First name
Sarah
Last name
Wood

Title

Chlamydia Trachomatis/Neisseria Gonorrhea Retesting Among Adolescents and Young Adults in a Primary Care Network.

Year of Publication

2022

Date Published

08/2022

ISSN Number

1879-1972

Abstract

PURPOSE: Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting.

METHODS: We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8-16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting.

RESULTS: Overall, 23.5% (n = 731) of patients were retested within 8-16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period.

DISCUSSION: Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.

DOI

10.1016/j.jadohealth.2022.06.014

Alternate Title

J Adolesc Health

PMID

35963759

Title

HIV pre-exposure prophylaxis: assessment of acceptability among members of HIV serodiscordant/serostatus unknown couples.

Year of Publication

2022

Number of Pages

9564624221097753

Date Published

2022 Apr 29

ISSN Number

1758-1052

Abstract

<p><strong>BACKGROUND: </strong>Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection but is not yet widely available in resource-limited settings such as the Dominican Republic. We aimed to ascertain PrEP acceptability among people living with HIV in the Dominican Republic who are part of HIV serodiscordant partnerships and understand relationships between PrEP acceptability, HIV stigma, and intimate partner violence. A cross-sectional survey of people in care for HIV infection included acceptability-related questions and assessments of HIV stigma and intimate partner violence. We also explored the expected impact of PrEP on HIV disclosure rates and fertility intentions. Of the 100 participants, 74% had been in their current partnership for &gt;1&nbsp;year; 38% had not disclosed to their partner; 29% reported condomless sex, and 23% reported sex with multiple partners. PrEP was highly acceptable with 84% of participants saying they were "very likely" to offer PrEP to their partner if available and 21% stating it would allow them to have more children. Of those who had not disclosed to their partner, 71% stated PrEP would help them do so. No relationship was found between PrEP acceptability, HIV stigma, and intimate partner violence. However, higher than expected rates of PrEP acceptability limited the power of these analyses. Pre-exposure prophylaxis was considered to be highly acceptable among people living with HIV in the Dominican Republic who are part of serodiscordant partnerships.</p>

DOI

10.1177/09564624221097753

Alternate Title

Int J STD AIDS

PMID

35488451

Title

Identifying Opportunities to Discuss Pre-Exposure Prophylaxis During Contraceptive Coaching Discussions With Urban Adolescent Women.

Year of Publication

2021

Date Published

2021 Jun 05

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>HIV pre-exposure prophylaxis (PrEP) reduces HIV transmission and is approved for adolescents aged 12-17 years. Adolescent girls and young women (AGYW) have modest PrEP uptake rates, while many receive reproductive health counseling. We sought to identify opportunities for incorporating PrEP education in contraceptive counseling delivered to AGYW.</p>

<p><strong>METHODS: </strong>We performed a secondary analysis of data from the Health Coaching for Contraceptive Continuation pilot study, which supported contraceptive use among AGYW. Participants were 14-22 years old, sexually active with males, and not desiring pregnancy within 12 months. Coaches were sexual health educators with ≥5&nbsp;years' experience providing contraceptive and PrEP counseling to youth. Participants completed a baseline visit within 30 days of contraceptive initiation and completed up to five monthly coaching sessions. Of 33 enrollees, this analysis includes the 21 who completed ≥4 sessions. Two coders deductively coded session transcripts for five themes: opportunities to discuss PrEP; HIV knowledge, risk perception, and testing attitudes; changes in HIV risk status; condom use knowledge and skills; and sexually transmitted infection knowledge and risk perception.</p>

<p><strong>RESULTS: </strong>Of the 111 transcripts coded, 24 contained opportunities to discuss PrEP and were inductively analyzed. Thematic analysis demonstrated three types of opportunities for PrEP discussions: failure to introduce information, and provision of incomplete information or misinformation. Analysis also revealed four opportunity contexts: sexually transmitted infection prevention strategies, HIV risk reduction, avoidance of adverse sexual health outcomes, and disclosures of condom nonprotected sexual behaviors. Only one transcript mentioned PrEP.</p>

<p><strong>CONCLUSIONS: </strong>Multiple opportunities to introduce PrEP counseling exist within contraceptive counseling provided to AGYW.</p>

DOI

10.1016/j.jadohealth.2021.04.031

Alternate Title

J Adolesc Health

PMID

34103237

Title

Facilitators and Barriers to Implementation of Long-Acting Reversible Contraceptive Services for Adolescent Girls and Young Women in Gaborone, Botswana.

Year of Publication

2021

Date Published

2021 Mar 22

ISSN Number

1873-4332

Abstract

<p><strong>STUDY OBJECTIVE: </strong>Botswana has a high pregnancy rate among adolescent girls and young women (AGYW). Long-acting reversible contraceptive (LARC) use among AGYW in Botswana is low, despite its high effectiveness for preventing pregnancy. Using an implementation science framework, we assessed barriers and facilitators to LARC implementation among AGYW in Botswana.</p>

<p><strong>DESIGN: </strong>Cross-sectional mixed methods.</p>

<p><strong>SETTING: </strong>Gaborone, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>20 sexually active AGYW ages 18-24; 20 health system stakeholders.</p>

<p><strong>INTERVENTIONS: </strong>Surveys and semi-structured interviews grounded in the Consolidated Framework for Implementation Research (CFIR).</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Themes reflecting barriers and facilitators of LARC implementation.</p>

<p><strong>RESULTS: </strong>The median age for AGYW was 22 (IQR 21-23). Twenty percent were using an implant and none had ever used an intrauterine device. Barriers and facilitators to LARC implementation spanned factors at each CFIR domain: 1) LARC characteristics like side effects; 2) the clinics' inner settings, including availability of youth-friendly services; 3) characteristics of health system stakeholders, such as LARC skills, and AGYW experiences, attitudes and beliefs about LARCs; 4) the outer setting external to clinics and Botswana's health system including reproductive health law and policy for minor adolescents; and 5) the implementation process level such as the availability of free or low-cost LARCs.</p>

<p><strong>CONCLUSIONS: </strong>We identified multi-level, context-specific factors that affect LARC implementation. Our findings can inform the development of interventions to increase LARC implementation in Botswana by addressing intersecting factors across patient, clinic, health system, and sociopolitical levels, such as providing confidential services to minors and improving LARC training and supply chain pipelines.</p>

DOI

10.1016/j.jpag.2021.03.005

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33766793

Title

Effect of Prior Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation.

Year of Publication

2021

Date Published

2021 Feb 08

ISSN Number

1873-4332

Abstract

<p><strong>OBJECTIVE: </strong>Nonadherence in sexual risk reduction interventions may be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a prior pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation.</p>

<p><strong>DESIGN: </strong>Secondary data analysis from a feasibility study of a health coaching intervention to improve contraceptive continuation.</p>

<p><strong>SETTING: </strong>Three urban pediatric clinics in Philadelphia.</p>

<p><strong>PARTICIPANTS: </strong>Women ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method.</p>

<p><strong>INTERVENTIONS: </strong>At baseline, participants completed a sociodemographic questionnaire and semi-structured interview, followed by five monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Intervention completion was defined as the number of completed coaching sessions.</p>

<p><strong>SECONDARY OUTCOMES: </strong>Qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception.</p>

<p><strong>RESULTS: </strong>Participants with a prior adverse outcome (a prior STI and/or a prior pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs. 4, p=0.03). Both groups had low HIV/STI knowledge, negative attitudes towards pregnancy, and low HIV/STI risk perception. Those with a prior adverse reproductive outcome held more negative attitudes towards condoms.</p>

<p><strong>CONCLUSION: </strong>Despite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome may be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize interventions reach for vulnerable youth.</p>

DOI

10.1016/j.jpag.2021.02.003

Alternate Title

J Pediatr Adolesc Gynecol

PMID

33571659

Title

HIV Testing Among Adolescents With Acute Sexually Transmitted Infections.

Year of Publication

2020

Date Published

2020 Mar 16

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing.</p>

<p><strong>METHODS: </strong>Retrospective study of STI episodes (gonorrhea, <em>Chlamydia,</em>&nbsp;trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis.</p>

<p><strong>RESULTS: </strong>The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing.</p>

<p><strong>CONCLUSIONS: </strong>HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.</p>

DOI

10.1542/peds.2019-2265

Alternate Title

Pediatrics

PMID

32179661

Title

Social Support Networks Among Young Men and Transgender Women of Color Receiving HIV Pre-Exposure Prophylaxis.

Year of Publication

2019

Date Published

2019 Oct 28

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>The aim of the study was to characterize perceived social support for young men and transgender women who have sex with men (YM/TWSM) taking HIV pre-exposure prophylaxis (PrEP).</p>

<p><strong>METHODS: </strong>Mixed-methods study of HIV-negative YM/TWSM of color prescribed oral PrEP. Participants completed egocentric network inventories characterizing their social support networks and identifying PrEP adherence support figures. A subset (n&nbsp;= 31) completed semistructured interviews exploring adherence support and qualities of PrEP support figures. We calculated proportions of role types (e.g., family), individuals disclosed to regarding PrEP use, and PrEP-supportive individuals within each participant network. Interviews were analyzed using an inductive approach.</p>

<p><strong>RESULTS: </strong>Participants (n&nbsp;= 50) were predominately African American men who have sex with men. Median age was 22&nbsp;years (interquartile range: 20-23). Biologic family were the most common support figures, reported by 75% of participants (mean family proportion .37 [standard deviation (SD): .31]), followed by 67% reporting friends (mean friend proportion .38 [SD: .36]). Most network members were aware (mean disclosed proportion .74 [SD: .31]) and supportive (mean supportive proportion .87 [SD: .28]) of the participants' PrEP use. Nearly all (98%) participants identified ≥1 figure who provided adherence support; more often friends (48%) than family (36%). Participants characterized support as instrumental (e.g., transportation); emotional (e.g., affection); and social interaction (e.g., taking medication together). Key characteristics of PrEP support figures included closeness, dependability, and homophily (alikeness) with respect to sexual orientation.</p>

<p><strong>CONCLUSIONS: </strong>Although most YM/TWSM identified family in their support networks, friends were most often cited as PrEP adherence support figures. Interventions to increase PrEP adherence should consider integrated social network and family-based approaches.</p>

DOI

10.1016/j.jadohealth.2019.08.014

Alternate Title

J Adolesc Health

PMID

31672523

Title

Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color.

Year of Publication

2019

Date Published

2019 Apr 16

ISSN Number

1573-3254

Abstract

<p>We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48&nbsp;h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22&nbsp;years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility,&nbsp;reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.</p>

DOI

10.1007/s10461-019-02502-y

Alternate Title

AIDS Behav

PMID

30993479

Title

Impact of insurance coverage on HIV transmission potential among antiretroviral therapy-treated youth living with HIV.

Year of Publication

2018

Number of Pages

895-902

Date Published

2018 Apr 24

ISSN Number

1473-5571

Abstract

<p><strong>OBJECTIVE: </strong>To identify the prevalence of high HIV transmission potential in a cohort of youth living with HIV (YLWH), and determine the impact of insurance coverage on potential for HIV transmission.</p>

<p><strong>DESIGN: </strong>Retrospective cohort study of antiretroviral therapy (ART)-treated YLWH at a US adolescent HIV clinic, 2002-2015.</p>

<p><strong>METHODS: </strong>The primary exposure was presence or absence of insurance, defined as private, public or pharmacy-only coverage. The primary outcome was high HIV transmission potential, defined as time-concurrent incident bacterial STI (gonorrhea, chlamydia or syphilis) and HIV RNA greater than 1500 copies/ml. Marginal structural models adjusting for baseline demographic covariates, prior history of STI and time-varying retention in care assessed the relationship between insurance status and HIV transmission potential.</p>

<p><strong>RESULTS: </strong>Participants (n = 240) were followed for a median of 22 (IQR 8.1-49) months after ART initiation, and were predominately African-American men and transgender women who have sex with men, with a median age at HIV diagnosis of 19 years (IQR 17-21). We identified 37 (15%) participants with at least one episode of high HIV transmission potential. Insurance coverage was associated with a greater than 50% lower odds of high HIV transmission potential (aOR 0.46, 95% CI 0.26-0.84), and history of STI at or before entry to HIV care conferred more than three-fold higher odds of high transmission potential (aOR 3.21, 95% CI 1.55-6.63).</p>

<p><strong>CONCLUSION: </strong>We found 17% of YLWH to have episodic high HIV transmission potential despite receiving ART. Insurance coverage, including pharmacy-only benefits, was protective against transmission risk, suggesting a pivotal role for universal ART coverage in treatment as prevention.</p>

DOI

10.1097/QAD.0000000000001772

Alternate Title

AIDS

PMID

29424777

WATCH THIS PAGE

Subscription is not available for this page.