Willingness to use and intention to adhere to pre-exposure prophylaxis (PrEP) among men who have sex with men in Jiangsu Province, China.

ABSTRACTPre-exposure prophylaxis (PrEP) is a biomedical prevention approach that significantly reduces HIV acquisition. Our study aimed to explore factors associated with PrEP willingness and intention to adhere to PrEP among MSM through a cross-sectional survey in Nanjing, Jiangsu province, China. Location sampling (TLS) and online recruitment were used to recruit participants to gauge their PrEP willingness and intention to adhere. Of 309 HIV-negative/unknown serostatus MSM, 75.7% were willing to use PrEP and 55.3% had high intention to take PrEP daily. Willingness to use PrEP was positively associated with having a college degree or higher (AOR = 1.90, 95%CI: 1.11-3.26) and higher anticipated HIV stigma (AOR = 2.74, 95%CI: 1.13-6.61). Facilitators of intention to adhere included higher education levels (AOR = 2.12, 95%CI: 1.33-3.39) and higher anticipated HIV stigma (AOR = 3.65, 95%CI: 1.36-9.80), whereas a primary barrier was community homophobia (AOR = 0.43, 95%CI: 0.20-0.92). This study documented high willingness to use PrEP, yet lower intention to adhere to PrEP in a sample of MSM in China. Public interventions and programs to promote adherence of PrEP for MSM is urgently needed in China. Psychosocial factors should be addressed and taken into consideration for PrEP implementation and adherence programs.

Barriers and facilitators to HIV care engagement: Recommendations from people with HIV in rural Arkansas.

PURPOSE: Little is known about factors affecting HIV care engagement and retention among rural people with HIV (PWH) in the South. About half of PWH in Arkansas reside in rural areas. The purpose of this study was to explore factors affecting engagement and retention in HIV care among PWH in rural areas of Arkansas. METHODS: We conducted an exploratory qualitative study in 2020 and completed individual interviews (N = 11) with PWH in rural counties in Arkansas. FINDINGS: Content analysis revealed the following themes: (1) Barriers to HIV care included long distances to the nearest HIV clinic and transportation issues along with anticipating and/or experiencing HIV-related stigma; (2) facilitators of HIV care included having a helpful HIV care provider and Ryan White case manager and a social support network that aided them in prioritizing their own health; (3) participants had the most favorable reactions to Ryan White case management, peer navigators, and telemedicine for HIV treatment/care; and (4) participants demonstrated resilience overcoming various obstacles as they worked toward being healthy mentally and physically while living with HIV. CONCLUSION: Interventions need to address multilevel factors, including hiring PWH as peer navigators and/or caseworkers and offering HIV care via telemedicine, to improve HIV care engagement and retention among rural populations.

Providing substance use disorder treatment in correctional settings: knowledge gaps and proposed research priorities-overview and commentary.

This manuscript is the product of the authors' discussions, literature overview, and consultation with experts in the field, and identifies important gaps in the evidence base for substance use disorder (SUD) treatment effectiveness within criminal justice (CJ) settings. Lacking from the extant literature are longitudinal investigations of treatment related outcomes during and after incarceration. Such studies could provide rich contextual data about treatment delivery and effectiveness across the CJ continuum, and would provide important insight into individual characteristics (e.g., motivation, treatment modality preferences, treatment completion rates, etc.) as well as institutional and environmental factors (e.g., appropriate staffing, space limitations for individual treatment sessions, distribution of medications, etc.). We also identified the importance of reproducibility within CJ research, and the unfortunate reality of too many single studies conducted in single (or relatively few) correctional facilities. Some of this has been because the studies designed to produce that evidence are not prioritized for funding, which has continually placed researchers in a position where we cannot make firm conclusions or recommendations based on available evidence. The importance of replicating the foundational studies in this field cannot be overstated. We hope this article spurs other researchers to join in the healthy process of questioning the existing state of the CJ-based SUD treatment research, what should be re-examined, and how we can lay a stronger foundation for the future.

The Perpetual Blind Spot in Public Health Surveillance.

The jail population is disproportionately affected by poor health outcomes compared with the general population. Despite this, many jail systems do not have adequate surveillance of various health indicators, making it difficult to identify and address health concerns within this setting. In this commentary, the authors highlight four public health crises within the jail setting and identify gaps in data surveillance. The public health domains discussed in this commentary are HIV, suicide, overdose, and COVID-19. Authors also explore current barriers to data collection and reporting within the jail setting and provide recommendations for improved surveillance efforts.

A participant-randomized pilot hybrid II trial of group cognitive processing therapy for incarcerated persons with posttraumatic stress and substance use disorder symptoms: study protocol and rationale.

BACKGROUND: Trauma exposure and drug addiction go hand-in-hand for the 2.17 million people who are incarcerated in US prisons; prevalence of both exceed 80% among this population. This manuscript describes the rationale and methods for a participant-randomized effectiveness-implementation hybrid type II pilot trial designed to: 1) examine the effectiveness of Cognitive Processing Therapy group (CPT), an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), for reducing post-release drug use and PTSD symptoms when adapted for and delivered in prisons; and 2) provide data on implementation outcomes associated with the use of implementation facilitation as a strategy for supporting uptake of CPT in prisons. METHOD: Participants in the effectiveness portion of the trial (N = 120) will be incarcerated men and women who are randomly assigned to one of two group therapies: CPT or a control condition (PTSD coping skills group; PCS). Participants will complete assessment measures three times: pre-treatment, post-treatment, and 3 months following release from incarceration. CPT groups will be led by prison counselors who are receiving implementation facilitation to support their efforts. PCS groups will be led by trained clinicians on the research team. Implementation outcomes will include acceptability, appropriateness, adoption, feasibility, fidelity, and sustainability. After enrollment ends, the research team will monitor CPT sustainment and recidivism outcomes of study participants for one year. DISCUSSION: This study will lay the groundwork for a larger study of interventions for co-occurring PTSD and SUD in prisons and, critically, inform the development of strategies (such as implementation facilitation) for supporting their uptake in routine practice. TRIAL REGISTRATION: NCT04007666 , clinicaltrials.gov, 24 June 2019, 02 September 2021.

Crisis stabilization units for jail diversion: A preliminary assessment of patient characteristics and outcomes.

Crisis stabilization units (CSUs), which offer a range of short-term psychiatric and psychological services, are one of several treatment programs that may create "alternative to arrest" options for law enforcement. Here, we examined the characteristics of the population who was referred to a newly established CSU in its first year of operation and examined the impact of the CSU on regional jail bookings. Administrative medical records and regional jail booking data were merged to form our study sample. Adults who had at least one jail booking and/or one CSU admission during our study period were included. We found that from September 1, 2018 to August 30, 2019, 458 people were admitted into the CSU. Approximately one-third (33.8%) had a jail booking during the study period. In the 3 months following CSU admission, 4.1% had an increase in jail bookings, 11.1% had a decrease, and 66.2% had no change. CSU patients self-reported high depressive and posttraumatic stress disorder symptoms, while also reporting low quality of life scores overall. We conclude that CSUs may be promising components of jail diversion efforts, providing critical services to populations experiencing significant mental health symptoms and who are at risk for incarceration. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Recent Incarceration and Other Correlates of Psychological Distress Among African American and Latino Men Who Have Sex with Men.

There is a dearth of research on the intersection of incarceration and psychological distress among men who have sex with men including African American (AAMSM) and Latino MSM (LMSM), populations which bear a large burden of HIV in the U.S. Recent incarceration is an important context to examine psychological distress given the critical implications it has on health outcomes. Using baseline data from the Latino and African American Men's Project (LAAMP), a multi-site randomized HIV behavioral intervention trial, this paper examined the association between previous incarceration within the past three months (i.e., recent incarceration) and psychological distress in the past four weeks, assessed by the Kessler Psychological Distress Scale (K10). Among 1482 AAMSM and LMSM (AAMSM: 911, LMSM: 571), we found 768 (52%) were previously incarcerated, but not in past three months and 138 (9.3%) had been recently incarcerated. After adjusting for race, education, access to resources, current living arrangement, HIV status, and substance use, participants who had been recently incarcerated were more likely to have mild psychological distress i.e., K10 score 20-24 (aRRR:1.43, 95% CI 1.20, 1.71) or severe psychological distress, i.e., K10 score > 30 (aRRR: 1.89, 95% CI 1.22, 2.93) in the past four weeks than those never incarcerated and those previously incarcerated, but not in past three months. Our findings have implications for mental health and HIV prevention services for AAMSM and LMSM with previous incarceration within the past three months.

Characterizing Firearm Assault Injury Among Young Black Men Using Arkansas Hospital Discharge Data.

Using statewide hospital discharge data from 2005 to 2014, this study aimed to describe and identify predictors of firearm assault among young Black men ages 18 to 44 in Arkansas. Descriptive analyses of data were performed for patient demographics (age, marital status, residential location, etc.), injury, and health care information (hospital charges, length of stay, mortality, time, day and season of injury, etc.). Logistic regression analysis was performed to identify significant predicting factors for firearm assault among this population. Most of the sample survived firearm assault injury, were ages 18-35, were not married, resided in Central Arkansas, and were admitted to a Central Arkansas hospital during night hours on weekends. The majority had a short hospital stay, and total charges exceeded $34 million during the study observation years. Most patients had no diagnosis of a mental disorder, and a little less than half had drug use disorders. Being ages 18-25, living in the Central region of Arkansas, and being married were all significant predictors of firearm assault for this population. Death was also significantly associated with firearm assault. Our findings lay the groundwork for understanding firearm assault injury among young Black men in Arkansas. Research should be expanded to examine other important data sources for firearm assault and to further explore the context of predicting factors, in order to provide a more comprehensive understanding of firearm assault and to better inform future prevention efforts.

An Economic Analysis of the Cost of a Regional Crisis Stabilization Unit.

Crisis stabilization units (CSUs) are one type of "alternative to arrest" program used for jail diversion. We aimed to estimate the economic costs of starting and operating a CSU in Arkansas. We estimated the economic costs of the Pulaski County Regional CSU (PCRCSU) located in Little Rock, Arkansas, from September 1, 2018, to August 31, 2019. We collected data through interviews about start-up and ongoing management costs. We calculated total annual economic cost, average admission cost, and average 24 hr admission cost. There were 536 admissions to the CSU during the study period. The average length of stay was 60.27 hr. The total annual cost of the PCRCSU was $1,636,831 and average per admission cost was $3,054. Our results provide valuable economic data to government stakeholders who are considering establishing a CSU.

A Qualitative Exploration of Women's Lives and Resilience in Substance Use Disorder Recovery.

OBJECTIVE: This study sought to explore constructs of the Whole Health resilience model to identify potential intervention and local research opportunities as a precursor to intervention development, as well as to describe women's resilience in Substance Use Disorder (SUD) recovery including current strengths, coping, self-care, needs and priorities in the context of their everyday lives. METHODS: Qualitative data were collected from December 2018 to January 2020 in the Mid-South United States. In-depth interviews of 17 women age 25 to 65 years in SUD recovery for 2 weeks or longer were conducted in 9 different settings including a Medication Assisted Treatment (MAT) hospital setting, a MAT pilot program in a community corrections setting, an incarceration re-entry residential program, community-based peer support organizations (eg, Narcotics Anonymous, Alcoholics Anonymous), a residential SUD treatment facility and a yoga teachers' online group. These data were analyzed with a hybrid approach (inductive and deductive coding). RESULTS: The major themes that emerged from the analysis included social support, individual-level cognitive and spiritual strategies; self-care; stressors, priorities, needs, and self-care barriers and trauma. In this context, women needed a wide range of support including treatment of severe physical injuries, professional psychological support, help with restoring relationships, SUD treatment and recovery services, job training and coaching, health insurance advice, transportation, intimate partner violence (IPV) counseling and housing. Peer-support groups and faith communities were instrumental in many (but not all) of these women's lives in recovery-a gap was identified for women who did not have social support from these groups. CONCLUSION: These data highlight the need for developing interventions for women in SUD recovery that take a holistic view of resilience life areas, as well as integrate professional services, family support, community support and approach care as wrap-around support that includes integration of social services to meet women's basic needs.

Opioid overdose counseling and prescribing of naloxone in rural community pharmacies: A pilot study.

INTRODUCTION: Fatal overdoses from opioids increased four-fold from 1999 to 2009, and they are now the leading cause of death among Americans under 50. Legislation has been passed by every state to increase access to naloxone but dispensing by community pharmacies remains low. OBJECTIVES: The objective of this study was to pilot test a proactive opioid overdose counseling intervention and a passive naloxone intervention, and the implementation strategies developed to support their delivery, in rural community pharmacies on relevant implementation outcomes. METHODS: The interventions, implementation strategies, and the overall pilot study approach were developed in a collaborative partnership with a regional supermarket pharmacy chain. They selected 2 rural pharmacies to participate in the pilot study and 2 non-intervention pharmacies to serve as comparison sites. Two interventions were pilot tested in the 2 intervention pharmacies: 1)a proactive opioid overdose counseling intervention and 2) a passive naloxone intervention. An explanatory sequential mixed-methods design was utilized to evaluate adoption, feasibility, acceptability, and appropriateness outcomes after the 3-month observation period. RESULTS: Between the 2 intervention pharmacies, 130 patients received the opioid overdose counseling intervention. 44 (33.8%) were prescribed and dispensed naloxone. Zero naloxone prescriptions were written or dispensed at the comparison pharmacies. Interviews with pharmacy staff found the interventions to be feasible, acceptable, and appropriate in their settings. CONCLUSION: This small scale pilot study in partnership with a regional supermarket pharmacy chain had positive results with a third of patients who received the opioid overdose counseling intervention being dispensed naloxone. However, the majority of patients did not receive naloxone indicating additional revisions to the intervention components and/or implementation strategies are needed to improve the overall impact of the interventions.

An Exploratory Study of the Acceptability and Feasibility of Yoga Among Women in Substance Use Disorder Recovery.

Objectives: This qualitative study explored the acceptability and feasibility of yoga among women in substance use disorder (SUD) recovery. Design: Seventeen women in SUD recovery for 2 weeks or longer were recruited from nine sites in the mid-South, including a Medication-Assisted Treatment clinic in a hospital setting, prison re-entry housing, community-based peer support organizations (e.g., Alcoholics Anonymous [AA], Narcotics Anonymous [NA]), a residential SUD treatment facility, a yoga teachers' online group, and through referrals. The median age of participants was 41.5, with ages ranging from 25 to 65. We used an interpretive description approach to explore both the perceptions of women without yoga experience and the experiences of women with yoga experience to collect formative data for intervention development and implementation. The interviews were recorded and transcribed verbatim. A hybrid analysis (i.e., inductive and deductive coding) was applied to the data. Results: Women's narratives included a high prevalence of trauma exposure. Overall, women in this sample were interested in either beginning or continuing yoga. Barriers to participation included perceived lack of self-efficacy of yoga, weight, and physical injuries. Additional environmental barriers included balancing care of self with caring for others, including partners, children, and NA/AA sponsees; as well as prioritizing finances, housing, employment, and transportation. Conclusion: High prevalence of trauma exposure among women in SUD recovery necessitates careful consideration of co-occurring psychiatric disorders such as post-traumatic stress disorder, anxiety and depression and the necessary professional psychological support, as well as serious physical injuries that require modification in yoga asana classes. As transportation and balancing care needs were salient in these data, rural SUD populations could be served with telehealth interventions that provide SUD recovery support with integrative health practices such as adjunctive yoga interventions.

Making change happen in criminal justice settings: leveraging implementation science to improve mental health care.

BACKGROUND: It is a constitutional right to receive health care, including mental health care, while incarcerated. Yet, even basic evidence-based mental health care practices have not been routinely integrated into criminal justice (CJ) settings. Strategies from implementation science, or the study of methods for integrating evidence-based practices into routine care, can accelerate uptake of established interventions within low-resource, high-need settings such as prisons and jails. However, most studies of mental health practices in CJ settings do not use implementation frameworks to guide efforts to integrate treatments, systematically select or report implementation strategies, or evaluate the effectiveness of strategies used. CASE PRESENTATIONS: After introducing implementation science and articulating the rationale for its application within CJ settings, we provide two illustrative case examples of efforts to integrate mental health interventions within CJ settings. Each case example demonstrates how an implementation framework either was applied or could have been applied to promote intervention adoption. The first focuses on poor implementation of a mental health screener in a county jail, retrospectively highlighting how use of a determinants framework (e.g., the Consolidated Framework for Implementation Research [CFIR]) could help staff identify factors that led to the implementation failure. The second describes an investigator-initiated research study that used a process framework (the Exploration, Preparation, Implementation, Sustainment [EPIS] framework) to systematically investigate and document the factors that led to successful implementation of a psychotherapy group for survivors of sexual violence in a women's community corrections center. Both are presented in accessible language, as our goal is that this article can be used as a primer for justice health researchers, community partners, and correctional leadership who are unfamiliar with implementation science. CONCLUSIONS: Scientific research on the application of implementation science to justice settings is growing, but lags behind the work done in health systems. Given the tremendous need for mental and behavioral health intervention across the full spectrum of justice settings, information on how to successfully implement evidence-based intervention and prevention efforts is sorely needed but possible to obtain with greater integration of knowledge from implementation science.

Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis.

Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release.

Conducting Health Research in Carceral Systems: Considerations and Recommendations.

Although the number of people incarcerated in the United States has grown dramatically, research on how incarceration affects individuals and the communities they return to has lagged behind. This may be because of the unique challenges of doing research within carceral systems and the relatively small number of investigators who are competent to undertake these efforts.We provide a primer for investigators with limited experience conducting research in carceral settings and highlight considerations and recommendations that may aid those conducting health research with incarcerated persons. We follow this with an illustrative case example exemplifying how the considerations apply to recent health research that our team conducted on mental illness prevalence in a large regional jail.Understanding how to effectively conduct research with criminal justice populations and systems is the first step in beginning to understand the effects of mass incarceration as a driver of health disparities and health inequity.

Best practices for identifying men who have sex with men for corrections-based pre-exposure prophylaxis provision.

PURPOSE: Men who have sex with men (MSM) who are incarcerated are at increased risk for HIV acquisition, yet there are challenges associated with disclosing sexual identity/orientation among people who are incarcerated. METHODS: The current study used semi-structured, qualitative interviews to explore attitudes and awareness of pre-exposure prophylaxis (PrEP) among 26 MSM who were incarcerated at the Rhode Island Department of Corrections. RESULTS: Participants noted variable levels of willingness to disclose sexual identity/orientation. CONCLUSIONS: CJ institutions should consider involving medical staff and outside agencies when using the CDC PrEP guidelines or consider a WHO-based, rather than behavior-based, approach to determining candidacy for PrEP.

Longitudinal HIV Transmission Risk Profiles Among Men Who Have Sex With Men Living With HIV in the SUN Study.

Examining how multiple concomitant factors interact to augment HIV transmission risk is needed to inform more effective primary and secondary HIV prevention programs for men who have sex with men (MSM) in the United States. The development of a "taxonomy" of long-term sexual and drug-related risk behavior profiles may have important implications for resource allocation and targeted HIV prevention programming. A secondary data analysis was conducted to explore longitudinal HIV transmission risk profiles among 423 MSM living with HIV enrolled in the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (SUN Study). Between March 2004 and February 2012, participants completed semiannual, audio computer-assisted self-interviews that included demographics, employment status, medical information, alcohol use, stimulant use, sexual risk, and depression. Latent class analysis was used to identify patterns of risky behavior over time with respect to sexual risk, heavy drinking, and stimulant (i.e., methamphetamine and cocaine) use taken collectively. Three classes were identified: (a) High Sustained Heavy Drinker Class (33%), (b) High Mostly Stable Sexual Risk Class (17%), and (c) Overall Low Risk Class. (50%). Post hoc comparisons between classes revealed that men in Classes 1 ( p = .03) and 2 ( p = .02) were significantly younger than those in Class 3. In comparison to those in Classes 1 and 3, those in Class 2 were less likely to report being a racial/ethnic minority ( p = .04) and had the highest self-reported sexually transmitted infections ( p < .001). Findings indicate the need to better integrate sexual and substance use risk reduction strategies, including brief interventions and engagement in addiction treatment, for MSM living with HIV in the United States.