Limited Risk Compensation Among Women Who Inject Drugs: Results From the Project Sexual Health Equity Preexposure Prophylaxis Demonstration Study in Philadelphia.

ABSTRACT: The impact of preexposure prophylaxis uptake on sexual and injection-related behaviors among women who inject drugs is poorly understood. Over 24 weeks, preexposure prophylaxis uptake among women who inject drugs was associated with increased sharing of injection equipment but not syringes and no changes in condomless sex, providing limited evidence of risk compensation in this vulnerable population.

Pre-Exposure Prophylaxis (PrEP) Awareness Is Low Among Heterosexual People of Color Who Might Benefit From PrEP in Philadelphia.

INTRODUCTION: We assessed awareness of pre-exposure prophylaxis (PrEP) among HIV-negative Black and Latinx persons living in the Philadelphia Metropolitan Statistical Area. METHODS: Using chi-square and Wilcoxon rank-sum tests, we analyzed data from the 2016 heterosexual cycle of the National HIV Behavioral Surveillance system to assess how sociodemographic factors, health care utilization, and risk behaviors affected PrEP awareness. RESULTS: Participants (n = 472) were predominately Black, non-Hispanic (88.1%) with a median age of 41.5 years. Most participants reported having a usual source of medical care (92.1%) and seeing a medical provider within 12 months (87.0%). However, PrEP awareness was low in this sample (4.9%) and was lower among those who had a medical visit compared with those who had not ( P < .01). CONCLUSION: Current Centers for Disease Control and Prevention clinical guidelines suggest that providers counsel high-risk patients about PrEP. Our data suggest that this is not happening with people of color in Philadelphia. Interventions targeting medical providers working with HIV-risk people of color may be appropriate.

Potential benefits of using ecological momentary assessment to study high-risk polydrug use.

BACKGROUND: While studies have documented both the feasibility and acceptability of using ecological momentary assessment (EMA) to study drug use, there is little empirical research assessing participants' perceptions of utilizing this technology-driven approach. METHODS: Participants were English-speaking persons ≥18 years old who reported injection drug use and sequential (e.g., alcohol followed by opioid use) or simultaneous (i.e., injecting heroin and cocaine in one shot) polydrug use within 30 days recruited in San Diego, CA and Philadelphia, PA. Participants (N=36) completed two cell phone-based EMA simulations assessing mood, drug use, HIV risk behaviors, and daily activities, followed by semi-structured interviews that probed for potential benefits of participation over time. Qualitative analysis involved an iterative process of reviewing texts from the interviews to create a coding framework, which was then applied to all transcripts to identify themes. RESULTS: Findings suggest participants may derive indirect benefits from participation in EMA studies including: improved self-worth from helping others; experiencing increased social support through utilization of the study-provided mobile device for non-research purposes; and most importantly, increased self-reflection, which could lead to therapeutic and intervention-like effects such as decreased substance use or reduced HIV risk. CONCLUSIONS: Participants identified a variety of potential benefits from participating in a study that utilizes EMA. This research suggests that benefits are highly salient for individuals involved in studies of polydrug use.

Potential Risks of Ecological Momentary Assessment Among Persons Who Inject Drugs.

BACKGROUND: Ecological momentary assessment (EMA)-which often involves brief surveys delivered via mobile technology-has transformed our understanding of the individual and contextual micro-processes associated with legal and illicit drug use. However, little empirical research has focused on participant's perspective on the probability and magnitude of potential risks in EMA studies. OBJECTIVES: To garner participant perspectives on potential risks common to EMA studies of illicit drug use. METHODS: We interviewed 38 persons who inject drugs living in San Diego (CA) and Philadelphia (PA), United States. They completed simulations of an EMA tool and then underwent a semi-structured interview that systematically explored domains of risk considered within the proposed revisions to the Federal Policy for the Protection of Human Subjects or the "Common Rule." Interviews were transcribed verbatim and coded systematically to explore psychological, physical, social, legal, and informational risks from participation. RESULTS: Participants perceived most risks to be minimal. Some indicated that repetitive questioning about mood or drug use could cause psychological (i.e., anxiety) or behavioral risks (i.e., drug use relapse). Ironically, the questions that were viewed as risky were considered motivational to engage in healthy behaviors. The most cited risks were legal and social risks stemming from participant concerns about data collection and security. IMPORTANCE: Improving our understanding of these issues is an essential first step to protect human participants in future EMA research. We provide a brief set of recommendations that can aid in the design and ethics review of the future EMA protocol with substance using populations.

Court-based participatory research: collaborating with the justice system to enhance sexual health services for vulnerable women in the United States.

BACKGROUND: Although jail screening programs have an important role in the diagnosis and treatment of sexually transmissible infections (STI) and HIV among incarcerated individuals, many arrestees are not screened before release. Justice-involved women are at particularly high risk for these conditions because of individual risk behaviour as well as other network-level risk factors. Court-based programs could provide a critical bridge between these women, STI risk counselling and health services. This formative study explored the features of a program that would encourage STI testing among court-involved women. Further, we describe how community-based participatory research principles were adapted for use in a court setting and the resulting justice-public health partnership. METHODS: Using semistructured interviews and focus group discussions, we explored issues related to health-seeking behaviours, perceived gaps in services for high-risk women and the components of a court-based screening program. RESULTS: Six focus groups were conducted with women with a history of commercial sex work and staff from the court, as well as local organisations providing HIV and social support services for high-risk women. Community-based participatory research (CBPR) principles facilitated development of relevant research questions and equitable processes, and assisted partners to consider individual and sociostructural sources of health disparities. DISCUSSION: Although not every principle was applicable in a court setting, the CBPR framework was helpful for building cohesion and support for the project. We provide a description of how CBPR principles were operationalised, describe the key lessons learned and discuss the implications for CBPR projects in a community court.

Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program.

OBJECTIVE: To evaluate Positive Choices (PC), a program that employed lay health workers to motivate antiretroviral adherence among persons living with HIV with coverage from Indiana's high-risk insurance pool. METHODS: Four hundred and forty nine participants living in the greater Indianapolis area were randomly allocated to treatment (n = 91) or control (n = 358) groups and followed for one year. RESULTS: Compared to control subjects, PC subjects were more likely to adhere to HIV medications (medication possession ratio adherence ≥ 0.95, OR = 1.83, p = 0.046), and to achieve undetectable viral load (<50 copies/mL, OR = 2.01, p = 0.011) in the 12 months following introduction of PC. There were no significant differences observed between groups in any of self-reported health status indicators. CONCLUSION: Estimates suggest that PC clients were 16% more likely to have undetectable viral loads than clients in standard care. The incremental program cost was approximately $10,000 for each additional person who achieved an undetectable viral load. PRACTICE IMPLICATIONS: As persons living with HIV experience greater longevity and healthcare reform expands coverage to these high-risk populations, greater demands will be placed on the HIV-care workforce. Results suggest lay health workers may serve as effective adjuncts to professional care providers.

The structure and content of telephonic scripts found useful in a Medicaid Chronic Disease Management Program.

In 2003, the Indiana Office of Medicaid Policy and Planning launched the Indiana Chronic Disease Management Program (ICDMP), a programme intended to improve the health and healthcare utilization of 15,000 Aged, Blind and Disabled Medicaid members living with diabetes and/or congestive heart failure in Indiana. Within ICDMP, programme components derived from the Chronic Care Model and education based on an integrated theoretical framework were utilized to create a telephonic care management intervention that was delivered by trained, non-clinical Care Managers (CMs) working under the supervision of a Registered Nurse. CMs utilized computer-assisted health education scripts to address clinically important topics, including medication adherence, diet, exercise and prevention of disease-specific complications. Employing reflective listening techniques, barriers to optimal self-management were assessed and members were encouraged to engage in health-improving actions. ICDMP evaluation results suggest that this low-intensity telephonic intervention shifted utilization and lowered costs. We discuss this patient-centred method for motivating behaviour change, the theoretical constructs underlying the scripts and the branched-logic format that makes them suitable to use as a computer-based application. Our aim is to share these public-domain materials with other programmes.