Patient recommendations for PrEP information dissemination at family planning clinics in Atlanta, Georgia.

OBJECTIVE: Family planning (FP) clinics are an ideal setting to disseminate information about pre-exposure prophylaxis (PrEP), but little is known about women's preferences for learning about PrEP in this setting. STUDY DESIGN: We surveyed 500 women seeking care at 4 FP clinics in Atlanta. Before their provider visit, participants completed an HIV-risk screener. After, we asked participants about the HIV prevention counseling they received and how clinics could share information about PrEP. We performed descriptive analyses on demographics, HIV risk, and PrEP awareness/interest, and conducted thematic analysis on open-ended responses. RESULTS: Only 18% knew about PrEP before the study; 28% of 376 sexually-active women had≥1 risk indicator consistent with PrEP eligibility. Three hundred forty seven women (69%) shared suggestions about how clinics should share PrEP information. We categorized suggestions into 4 themes - Advertising, Conversations, Awareness and Access. Participants (n=150) suggested clinics should advertise PrEP via brochures, posters, texts, or emails; 134 wanted providers to talk to patients about PrEP. Several (n=71) suggested sharing PrEP information broadly in the community and with other clinics/providers; others (n=11) wanted improved access to PrEP services. CONCLUSIONS: Our results demonstrate overwhelming patient interest in learning more about PrEP through educational materials and directly from FP providers. Women were vocal about increasing PrEP awareness in the community, particularly among populations especially at risk for HIV (e.g., teens). These suggestions can be translated into actionable steps FP clinics can take to increase PrEP awareness and expand their reach to benefit women at risk for HIV. IMPLICATIONS: High HIV rates among women in the South make it imperative to increase awareness of PrEP among women. Atlanta women seeking care in FP clinics valued learning about PrEP and recommended feasible strategies for disseminating information about PrEP in community settings, the clinic or during patient-provider discussion.

Sexual and Reproductive Health Services and Related Health Information on Pregnancy Resource Center Websites: A Statewide Content Analysis.

BACKGROUND: Pregnancy resource centers (PRCs) are nonprofit organizations with a primary mission of promoting childbirth among pregnant women. Given a new state grant program to publicly fund PRCs, we analyzed Georgia PRC websites to describe advertised services and related health information. METHODS: We systematically identified all accessible Georgia PRC websites available from April to June 2016. Entire websites were obtained and coded using defined protocols. RESULTS: Of 64 reviewed websites, pregnancy tests and testing (98%) and options counseling (84%) were most frequently advertised. However, 58% of sites did not provide notice that PRCs do not provide or refer for abortion, and 53% included false or misleading statements regarding the need to make a decision about abortion or links between abortion and mental health problems or breast cancer. Advertised contraceptive services were limited to counseling about natural family planning (3%) and emergency contraception (14%). Most sites (89%) did not provide notice that PRCs do not provide or refer for contraceptives. Two sites (3%) advertised unproven "abortion reversal" services. Approximately 63% advertised ultrasound examinations, 22% sexually transmitted infection testing, and 5% sexually transmitted infection treatment. None promoted consistent and correct condom use; 78% with content about condoms included statements that seemed to be designed to undermine confidence in condom effectiveness. Approximately 84% advertised educational programs, and 61% material resources. CONCLUSIONS: Georgia PRC websites contain high levels of false and misleading health information; the advertised services do not seem to align with prevailing medical guidelines. Public funding for PRCs, an increasing national trend, should be rigorously examined. Increased regulation may be warranted to ensure quality health information and services.

Trauma-Informed HIV Prevention and Treatment.

The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the USA and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified eight studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention, interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the USA or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV-infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience.

Physician Preferences for Physician-Targeted HIV Testing Campaigns.

The U.S. Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force issued HIV testing recommendations, encouraging physicians to routinely test all adult patients for HIV. Studies have found that not all physicians are abiding by these guidelines, but that physician recommendations for HIV testing could encourage patients to get tested. Our study sought to determine physician preferences for a physician-targeted campaign to encourage them to offer HIV tests to their patients. The study took place across 19 publicly-funded community health centers. A web-based survey was sent to primary care physicians, assessing their preferences for physician-targeted HIV testing campaign elements. Response frequencies were calculated for each element. 175 physicians participated. Campaign elements were divided into "HIV Testing Information," "Communication Tools," and "Promotion Strategies." Physicians selected receiving a copy of the latest HIV testing recommendations, having patients ask for the HIV test, and receiving an EMR alert for HIV testing as their top elements for each category, respectively. An effective physician HIV testing campaign should include information about HIV testing recommendations, proof of patient receptiveness to HIV testing, and strategies to prompt HIV testing conversations. A multi-faceted approach combining patient and physician prompts to discuss HIV testing might be the most effective method to improve HIV testing rates.

Using text messages to improve patient-doctor communication among racial and ethnic minority adults: an innovative solution to increase influenza vaccinations.

Despite the 2010 CDC recommendation that all adults receive influenza vaccinations, in the 2013-2014 influenza season, only 35% of Blacks and 37% of Hispanics were vaccinated, compared to 40% of Whites. This disparity could be due to poor patient-doctor communication, among other barriers. Doctors provide more health information to active communicators; unfortunately, they perceive minority patients to be poor communicators. A novel way to prompt minority patients to better communicate with their doctors is through mHealth. Text messaging is a simple, low cost, mHealth platform widely-used among racial and ethnic minorities. A text message campaign could be effective in providing vaccine education and prompting patients to converse with their doctors about influenza vaccinations. Text prompts could improve patient communication, thus increasing their likelihood of vaccination. This campaign could accomplish Healthy People 2020 goals: increase influenza vaccination, improve patient-doctor communication, increase use of mHealth, and reduce health disparities.