Julie Franks

Are Peer Interventions for HIV Efficacious? A Systematic Review

Behavioral interventions to prevent HIV or assist HIV-positive persons often incorporate peers, yet empirical support for their efficacy is only recently accumulating. We describe the results of a review of the global literature, identifying 117 studies evaluating the efficacy of peer-based interventions in the area of HIV/AIDS. About half were conducted in the developing world and half in Western nations. Across a range of populations and intervention modalities, the majority of studies provided some support for peer interventions according to outcome indicators in the domains of sexual risk behavior, attitudes and cognitions, HIV knowledge, and substance use. However, outcomes assessed using biomarkers and other non-self-report variables were less likely to indicate intervention efficacy. Overall, findings suggest that we can have some confidence in peer interventions, yet more data are needed demonstrating an effect in the most rigorous study designs and with outcomes that are not potentially affected by respondent bias.ResumenLas intervenciones que pretenden cambiar el comportamiento para prevenir el VIH o para aydar a las personas infectadas por el VIH frecuentemente incluyen a los trabajadores no profesionales como promotores de salud, o “pares”. Sin embargo, los datos sobre la eficacia de las intervenciones que utilizan pares apenas están acumulando recientemente. Esta revisión sistemática describe los resultados de una revista de la literatura global, la cual identificó 117 estudios que evalúan la eficacia de las intervenciones basadas en pares relacionadas con el VIH. Aproximadamente la mitad de los estudios fueran llevados a cabo en los países en desarrollo y la mitad en los países desarrollados. Representando diversas poblaciones y tipos de intervenciones, la mayor parte de los estudios demuestra apoyo para el uso de pares, según resultados relacionados con comportamiento sexual riesgoso, las actitudes y la cognición, los conocimientos relacionados con el VIH, y el uso de sustancias. Sin embargo, los resultados medidos por datos biológicos y otros datos objetivos mostraron menos tendencia a indicar una intervención eficaz. En general, los resultados parcialmente apoyan el uso de las intervenciones basadas en pares pero todavía se precisan mas datos demostrando efectos en estudios de diseño riguroso y con resultados que no son limitados por un sesgo potencial de respuesta.

Peer interventions to promote health: conceptual considerations.

Peers have intervened to promote health since ancient times, yet few attempts have been made to describe theoretically their role and their interventions. After a brief overview of the history and variety of peer-based health interventions, a 4-part definition of peer interveners is presented here with a consideration of the dimensions of their involvement in health promotion. Then, a 2-step process is proposed as a means of conceptualizing peer interventions to promote health. Step 1 involves establishing a theoretical framework for the interventions main focus (i.e., education, social support, social norms, self-efficacy, and patient advocacy), and Step 2 involves identifying a theory that justifies the use of peers and might explain their impact. As examples, the following might be referred to: theoretical perspectives from the mutual support group and self-help literature, social cognitive and social learning theories, the social support literature, social comparison theory, social network approaches, and empowerment models.

Tuberculosis Knowledge, Attitudes, and Beliefs in Foreign-born and US-born Patients with Latent Tuberculosis Infection

Foreign-born individuals comprise the majority of patients treated for latent tuberculosis infection (LTBI) in the US. It is important to understand this population’s tuberculosis-related knowledge, attitudes, and beliefs (KAB) as they may affect treatment acceptance and completion. KAB in 84 US-born and 167 foreign-born LTBI patients enrolled in a clinical trial assessing treatment completion at an urban public hospital were assessed at baseline. Demographic and substance use information was also collected. Results: Of 251 participants, 66.5% were foreign-born. While misconceptions existed among both US and foreign-born regarding transmission and contagiousness of LTBI, overall knowledge scores did not differ significantly between groups. With respect to attitudinal factors, foreign-born participants were less likely to acknowledge that they had LTBI and felt more “protected” from developing TB. Improved understanding of foreign-born patients’ KAB may contribute to the reduction of barriers to treatment and improved outcomes.

Engaging, recruiting, and retaining black men who have sexwith men in research studies: Don't underestimate the importance of staffing-lessons learned from HPTN 061, the BROTHERS study

CONTEXT HIV/AIDS in the United States continues to primarily impact men who have sex with men (MSM), with disproportionately high rates among black MSM. OBJECTIVE The purpose of this study was to identify factors that may influence engagement and retention of black MSM in HIV research. DESIGN AND PARTICIPANTS This was a qualitative evaluation of study implementation within a multisite, prospective, observational study (HIV Prevention Trials Network 061, BROTHERS) that enrolled 1553 black MSM in 6 cities throughout the United States. Data collection for this evaluation included a written, structured survey collected from each of the sites describing site characteristics including staff and organizational structure, reviews of site standard operating procedures, and work plans; semistructured key informant interviews were conducted with site coordinators to characterize staffing, site-level factors facilitating or impeding effective community engagement, study recruitment, and retention. Data from completed surveys and site standard operating procedures were collated, and notes from key informant interviews were thematically coded for content by 2 independent reviewers. RESULTS Several key themes emerged from the data, including the importance of inclusion of members of the community being studied as staff, institutional hiring practices that support inclusive staffing, cultivating a supportive working environment for study implementation, and ongoing relationships between research institutions and community. CONCLUSIONS This study underscores the importance of staffing in implementing research with black MSM. Investigators should consider how staffing and organizational structures affect implementation during study design and when preparing to initiate study activities. Ongoing monitoring of community engagement can inform and improve methods for engagement and ensure cultural relevance while removing barriers for participation.

Limited awareness of pre-exposure prophylaxis among black men who have sex with men and transgender women in New York city

ABSTRACT Awareness of Pre-exposure prophylaxis (PrEP) was assessed among a cohort of substance-using black men who have sex with men and transgender women (MSM/TGW) participating in the STAR Study, which recruited black MSM/TGW in New York City for HIV testing and linked HIV-infected individuals into care from July 2012 to April 2015. Sociodemographic, psychosocial, known HIV risk factors, and PrEP awareness were assessed among participants. Multivariable logistic regression was conducted to assess factors associated with PrEP awareness. Of 1673 participants, median age was 43 years and 25% were under age 30. Most participants (85.8%) reported having insufficient income for basic necessities at least occasionally, 54.8% were homeless, and 71.3% were unemployed. Awareness of PrEP was reported among 18.2% of participants. PrEP awareness was associated with younger age (adjusted odds ratio [aOR] 0.87, per 5 years), gay identity (aOR 2.46), higher education (aOR 1.70), more frequent past HIV testing (aOR 3.18), less HIV stigma (aOR 0.61), less hazardous/harmful alcohol use (aOR 0.61), and more sexual partners (aOR 1.04, per additional partner in past 30 days). In this substance-using black MSM/TGW cohort with high rates of poverty and homelessness, PrEP awareness was low. This study demonstrates the need for targeted dissemination of PrEP information to key populations to increase awareness and ultimately improve uptake and utilization of PrEP.

Perceptions of community HIV/STI risk among u.S women living in areas with high poverty and HIV prevalence rates

Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community’s HIV/STI risk. We explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women’s HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/STI risk driven by structural factors.

Innovation to confront Ebola in Sierra Leone: the community-care-centre model

www.thelancet.com/lancetgh Vol 3 July 2015 e361 to Ebola treatment units as beds became available. All sites had the capacity to provide oral rehydration solution, empirical antibiotics, empirical treatment for malaria, and Ebola diagnostic testing according to national guidelines. At the time of the assessment, two sites were able to provide intravenous hydration. Essential safety measures were in place at all sites, alt hough some safety challenges were noted such as patients being left unattended overnight at some centres owing to lack of electricity. Some factors differed among community care centres including staffing patterns, supervisory approaches, patient fl ow, and presence of specifi c innovations. Implementing par tners made concerted efforts to engage communities in the planning of these centres, recruiting community members to provide non-clinical services and to act as liaisons between the centres and local communities. Despite the initial intention to staff community care centres entirely with laypeople, partners were able to recruit trained health workers for all centres on the basis of their concern about safety of the lay staff model. Staff from the Ministry of Health and Sanitation, implementing partners, staff at community care centres, and Innovation to confront Ebola in Sierra Leone: the community-carecentre model

Opportunities for Tuberculosis Diagnosis and Prevention among Persons Living with HIV: A Cross-Sectional Study of Policies and Practices at Four Large Ryan White Program-Funded HIV Clinics

Objective We describe the frequency and attributes of tuberculosis testing and treatment at four publicly-funded HIV clinics. Methods We abstracted medical records from a random sample of 600 HIV-infected patients having at least one clinic visit in 2009 at four clinics in New York and Los Angeles Metropolitan Statistical areas. We described testing and treatment for tuberculosis infection (TBI), 2008–2010, and estimated adjusted odds ratios (aORs). We interviewed key informants and described clinic policies and practices. Results Of 600 patients, 500 were eligible for testing, and 393 (79%) were tested 2008–2010; 107 (21%) did not receive at least one tuberculin skin test or interferon gamma release assay. Results were positive in 20 (5%) patients, negative in 357 (91%), and unknown in 16 (4%). Fourteen (70%) of 20 patients with TBI initiated treatment at the clinics; only three were documented to have completed treatment. Three hundred twenty three (54%) patients had chest radiography, 346 (58%) had tuberculosis symptom screening, and three had tuberculosis disease (117 per 100,000 person-years, 95% confidence interval (CI) = 101–165). Adjusting for site, non-Hispanic ethnicity (aOR = 4.9, 95% CI = 2.6–9.5), and employment (aOR = 1.9, 95% CI = 1.0–3.4) were associated with TBI testing; female gender (aOR = 2.0, 95% CI = 1.4–3.3), non-black race (aOR = 1.7, 95% CI = 1.3–2.5), and unemployment (aOR = 1.5, 95% CI = 1.1–2.1) were associated with chest radiography. Clinics evaluated TBI testing performance annually and identified challenges to TB prevention. Conclusions Study clinics routinely tested patients for TBI, but did not always document treatment. In a population with a high TB rate, ensuring treatment of TBI may enhance TB prevention.

Risk behaviors and HIV care continuum outcomes among criminal justice-involved HIV-infected transgender women and cisgender men: Data from the Seek, Test, Treat, and Retain Harmonization Initiative

Background Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system. Methods To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine HIV risk and care continuum indicators among CJ-involved HIV-infected TW compared to cisgender men (CM), matched on age (within 5 years) and study at a ratio of 1:5. Results Eighty-eight TW and 440 CM were included in the study. Among matched participants, TW were more likely to report crack and cocaine use compared to CM (40%,16% respectively, p<0.001); both TW and CM reported high rates of condomless sex (58%, 64%, respectively); TW were more likely than CM to have more than one sexual partner (OR = 2.9, 95% CI: 1.6, 5.2; p<0.001) and have engaged in exchange sex (OR = 3.9, 95% CI: 2.3, 6.6; p<0.001). There were no significant differences between TW and CM in the percentage currently taking ART (52%, 49%, respectively), the mean percent adherence to ART (77% for both groups), and the proportion who achieved viral suppression (61%, 58%, respectively). Conclusions HIV-infected CJ-involved TW and CM had similar use of ART and viral suppression but TW were more likely than matched CM to engage in exchange sex, have multiple sexual partners, and use crack/cocaine. TW and CM had similarly high rates of condomless sex and use of other drugs. TW require tailored risk reduction interventions, however both CJ-involved TW and CM require focused attention to reduce HIV risk and improve HIV continuum of care outcomes.

Response Rates of Medical Providers to Internet Surveys Regarding Their Adoption of Preexposure Prophylaxis for HIV: Methodological Implications

In 2016 to 2017, we surveyed primary care providers (PCPs) in upper Manhattan and the South Bronx, New York, on their knowledge, attitudes, and practices surrounding preexposure prophylaxis (PrEP) for HIV. Despite efforts to promote survey response, we were only able to obtain a meager response rate, limiting our ability to interpret results. In this short communication, we examine our survey’s methodology, as well as the methods used by other similar studies, in order to suggest how certain strategies appear to influence PCP response to PrEP surveys. Administering the survey in a variety of modes, sampling from a professional organization’s listserv, promoting the survey topic’s relevance to potential participants, and offering monetary incentives to each survey respondent all appear to be promising strategies for increasing response rates in PrEP provider surveys.