Collaborative PrEP Implementation Strategies for Latino Men Who have Sex with Men: A Health Center-Community Consensus Process.

Community-based organizations (CBOs) deliver services in culturally-responsive ways, and could effectively partner with health centers to deliver HIV pre-exposure prophylaxis (PrEP) to Latino men who have sex with men (LMSM). However, few such models exist. We conducted a planning study in collaboration with three CBOs serving LMSM to identify optimal PrEP delivery strategies for health centers and CBOs to implement jointly. We established a Community Expert Panel (CEP) of eight client-facing CBO and health center staff. Over 6 months, the panel met monthly to identify collaborative strategies for PrEP delivery, using a modified Delphi method consisting of the following steps: (1) brainstorming strategies; (2) rating strategies on acceptability, appropriateness and feasibility; (3) review of data from qualitative focus group discussions with CBO clients; and (4) final strategy selection. The panel initially identified 25 potential strategies spread across three categories: improving communication between health centers and CBOs; using low-barrier PrEP options (e.g. telemedicine), and developing locally-relevant, culturally-sensitive outreach materials. Focus groups with CBO clients highlighted a desire for flexible options for PrEP-related care and emphasized trust in CBOs. The final package of strategies consisted of: (1) a web-based referral tool; (2) telemedicine appointments; (3) geographically-convenient options for lab specimen collection; (4) tailored print and social media; and (5) regular coaching sessions with CBO staff. Through a community-engaged process, we identified a package of PrEP delivery strategies that CBOs and health centers can implement in partnership, which have the potential to overcome barriers to PrEP for LMSM.

Estimated Effectiveness of JYNNEOS Vaccine in Preventing Mpox: A Multijurisdictional Case-Control Study - United States, August 19, 2022-March 31, 2023.

As of March 31, 2023, more than 30,000 monkeypox (mpox) cases had been reported in the United States in an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and transgender persons (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) was approved by the Food and Drug Administration (FDA) in 2019 for the prevention of smallpox and mpox via subcutaneous injection as a 2-dose series (0.5 mL per dose, administered 4 weeks apart) (2). To expand vaccine access, an Emergency Use Authorization was issued by FDA on August 9, 2022, for dose-sparing intradermal injection of JYNNEOS as a 2-dose series (0.1 mL per dose, administered 4 weeks apart) (3). Vaccination was available to persons with known or presumed exposure to a person with mpox (postexposure prophylaxis [PEP]), as well as persons at increased risk for mpox or who might benefit from vaccination (preexposure mpox prophylaxis [PrEP]) (4). Because information on JYNNEOS vaccine effectiveness (VE) is limited, a matched case-control study was conducted in 12 U.S. jurisdictions,† including nine Emerging Infections Program sites and three Epidemiology and Laboratory Capacity sites,§ to evaluate VE against mpox among MSM and transgender adults aged 18-49 years. During August 19, 2022-March 31, 2023, a total of 309 case-patients were matched to 608 control patients. Adjusted VE was 75.2% (95% CI = 61.2% to 84.2%) for partial vaccination (1 dose) and 85.9% (95% CI = 73.8% to 92.4%) for full vaccination (2 doses). Adjusted VE for full vaccination by subcutaneous, intradermal, and heterologous routes of administration was 88.9% (95% CI = 56.0% to 97.2%), 80.3% (95% CI = 22.9% to 95.0%), and 86.9% (95% CI = 69.1% to 94.5%), respectively. Adjusted VE for full vaccination among immunocompromised participants was 70.2% (95% CI = -37.9% to 93.6%) and among immunocompetent participants was 87.8% (95% CI = 57.5% to 96.5%). JYNNEOS is effective at reducing the risk for mpox. Because duration of protection of 1 versus 2 doses remains unknown, persons at increased risk for mpox exposure should receive the 2-dose series as recommended by the Advisory Committee on Immunization Practices (ACIP),¶ regardless of administration route or immunocompromise status.

An organizational capacity-building program to enhance adolescent sexual and reproductive health.

OBJECTIVES: To present a new practice for promoting sexual health among youth, and a pilot evaluation. The Afterschool Health and Sexuality Education Project is a capacity-building program that provides staff training, technical assistance, resource materials, and policy recommendations to create organizational change that facilitates staff members' abilities to promote sexual and reproductive health for adolescents. METHOD: The evaluation included assessment of (a) sexual health educational materials, resources, and referral lists; (b) organizational policies that guide provision of sexual information and referrals; and (c) communication about sexual health. Data were collected prior to intervention, 7 months later, and 1 year later using anonymous surveys of staff and adolescents, and researcher observations. RESULTS: Results indicate that organizational support for addressing youth sexual health increased as did communication between staff and youth, with decreased barriers. Most, but not all, improvements were maintained at the 1-year follow-up. Organizational policies that support youth sexual health and the availability of educational materials, resources such as condoms, and referral lists also increased and were maintained at follow-up. CONCLUSIONS: Organizational systems change may create a broader, more sustainable environment for increasing communication between youth and adults and increasing resources to promote sexual health.

Factors associated with sexual and reproductive health care by Mexican immigrant women in New York City: a mixed method study.

Limited research has examined barriers to sexual and reproductive health (SRH) services for Mexican immigrant women, especially those living in the eastern United States. This mixed-method study describes SRH care utilization and barriers experienced by female Mexican immigrants living in New York City. One hundred and fifty-one women completed surveys, and twenty-three also participated in focus groups. Usage of SRH care was low apart from prenatal services. The highest barriers included cost, language differences, child care, and poor service quality. After adjusting for insurance status, barriers were associated with receipt of gynecological care from a clinic or private doctor. Greater SRH knowledge was associated with current contraceptive use and a recent PAP test. Women reported that promotoras could increase information about SRH and decrease barriers. Results suggest that in a context where services are geographically available, health care utilization is impacted by lack of knowledge and structural barriers such as language, cost, and child care. Implications for community outreach are discussed.

Screening for intimate partner violence in reproductive health centers: an evaluation study.

This study compared rates of intimate partner violence reports on a new, empirically-developed screening tool completed by 385 women in 2007 to those from an older tool completed by 420 women in 2006. Data were obtained from randomly selected medical charts across three health center locations, which were part of the same reproductive health care organization. Chi-square analyses were conducted to test associations between demographic characteristics and partner violence reports. Multiple regression analyses were used to compare odds ratios of disclosure by type of screening tool, adjusting for associated demographic factors associated with partner violence reports. Women completing the old and new tools were similar across all demographic characteristics. After adjusting for age and center location, women completing the new screening form were more than 2.5 times as likely to report any partner violence. When analyzed by mutually exclusive violence history categories, women completing the new screening form were over 2.5 times as likely to report past or current violence and over 4 times as likely to report experiencing both past and current violence. Findings suggest that implementing empirically developed brief screening tools for partner violence in reproductive health settings may elicit more disclosures from patients than more traditional tools.