Linking HIV-Negative Youth to Prevention Services in 12 U.S. Cities: Barriers and Facilitators to Implementing the HIV Prevention Continuum

Doll, Mimi; Fortenberry, J. Dennis; Roseland, Denise; McAuliff, Kathleen; Wilson, Craig M.; Boyer, Cherrie B.

doi:10.1016/j.jadohealth.2017.09.009

Cited by 38 publications

(36 citation statements)

References 17 publications

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“…However, individuals enrolled in government programs (e.g., Medicare Part D, Medicaid, TRICARE, or VA) are not eligible for this program. Adolescents under 18-years-old and young people covered by their parents’ insurance, and who may wish to seek PrEP independently to avoid disclosure through their parents’ Explanation of Benefits, are also excluded from this program [ 65 , 66 , 72 ]. Private insurers’ policies concerning medications, including PrEP, are insurance-specific and thus outside the scope of this review.…”

Section: Resultsmentioning

confidence: 99%

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

et al. 2018

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There are many challenges to accessing PrEP and thus low uptake in the United States. This review (2007–2017) of PrEP implementation identified barriers to PrEP and interventions to match those barriers. The final set of articles (n = 47) included content on cognitive aspects of HIV service providers and individuals at risk for infection, reviews, and case studies. Cognitive barriers and interventions regarding patients and providers included knowledge, attitudes, and beliefs about PrEP. The “purview paradox” was identified as a key barrier—HIV specialists often do not see HIV-negative patients, while primary care physicians, who often see uninfected patients, are not trained to provide PrEP. Healthcare systems barriers included lack of communication about, funding for, and access to PrEP. The intersection between PrEP-stigma, HIV-stigma, transphobia, homophobia, and disparities across gender, racial, and ethnic groups were identified; but few interventions addressed these barriers. We recommend multilevel interventions targeting barriers at multiple socioecological domains.

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Section: Resultsmentioning

confidence: 99%

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

et al. 2018

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“…A limited number of studies have shown that, with the exception of HIV prevention fatigue and feelings of invincibility, HIV providers have previously named these child themes as affecting whether YMSM access the PrEP continuum 21 or are linked to 20 or are retained in 22,23 HIV care. Similar to our study findings, Doll et al recently reported that HIV providers who primarily served YMSM patients named medical mistrust, having multiple marginalized identities, ability to navigate healthcare, transportation safety, and privacy issues as tied to the ability of their patient populations to navigate PrEP services.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to self-reported barriers and facilitators affecting YMSM's ability to engage with HIV services, a limited number of studies have assessed what factors YMSM-serving providers believe lead YMSM to successfully or unsuccessfully seek HIV-related services. [20][21][22][23][24][25] As recently reported within a systematic review by Wao et al, the literature examining provider perceptions of barriers and facilitators to HIV care for MSM overall, let alone YMSM, is sparse. 26 In brief, previous studies have found that providers were more likely to prescribe PrEP to YMSM who they perceived had fewer barriers and a greater number of facilitators.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Seeking HIV Services in Chicago Among Young Men Who Have Sex with Men: Perspectives of HIV Service Providers

Beach

Greene

Lindeman

et al. 2018

AIDS Patient Care and STDs

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Young men who have sex with men (YMSM) are disproportionally impacted by HIV, and continue to lag behind other age groups in the receipt of HIV prevention and care services. To inform the development of interventions to improve pre-exposure prophylaxis and HIV care engagement outcomes among YMSM, a growing number of studies have reported the barriers and facilitators YMSM encounter when accessing HIV services. Few studies, however, have assessed how HIV service providers perceive these facilitators and barriers. In total, 21 interviews were conducted with HIV service providers in Chicago about barriers and facilitators they perceived affected YMSM's engagement in HIV services. Barriers included lack of comprehensive wraparound services, lack of trust of providers, unfamiliarity with seeking HIV services, feelings of invincibility, lack of knowledge of HIV service providers, intersectional and structural concerns (e.g., not thinking the site's services were for YMSM), geography and distance to clinic, and HIV stigma. Facilitators included presence of comprehensive wraparound services, high trust in providers, a clinic's willingness to serve uninsured patients, community engagement, word-of-mouth recommendations from lesbian, gay, bisexual, and transgender (LGBT) friends, intersectionality (e.g., offering LGBT-tailored services), geography and distance, lack of HIV stigma. Axial coding revealed that five conceptual themes cut across multiple barriers and facilitators, including health system characteristics, intersectionality, geography and transportation, community outreach, and stigma. These conceptual themes map closely onto Bronfenbrenner's ecological model. Overall, these findings highlight the importance of a multi-level approach to future intervention development to increase engagement in HIV services among YMSM.

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“…Studies on the safety and feasibility of PrEP showed that despite challenges in adherence, PrEP is well tolerated by adolescents [6]. However, PrEP uptake among adolescents in general, and racial/ ethnic minority adolescents in particular, has been slow due to lack of awareness of PrEP, behavioral factors, and legal and financial barriers to adolescents seeking sexual and reproductive health care [7][8][9]. Increasing PrEP uptake among adolescents at risk for HIV has the potential to reduce new infections and address persistent profound racial disparities in HIV [10,11].…”

Section: Introductionmentioning

confidence: 99%

Awareness of and willingness to use PrEP among Black and Latinx adolescents residing in higher prevalence areas in the United States

Taggart

Pina

et al. 2020

PLoS ONE

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This mixed-methods study examined awareness of and willingness to use pre-exposure prophylaxis (PrEP) among sexually active Black and Latinx adolescents (13-17 years) residing in five cities in the United States with some of the highest burden of HIV. Data are from adolescents who participated in a cross-sectional survey (n = 208) and one-on-one interviews and focus groups (n = 26) conducted from September 2017-August 2019. Approximately 50% of the sample were recruited through community efforts, and the other half through a panel. Logistic regression with covariates including sexual orientation, relationship status, socioeconomic status, and race/ethnicity were used to assess factors associated with PrEP awareness and willingness. For the qualitative data, thematic analysis was used to develop a codebook of a-priori and inductive codes while analytic memos were written to identify key themes. PrEP awareness was reported by 38% of the sample and was associated with Black race (AOR = 0.49; 95% CI = 0.27, 0.90) and prior HIV testing (AOR = 3.89, 95% CI = 1.25, 12.08). PrEP willingness (defined as "definitely would use PrEP") was reported by 22% of the sample and was associated with higher age, more education, having had condomless sex in the past 6 months (AOR = 0.23; 95% CI = 0.10, 0.56), perceived likelihood of acquiring HIV (AOR = 3.59; 95% CI = 1.06, 12.21), and PrEP awareness (AOR = 0.41; 95% CI = 0.19, 0.89). Qualitative data showed that misconceptions about PrEP persist and PrEP stigma, fear of being punished, provider attitudes and recommendations, and empowerment were related to adolescents' willingness to use PrEP. Study findings reveal important strategies for improving PrEP delivery and scale-up to Black and Latinx adolescents. These strategies include using sociodemographic and health behavior data to target adolescents who may be more or less willing to use PrEP, improving provider communication about PrEP, and creating culturally and developmentally appropriate PrEP education materials that address common misconceptions held by adolescents.

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Linking HIV-Negative Youth to Prevention Services in 12 U.S. Cities: Barriers and Facilitators to Implementing the HIV Prevention Continuum

Cited by 38 publications

References 17 publications

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

Improving PrEP Implementation Through Multilevel Interventions: A Synthesis of the Literature

Barriers and Facilitators to Seeking HIV Services in Chicago Among Young Men Who Have Sex with Men: Perspectives of HIV Service Providers

Awareness of and willingness to use PrEP among Black and Latinx adolescents residing in higher prevalence areas in the United States

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