to equip providers with the clinical knowledge for prescribing PrEP while building their competency discussing PrEP with Black women. This training is particularly important for providers who have racial or gender discordance with Black women and express lower comfort discussing PrEP with these clients. Provider training could lead to minimizing racial- and gender-based inequities in PrEP use.

Transmasculine individuals who have sex with cisgender men (TMSM) remain an understudied population regarding pre-exposure prophylaxis (PrEP). We used electronic medical record data to assess PrEP eligibility and initiation in TMSM in a large LGBTQ+ focused federally qualified health center in Chicago, Illinois. We examined a sample of 430 TMSM from January 1, 2015 to December 31, 2019, and used logistic regression to model PrEP eligibility and initiation. Overall, 37% of participants were eligible for and 18% initiated PrEP. Eligibility was not associated with initiation. National PrEP guidance should be tailored to include transmasculine people.

BackgroundBlack cisgender women (hereafter referred to as “women”) experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). ObjectiveThis study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. MethodsWe conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. ResultsBarriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. ConclusionsEvidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, “POWER Up”) to improve PrEP uptake among women. International Registered Report Identifier (IRRID)RR2-10.1371/journal.pone.0285858

Over the past two decades, cases of sexually transmitted infections (STIs) due to syphilis, gonorrhea, and chlamydia have been rising in the United States, disproportionately among gay, bisexual, and other men who have sex with men (MSM), as well as racial and ethnic minorities of all genders. In this review, we address updates about the evidence on doxycycline post-exposure prophylaxis (doxy-PEP) for prevention of bacterial STIs, including efficacy, safety, antimicrobial resistance (AMR), acceptability, modeling population impact, and evolving guidelines for use. Equitable implementation of doxy-PEP will require evaluation of who is offered and initiates it, understanding patterns of use and longer-term STI incidence and AMR, provider training, and tailored community education.

EDITORIAL article Front. Reprod. Health, 17 July 2023Sec. HIV and STIs Volume 5 - 2023 | https://doi.org/10.3389/frph.2023.1228325

Two parallel public health epidemics affecting the United States include the COVID-19 pandemic and a rise in substance use disorders (SUDs). Limited research has examined the potential relationship between these two epidemics. Our objective was therefore to perform an exploratory study in order to examine the association between public stigma toward people with a past history of opioid, methamphetamine, cocaine, and alcohol use disorder and COVID-19 vaccine hesitancy. A national sample of U.S. adults (N = 6515) completed a survey which assessed the degree of negative perceptions toward individuals with a past history of substance use disorders (referred to as substance use stigma) and COVID-19 vaccine hesitancy, along with variables such as racial prejudice, source of health news, and other demographics. We evaluated four multivariable logistic regression models to predict COVID-19 vaccine hesitancy, utilizing substance use stigma toward opioids, methamphetamine, cocaine, and alcohol use as independent variables. We found that COVID-19 vaccine hesitancy was positively associated with substance use stigma toward opioid (AOR = 1.34, p < 0.05), methamphetamine (AOR = 1.40, p < 0.01), and cocaine (AOR = 1.28, p < 0.05) use, but not alcohol use (AOR = 1.06, n.s.). Predictive models that incorporate substance use stigma may therefore improve our ability to identify individuals that may benefit from vaccine hesitancy interventions. Future research to understand the underlying reasons behind the association between substance use stigma and COVID-19 vaccine hesitancy may help us to construct combined interventions which address belief systems that promote both substance use stigma and vaccine hesitancy.

Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers—particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.

Monitoring pre-exposure prophylaxis (PrEP) metrics can guide service delivery yet does not occur routinely. We developed a survey to understand current practices for monitoring PrEP at PrEP-providing organizations in Illinois and Missouri. The survey was distributed from September through November 2020; 26 organizations participated. Most respondents indicated ongoing efforts to screen for PrEP eligibility (66.7%), link to care (87.5%), and retain clients in care (70.8%); 70.8% reported collecting data on PrEP initiation, 41.7% on retention in care, and 37.5% on missed visits. Barriers to monitoring PrEP metrics included lack of IT support (69.6%), manual processes (69.6%), and lack of staff resources (65.2%). Most respondents offered clients support for PrEP retention and adherence and wanted to expand interventions for PrEP persistence, yet fewer monitored corresponding metrics. To enhance PrEP implementation, organizations should improve monitoring and evaluation of PrEP metrics along the entire continuum and respond with appropriate services to support clients.

Black cisgender women (hereafter referred to as "women") have disproportionately high rates of HIV infection yet low rates of pre-exposure prophylaxis (PrEP) utilization. Barriers to PrEP uptake exist at the system, provider, and individual/client level. To learn how existing training and advertising can be adapted to address race- and sex-based gaps within PrEP service delivery, we conducted focus groups with providers and Black women. Participants were recruited at three health care organizations in the Midwest and South, screened for eligibility, and consented verbally. Focus groups occurred from August 2022 to February 2023. Women were asked about their knowledge and thoughts on PrEP. Providers were asked about factors influencing their decision-making about PrEP. A codebook was developed based on the Consolidated Framework for Implementation Research. Transcripts were coded using the Stanford Lightning Report Method. We completed four focus groups with 10 providers and 9 focus groups with 25 women. Three major themes emerged: (1) low comfort level and limited cultural sensitivity/competency among providers discussing HIV risk and PrEP with Black women, (2) women's concerns about PrEP's side effects and safety during pregnancy, and (3) lack of Black women representation in PrEP advertisement/educational materials. In addition, women in the South reported general medical mistrust and specific misconceptions about PrEP. PrEP trainings for providers need detailed information about the safety of PrEP for women and should include role-playing to enhance cultural competency. Likewise, PrEP advertisements/materials should incorporate information regarding side effects and images/experiences of Black women to increase PrEP awareness and uptake among this population. Clinical Trial Registration Number: NCT05626452.

Introduction:While the U.S. has seen a sustained rise in STI cases over the past decade, the impact of the COVID-19 on STIs and HIV is unclear.Methods:To examine the short- and medium-term impacts of COVID-19 and HIV and STI testing and diagnosis, we compared pre-pandemic trends to three periods of the pandemic: early- pandemic, March-May 2020; mid-pandemic June 2020-May 2021; and late-pandemic, June 2021-May 2022. We compared average number of monthly tests and diagnoses, overall and by gender, as well as the monthly change (slope) in testing and diagnoses.Results:We find that after decreases in average monthly STI and HIV testing and diagnoses during the early- and mid-pandemic, cases were largely back to pre-pandemic levels by the late-pandemic, with some variation by gender.Conclusion:Changes in testing and diagnoses varied by phase of the pandemic. Some key populations may require additional outreach efforts to attain pre-pandemic testing levels.

BACKGROUND:STI and HIV services and infection rates were affected during the COVID-19 pandemic, because of changes in access to health care and individual behavior. Understanding how individuals made decisions around prevention and sexual activities during different phases of the pandemic is useful to addressing the rising rates of STIs and HIV. SETTING:Federally-qualified health center focused on sexual and gender minority health, Chicago IL, 2021. METHODS:Patients with a history of PrEP use who were contacted by the PrEP retention team as part of standard care were invited to complete an online survey. A subset of survey participants were then contacted to complete one-on-one interviews. Participants were asked about two distinct periods: November 2020 to January 2021 and February to June 2021. RESULTS:From the 356 survey participants (mostly young, insured, and experienced with PrEP), more than half maintained their number of sex partners during the early pandemic and most also maintained PrEP use; during the later pandemic; most reported more or the same number of sex partners and almost all maintained PrEP use. From interviews, we identified diverse and changing experiences regarding sexual practices throughout the pandemic; whereas many participants changed PrEP use in accordance with sexual practices, many others maintained PrEP use as a habit. COVID-19 prevention was also a factor in sexual activities, particularly prevaccination. CONCLUSION:Many PrEP users try to align their HIV prevention with their sexual exposures and establish PrEP as a long-term habit. Removing financial and access barriers is important to improve PrEP use and STI testing.

Background: To achieve ending the HIV Epidemic goals, key populations, including sexual minority men, need to adhere to evidence-based biomedical interventions including antiretroviral therapy as treatment (ART) or preexposure prophylaxis (PrEP). The present study integrates traditional and machine learning methods to evaluate whether a common set of factors can predict adherence to ART for both treatment and prevention. Method: Participants included 365 sexual minority men taking antiretroviral therapy as treatment or PrEP in South Florida. Survey respondents provided information on adherence to treat-ment or PrEP and demographic, psychosocial, and behavioral factors potentially associated with adherence. Data were analyzed using machine learning algorithms that are simple to interpret such as Classi fi cation and Regression Tree and LASSO regression variable selection, techniques that require specialized extra steps to look inside “ black box models ” like Multivariate Adaptive Regression Spline (MARS) and Random Forest models, and traditional stepwise logistic regression to identify factors associated with adherence. Results: Taking ART for HIV treatment or PrEP was not an important predictor for adherence in any of the models. Rather, the models suggested that a common set of predictors can be used to predict adherence to ART for both treatment and PrEP. Race/ethnicity was identi fi ed by all models as an important predictor of adherence. Additionally, depressive symptoms, anxiety symptoms, and substance use were identi-fi ed as an important adherence predictor by at least three (of fi ve) models. Determinants less commonly identi fi ed as important for adherence were alcohol use (CART and LASSO only), sexual orientation (CART only), self-esteem, and condomless sex (Random Forest and LASSO only). Conclusion: