Intention to Use Different Formulations of Longer Acting HIV Pre-Exposure Prophylaxis Among Transgender and Gender Expansive Individuals: The Roles of Social Vulnerability and Medical Mistrust.

In 2012, the Federal Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for HIV prevention in adults. Longer acting injectable PrEP (LA PrEP) has been approved and other formulations are in development. A successful LA PrEP rollout requires examining potential facilitators and barriers to PrEP uptake. Given that transgender and gender expansive (TGE) individuals experience more social vulnerability and higher levels of medical mistrust compared to other populations, examining the role of these two factors in LA PrEP uptake is important. This study, PrEP for ALL, is a community-based participatory research project in Texas that engaged TGE community members and organizational partners through a community advisory board. In total, 482 TGE individuals were recruited and responded to all relevant questions in an online survey, including their intentions to use three formulations: a monthly oral pill, a bimonthly intramuscular injection, and an annual subdermal implant. Multiple regression analysis was used to examine the influence of social vulnerability and medical mistrust on intention to use each LA PrEP formulation adjusting for other relevant factors. Findings suggest that individuals with higher levels of social vulnerability had greater intentions to use the monthly oral pill (ß = 0.12, p = 0.009), the bimonthly intramuscular injection (ß = 0.18, p < 0.001), and annual subdermal implant (ß = 0.17, p < 0.001), whereas medical mistrust reduced intentions to use the bimonthly intramuscular injection (ß = -0.18, p < 0.001) and annual subdermal implant (ß = -0.11, p = 0.021). Improvements in gender-affirming clinical care are needed along with LA PrEP formulations that allow for greater autonomy and reduced clinical contact. Clinical Trial Registration number: NCT05044286.

Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic.

Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.

COVID-19 topics and emotional frames in vaccine hesitation: A social media text and sentiment analysis.

Objective: Addressing gaps in COVID-19 vaccine-hesitancy research, the current study aimed to add depth and nuance to the exploratory research examining vaccine-hesitant groups. Using a larger, but more focused conversation occurring on social media, the results can be used by health communicators to frame emotionally resonant messaging to improve COVID-19 vaccine advocacy while also mitigating negative concerns for vaccine-hesitant individuals. Methods: Social media mentions were collected using a social media listening software, Brandwatch, to examine topics and sentiments in COVID-19 hesitancy discourse during a period of September 1, 2020, through December 31, 2020. The results from this query included publicly available mentions on two popular social media sites, Twitter and Reddit. The dataset of 14,901 global, English language messages were analyzed using a computer-assisted process in SAS text-mining and Brandwatch software. The data revealed eight unique topics before being analyzed by sentiment. Results: Among the COVID-19 hesitancy data, trust-related topics emerged that included declining vaccine acceptance, a parallel pandemic of distrust, and a call for politicians to let the scientific process work, among others. Positive sentiment revealed interest in the sources which included healthcare professionals, doctors, and government organizations. Pfizer was found to elicit both positive and negative emotions in the vaccine-hesitancy data. The negative sentiment tended to dominate the hesitancy conversation, accelerating once vaccines hit the market. Conclusions: Relevant topics were identified to help support targeted communication, strategically accelerate vaccine acceptance, and mitigate COVID-19 vaccine hesitancy among the public. Strategic methods of online and offline messaging tactics are suggested to reach diverse, malleable populations of interest. Topics of personal anecdotes of safety, effectiveness, and recommendations among families are identified as persuasive communication opportunities.

Knowledge and Attitude About Pre-exposure Prophylaxis Among Primary Care Clinicians at a Federally Qualified Health Center in Central Texas: A Cross-sectional Study.

ABSTRACT: Pre-exposure prophylaxis (PrEP) for HIV prevention is a highly effective tool in preventing HIV, yet PrEP is underprescribed. Primary care providers are ideally positioned to increase access to and awareness of PrEP, but health care providers' knowledge of PrEP greatly varies. To evaluate PrEP knowledge and attitudes of primary care providers, we conducted a descriptive cross-sectional study examining primary providers' knowledge and concerns about PrEP. Participants ( n = 122) included physicians, nurses, pharmacists, and residency trainees in family medicine, internal medicine, and obstetrics. Despite high awareness of PrEP among these primary care providers (91.7%), fewer reported feeling comfortable prescribing PrEP (62.5%), and the average number of PrEP prescriptions per provider written in the last 6 months was less than 1. PrEP remains key to preventing HIV, but prescriptions remain low. Health care providers would benefit from additional education and training on communicating with their patients about sexual health and HIV prevention.

Learning with experts: Incorporating community into gender-diverse healthcare education.

The Association of American Medical Colleges (AAMC) encourages but does not require medical schools to train students on LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc.…) care and education on transgender, gender-diverse and/or intersex care is particularly lacking. This study evaluated the efficacy of a patient-centred educational intervention co-developed and facilitated with transgender and gender-diverse (TGD) patient collaborators on students' knowledge of TGD healthcare needs, perceived value of TGD healthcare training and TGD healthcare competency. The authors recruited second-year medical students from the Primary Care, Family and Community Medicine Clerkship at the University of Texas at Austin Dell Medical School (UT Dell Med) in Spring 2021. Students (n = 36) completed an online survey with closed- and open-ended questions that included AAMC TGD healthcare competencies, perceived value of TGD healthcare training, and knowledge of TGD healthcare needs before and after an educational intervention utilising clinical cases developed and delivered in collaboration with six TGD patient collaborators. The TGD patient collaborators completed a post-intervention survey evaluating the patient-centredness of the educational intervention's design and implementation and their perception of the student's competence during the intervention. There was a statistically significant increase in each AAMC TGD healthcare competency post-intervention, except for discussing sexual health practices. No changes in perceived value or knowledge were noted. Students reported that authentic engagement with TGD patient collaborators during the educational intervention had the most impact (n = 10, 58.4%). All responding TGD patient collaborators (n = 5, 100%) strongly agreed that their input was valued and at least somewhat agreed that they felt supported by the organiser of the educational intervention. Three respondents (75%) somewhat agreed that the development of the educational intervention was a collaborative process, with one (25%) somewhat disagreeing. Educational interventions that are co-developed with TGD patient collaborators may improve medical student understanding of gender diversity. Additional efforts are needed to further the patient-centredness of educational interventions.

Global health on the front lines: an innovative medical student elective combining education and service during the COVID-19 pandemic.

BACKGROUND: An innovative medical student elective combined student-directed, faculty-supported online learning with COVID-19 response field placements. This study evaluated students' experience in the course, the curriculum content and format, and its short-term impact on students' knowledge and attitudes around COVID-19. METHODS: Students responded to discussion board prompts throughout the course and submitted pre-/post-course reflections. Pre-/post-course questionnaires assessed pandemic knowledge and attitudes using 4-point Likert scales. Authors collected aggregate data on enrollment, discussion posts, field placements, and scholarly work resulting from course activities. After the elective, authors conducted a focus group with a convenience sample of 6 participants. Institutional elective evaluation data was included in analysis. Authors analyzed questionnaire data with summary statistics and paired t-tests comparing knowledge and attitudes before and after the elective. Reflection pieces, discussion posts, and focus group data were analyzed using content analysis with a phenomenological approach. RESULTS: Twenty-seven students enrolled. Each student posted an average of 2.4 original discussion posts and 3.1 responses. Mean knowledge score increased from 43.8 to 60.8% (p <  0.001) between pre- and post-course questionnaires. Knowledge self-assessment also increased (2.4 vs. 3.5 on Likert scale, p <  0.0001), and students reported increased engagement in the pandemic response (2.7 vs. 3.6, p <  0.0001). Students reported increased fluency in discussing the pandemic and increased appreciation for the field of public health. There was no difference in students' level of anxiety about the pandemic after course participation (3.0 vs. 3.1, p = 0.53). Twelve students (44.4%) completed the institutional evaluation. All rated the course "very good" or "excellent." Students favorably reviewed the field placements, suggested readings, self-directed research, and learning from peers. They suggested more clearly defined expectations and improved balance between volunteer and educational hours. CONCLUSIONS: The elective was well-received by students, achieved stated objectives, and garnered public attention. Course leadership should monitor students' time commitment closely in service-learning settings to ensure appropriate balance of service and education. Student engagement in a disaster response is insufficient to address anxiety related to the disaster; future course iterations should include a focus on self-care during times of crisis. This educational innovation could serve as a model for medical schools globally.

DNA priming and gp120 boosting induces HIV-specific antibodies in a randomized clinical trial.

BACKGROUNDRV144 is the only preventive HIV vaccine regimen demonstrating efficacy in humans. Attempting to build upon RV144 immune responses, we conducted a phase 1, multicenter, randomized, double-blind trial to assess the safety and immunogenicity of regimens substituting the DNA-HIV-PT123 (DNA) vaccine for ALVAC-HIV in different sequences or combinations with AIDSVAX B/E (protein).METHODSOne hundred and four HIV-uninfected participants were randomized to 4 treatment groups (T1, T2, T3, and T4) and received intramuscular injections at 0, 1, 3, and 6 months (M): T1 received protein at M0 and M1 and DNA at M3 and M6; T2 received DNA at M0 and M1 and protein at M3 and M6; T3 received DNA at M0, M1, M3, and M6 with protein coadministered at M3 and M6; and T4 received protein and DNA coadministered at each vaccination visit.RESULTSAll regimens were well tolerated. Antibodies binding to gp120 and V1V2 scaffold were observed in 95%-100% of participants in T3 and T4, two weeks after final vaccination at high magnitude. While IgG3 responses were highest in T3, a lower IgA/IgG ratio was observed in T4. Binding antibodies persisted at 12 months in 35%-100% of participants. Antibody-dependent cell-mediated cytotoxicity and tier 1 neutralizing-antibody responses had higher response rates for T3 and T4, respectively. CD4+ T cell responses were detectable in all treatment groups (32%-64%) without appreciable CD8+ T cell responses.CONCLUSIONThe DNA/protein combination regimens induced high-magnitude and long-lasting HIV V1V2-binding antibody responses, and early coadministration of the 2 vaccines led to a more rapid induction of these potentially protective responses.TRIAL REGISTRATIONClinicalTrials.gov NCT02207920.FUNDINGNational Institute of Allergy and Infectious Diseases (NIAID) grants UM1 AI068614, UM1 AI068635, UM1 AI068618, UM1 AI069511, UM1 AI069470, UM1 AI069534, P30 AI450008, UM1 AI069439, UM1 AI069481, and UM1 AI069496; the National Center for Advancing Translational Sciences, NIH (grant UL1TR001873); and the Bill & Melinda Gates Foundation (grant OPP52845).

Brief Report: Routine Use of Oral PrEP in a Phase 2 Rectal Microbicide Study of Tenofovir Reduced-Glycerin 1% Gel (MTN-017).

BACKGROUND: As daily oral preexposure prophylaxis (PrEP) becomes standard for HIV prevention, routine use of PrEP is likely to increase within clinical trials of novel preventive agents. We describe the prevalence and characteristics of participants reporting nonstudy oral PrEP use within Microbicide Trials Network-017 (MTN-017), a phase 2 trial of a rectal microbicide. SETTING AND METHODS: One hundred ninety-five HIV-uninfected men who have sex with men and transgender women were enrolled and followed in MTN-017 across 8 sites in the United States, Thailand, South Africa, and Peru from 2013 to 2015. Nonstudy oral PrEP use was recorded on case report forms and progress notes. Characteristics of PrEP users and non-PrEP users were compared using tests of statistical significance. RESULTS: Overall, 11% of participants reported nonstudy oral PrEP use, all from the San Francisco (SF) site, accounting for 58% (22/38) of participants enrolled in SF. There was a higher median number of sex partners reported in the past 8 weeks before enrollment among oral PrEP users vs. nonusers (7 vs. 2, P = 0.02). Most PrEP users (18/22, 82%) began PrEP treatment during screening/after enrollment, and most (19/22, 86%) decided to continue oral PrEP after study completion. CONCLUSION: Nonstudy oral PrEP use in the first phase 2 study of tenofovir reduced-glycerin 1% gel was high at a single site in SF where community PrEP availability and use was expanding. Investigators should consider the evolving context of nonstudy oral PrEP use across trial sites when designing and interpreting trials of novel biomedical prevention modalities.