Bridge Nodes Linking Depression and Medication Taking Self-Efficacy Dimensions Among Persons With HIV: A Secondary Data Analysis.

Depression and low medication taking self-efficacy are among the most important mechanisms contributing to poor adherence to treatment and care for persons with HIV (PWH). While the overall negative relationship between depression and medication taking self-efficacy has been well established, little is known on the precise pathways linking depression and medication taking self-efficacy. Thus, it is critical to identify a specific item of depression and medication taking self-efficacy that derives the overall negative relationship. The current study is a secondary data analysis using the baseline data from a randomized controlled trial that aims to support PWH to self-manage antiretroviral therapy regimens via mHealth technology and community health workers to monitor their adherence using a self-management app. A total of 282 participants were included. The machine-learning based network analysis was conducted to explore the structure of the depression and medication taking self-efficacy network and to identify bridge nodes between depression and medication taking self-efficacy. Our study identified difficulty concentrating on things and confidence to stick to treatment schedule when not feeling well are important bridge nodes connecting the network of depression and medication taking self-efficacy. Future studies should focus on developing interventions that would target the bridge pathway and examine their effectiveness in reducing depression and increasing medication taking self-efficacy.

Elucidating Harm Reduction Principles in a Client-Centered Representative Payee Program.

Harm Reduction seeks to mitigate harms associated with health behaviors without the expectation that these behaviors be extinguished completely. Client-Centered Representative Payee (CCRP) is an intervention that modifies the US Social Security Administration's (SSA) Representative Payee policy by incorporating relational harm reduction. We used Human-Centered Design (HCD) methods to elucidate ways that harm reduction principles are present in and integral to CCRP and to create a blueprint for replication. Thirteen individuals familiar with CCRP brainstormed 88 statements, which were parsed, consolidated, and then independently assigned by a subgroup of participants to six principles of harm reduction. After refining the data, 29 statements aligning with harm reduction principles remained. Delineating harm reduction within CCRP, which can empower and establish trust with clients, may help other providers identify how to offer representative payee services that are respectful, compassionate, rooted in harm reduction, and ultimately improve client outcomes.

HIV Pre-exposure Prophylaxis Services for Black and Hispanic or Latino Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in THRIVE, 2015-2020.

BACKGROUND AND SETTING: From 2015 to 2020, the THRIVE project supported 7 US health departments to improve HIV prevention services for Black or African American (Black) and Hispanic or Latino gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). METHODS: We described services provided in the THRIVE PrEP continuum. Using Poisson regression models, we estimated associations between race or ethnicity and age and PrEP screening, linkage, and prescription. We examined associations between colocation of services and PrEP linkage and prescription for 2 sites. RESULTS: THRIVE served 12,972 GBM without HIV; 37% of PrEP-eligible GBM were prescribed PrEP. THRIVE served 1185 TGW without HIV; 45% of PrEP-eligible TGW were prescribed PrEP. Black and Hispanic or Latino GBM were 29% (RR = 0.71, 95% CI: 0.66-0.77) and 19% (RR = 0.81, 95% CI: 0.75-0.87) less likely, respectively, to be prescribed PrEP than White GBM. GBM aged 18-24 years and 55 years or older were 19% (RR = 0.81, 95% CI: 0.75-0.87) and 22% (RR = 0.78, 95% CI: 0.67-0.9) less likely, respectively, to be prescribed PrEP compared with those aged 35-44 years. Colocated services were associated with a 54% (RR = 1.54, 95% CI: 1.44-1.64) and a 31% (RR = 1.31, 95% CI: 1.19-1.43) greater likelihood of PrEP linkage and prescription, respectively, compared with services at different locations. CONCLUSIONS: THRIVE provided PrEP to higher proportions of PrEP-eligible persons than current national estimates; however, PrEP use disparities persist. Colocation of services may be a useful component of jurisdictional strategies to increase PrEP coverage.