Exploring preferences and decision-making about long-acting injectable HIV pre-exposure prophylaxis (PrEP) among young sexual minority men 17–24 years old

John, Steven A.; Zapata, Juan Pablo; Dang, Madeline; Pleuhs, Benedikt; O’Neil, Andrew M.; Hirshfield, Sabina; Walsh, Jennifer L.; Petroll, Andrew E.; Quinn, Katherine

doi:10.1038/s41598-023-32014-8

Cited by 10 publications

(3 citation statements)

References 53 publications

(48 reference statements)

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“…Our findings demonstrate how interest in LA-PrEP among PrEP-indicated people will likely come with reservations, questions, and the need for additional information [ 46 ]. Given how long oral PrEP has been available, sexual and gender minorityindividuals may be more likely to encounter information about it in everyday life; however, this is not yet true of LA-PrEP.…”

Section: Discussionmentioning

confidence: 99%

“…Many potential LA-PrEP users will likely turn to their providers to get information. Health providers across specialties offer an opportunity to provide this information and a path for shared PrEP decision-making between injectable and oral options [ 46 ]. However, our focus groups confirmed that provider ignorance about PrEP is still a major issue, reinforcing the same challenge from the past decade: the majority of healthcare providers in the U.S. lack knowledge regarding PrEP and feel uncomfortable prescribing it [ 47 – 51 ].…”

Section: Discussionmentioning

confidence: 99%

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Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland

Kaptchuk,

Thomas,

Dhir

et al. 2024

BMC Public Health

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Background The approval of long-acting pre-exposure prophylaxis PrEP (LA-PrEP) in the United States brings opportunities to overcome barriers of oral PrEP, particularly among sexual and gender minority communities who bear a higher HIV burden. Little is known about real-time decision-making among potential PrEP users of LA-PrEP post-licensure. Methods We held focus group discussions with people assigned male at birth who have sex with men in Baltimore, Maryland to explore decision-making, values, and priorities surrounding PrEP usage. A sexual and gender minority-affirming health center that provides PrEP services supported recruitment. Discussions included a pile-sorting activity and were audio-recorded. Recordings were transcribed and analyzed iteratively, combining an inductive and deductive approach. Results We held five focus groups from Jan-June 2023 with 23 participants (21 cisgender men who have sex with men, two transgender women who have sex with men; mean age 37). Among participants, 21 were on oral PrEP, one was on injectable PrEP, and one had never taken PrEP. Most had never heard about LA-PrEP. When making decisions about PrEP, participants particularly valued efficacy in preventing HIV, side effects, feeling a sense of security, and ease of use. Perceptions varied between whether oral or injectable PrEP was more convenient, but participants valued the new opportunity for a choice in modality. Factors influencing PrEP access included cost, individual awareness, provider awareness, and level of comfort in a healthcare environment. Participants emphasized how few providers are informed about PrEP, placing the burden of being informed about PrEP on them. Comfort and trust in a provider superseded proximity as considerations for if and where to access PrEP. Conclusions There is still low awareness about LA-PrEP among sexual and gender minority communities; thus, healthcare providers have a critical role in influencing access to LA-PrEP. Despite this, providers are still vastly underinformed about PrEP and underprepared to support clients in contextualized ways. Clients are more likely to engage in care with affirming providers who offer non-judgmental conversations about sex and life experiences. Provider education in the United States is urgently needed to better support clients in choosing a PrEP modality that is right for them and supporting adherence for effective HIV prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland

Kaptchuk,

Thomas,

Dhir

et al. 2024

BMC Public Health

View full text Add to dashboard Cite

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“…As described previously [ 16 , 21 , 38 ], participants were recruited on the internet from social media and men-for-men geosocial networking apps between March and September 2020 to participate in web-based synchronous focus group discussions centered around topics of HIV testing and prevention. All ads featured images of 2 men, including a variety of young adult couples of various races and ethnicities.…”

Section: Methodsmentioning

confidence: 99%

Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study

Zapata,

Hirshfield,

Nelson

et al. 2023

JMIR Form Res

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Background Epidemiological trends in the United States have shown an increase in HIV cases among young sexual minoritized men. Using mobile health (mHealth), which refers to health services and information delivered or enhanced through the internet and related technologies, is a crucial strategy to address HIV disparities. However, despite its potential, the practical implementation of mHealth remains limited. Additionally, it is important to consider that young individuals may become accustomed to, distracted from, or lose interest in these apps, highlighting the need for regular updates and monitoring of relevant content. Objective In this study, we sought to highlight the voices of young sexual minoritized men aged 17-24 years and explored preferred mHealth intervention characteristics and willingness to adopt these technologies among a diverse, nationwide sample of young sexual minoritized men. Methods From April to September 2020, we recruited participants through web-based platforms such as social media and geosocial networking apps for men. These individuals were invited to participate in synchronous web-based focus group discussions centered around topics pertaining to HIV testing and prevention and their preferences for mHealth technologies. Results A total of 41 young sexual minoritized men, aged between 17 and 24 years, participated in 9 focus group discussions spanning April to September 2020, with 3-7 participants in each group. The findings shed light on three key insights regarding young sexual minoritized men’s preferences: (1) the need for personalized and representative content, (2) a preference for mobile and web-based simulation of prevention scenarios, and (3) a preference for digital software with individually tailored content. As expected, preference for mHealth apps was high, which supports the potential and need to develop or adapt interventions that use smartphones as a platform for engaging young sexual minoritized men in HIV prevention. This study expands on previous research in multiple meaningful ways, delving into the use and perceptions of mHealth information amid the COVID-19 pandemic. This study also highlighted the importance of streamlined access to health care providers, especially in light of the barriers faced by young people during the COVID-19 pandemic. In terms of presentation and navigation, participants favored a user-friendly design that was easy to use and appropriate for their age, which was effectively addressed through the implementation of web-based simulations. Conclusions Ultimately, this study provides valuable insight into the preferences of young sexual minoritized men when it comes to mHealth interventions and highlights the need for further research in order to develop effective and tailored HIV prevention tools. A future direction for researchers is to evaluate how best to address participants’ desire for personalized content within mHealth apps. Additionally, as technology rapidly evolves, there is a need to re-assess the effectiveness of web-based simulations, particularly those that are used in HIV prevention.

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HPTN 083‐02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study

Psaros,

Goodman,

Lee

et al. 2024

J Int AIDS Soc.

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IntroductionHPTN 083 demonstrated the superiority of long‐acting cabotegravir (CAB‐LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre‐exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial.MethodsParticipants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non‐adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis.ResultsParticipants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study‐related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non‐judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection‐related anxiety, which abated with time and when given some measure of control (e.g. pre‐injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules).ConclusionsRespondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non‐judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.

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Exploring preferences and decision-making about long-acting injectable HIV pre-exposure prophylaxis (PrEP) among young sexual minority men 17–24 years old

Cited by 10 publications

References 53 publications

Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland

Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland

Preferred Characteristics for mHealth Interventions Among Young Sexual Minoritized Men to Support HIV Testing and PrEP Decision-Making: Focus Group Study

HPTN 083‐02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study

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