"Where Did This [PrEP] Come From?" African American Mother/Daughter Perceptions Related to Adolescent Preexposure Prophylaxis (PrEP) Utilization and Clinical Trial Participation.

Despite the demonstrated effectiveness of preexposure prophylaxis (PrEP) to reduce incident HIV infections, PrEP's potential as an HIV prevention strategy for adolescent populations is unknown. This study assessed perceptions of adolescent PrEP use and clinical trial participation among African American women and their adolescent daughters. We conducted focus group discussions with 15 African American mother/daughter pairs ( N = 30). Findings suggest a general lack of PrEP awareness, favorable attitudes toward adolescent PrEP use, altruistic attitudes regarding research participation among daughters, and less favorable attitudes toward adolescent clinical trial participation among mothers. Study findings have the potential to inform strategies that provide equitable access to HIV scientific advances among African American women and girls and promote informed parent-child research decision making.

Dentists' decision strategies for suspicious occlusal caries lesions in a National Dental PBRN study.

OBJECTIVE: Case presentations (vignettes) were completed by dentists in the National Dental Practice-Based Research Network study "Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)". The objective was to determine dentists' decision strategies for SOCLs. METHODS: 107 dentists viewed a series of 16 vignettes that represented all combinations of 4 clinical cues: color, luster, lesion roughness, and patient-level caries risk. Each vignette included a patient description and a photograph of a tooth presenting the 4 cues. Dentists were asked to decide the likelihood that a suspected lesion extended into dentin. A lens model analysis was used to examine how dentists use these cues in making their decisions. RESULTS: 86% of dentists had a consistent pattern of cue use that defined their decision strategy. On average, 70% of the variance in their decisions was accounted for by their use of the 4 cues. However, there was considerable variability in the individual cues used by each dentist. The percentages of dentists who used the different cues consistently were: luster (58%), color (48%), roughness (36%), and risk (35%). 14% of dentists reliably used only color, 7% used only luster, 4% used only roughness, and 1% used only risk when making SOCL decisions. CONCLUSIONS: The online vignette system suggests that clinical SOCL decision strategies are highly individualized and dentists do not use all cues available to them to make these decisions. CLINICAL SIGNIFICANCE: Prior to this study, there has been little evidence about how dentists use these cues (either individually or in combination) when judging the extent of caries progression. Such knowledge would be valuable when designing interventions to help dentists maximize the likelihood of appropriate treatment decisions.

Missed Initial Medical Visits: Predictors, Timing, and Implications for Retention in HIV Care.

HIV disproportionately affects racial/ethnic minorities and individuals living in the southern United States, and missed clinic visits account for much of this disparity. We sought to evaluate: (1) predictors of missed initial HIV medical visits, (2) time to initial visit, and (3) the association between initial visit attendance and retention in HIV care. Chart reviews were conducted for 200 consecutive HIV-infected patients (100 in Dallas, 100 in San Antonio) completing case management (CM) intake. Of these, 52 (26%) missed their initial visit, with 22 (11%) never presenting for care. Mean age was 40 years, 85% were men, >70% were of minority race/ethnicity, and 28% had a new HIV diagnosis. Unemployment (OR [95% CI] = 2.33 [1.04-5.24], p = 0.04) and lower attendance of CM visits (OR = 3.08 [1.43-6.66], p = 0.004) were associated with missing the initial medical visit. A shorter time to visit completion was associated with CD4 ≤ 200 (HR 1.90 [1.25-2.88], p = 0.003), Dallas study site (HR = 1.48 [1.03-2.14], p = 0.04), and recent hospitalization (HR = 2.18 [1.38-3.43], p < 0.001). Patients who did not complete their initial medical visit within 90 days of intake were unlikely to engage in care. Initial medical visit attendance was associated with higher proportion of visits attended (p = 0.04) and fewer gaps in care (p = 0.01). Missed medical visits were common among HIV patients initiating or reinitiating care in Texas. Employment and CM involvement predicted initial medical visit attendance, which was associated with retention in care. New, early engagement strategies are needed to decrease missed visits and reduce HIV health disparities.

Developing mobile phone text messages for tobacco risk communication among college students: a mixed methods study.

BACKGROUND: Engaging young adults for the purpose of communicating health risks associated with nicotine and tobacco use can be challenging since they comprise a population heavily targeted with appealing marketing by the evolving tobacco industry. The Food and Drug Administration seeks novel ways to effectively communicate risks to warn about using these products. This paper describes the first step in developing a text messaging program delivered by smartphones that manipulate three messaging characteristics (i.e., depth, framing, and appeal). METHODS: Perceptions of community college students were described after previewing text messages designed to inform about risks of using conventional and new tobacco products. Thirty-one tobacco users and nonusers, aged 18-25 participated in five focus discussions held on two community college campuses. Attendees reviewed prototype messages and contributed feedback about text message structure and content. Qualitative data were coded and analyzed using NVivo Version 10. RESULTS: Most participants were female and two-thirds were ethnic minorities. A variety of conventional and new tobacco products in the past month were used by a third of participants. Three identified domains were derived from the qualitative data. These included perceived risks of using tobacco products, receptivity to message content, and logistical feedback regarding the future message campaign. CONCLUSION: Overall, participants found the messages to be interesting and appropriate. A gap in awareness of the risks of using new tobacco products was revealed. Feedback on the prototype messages was incorporated into message revisions. These findings provided preliminary confirmation that the forthcoming messaging program will be appealing to young adults.

"She Told Them, Oh That Bitch Got AIDS": Experiences of Multilevel HIV/AIDS-Related Stigma Among African American Women Living with HIV/AIDS in the South.

African American women bear a disproportionate burden of HIV/AIDS in the United States. Although they constitute only 13% of the US population, African Americans account for nearly 65% of all new HIV infections among American women. In addition, this population suffers comparatively greater adverse health outcomes related to HIV status. African American women living with HIV in the South may be further burdened by HIV/AIDS stigma, which is comparatively more pronounced in this region. To further explore this burden, we used narrative data and the Social Ecological Model to explore how African American women living with HIV in the US South recount, conceptualize, and cope with HIV/AIDS stigma at interpersonal, community, and institutional levels. Our narrative analysis suggests that HIV-positive African American women living in the South are vulnerable to experiences of multilevel HIV stigma in various settings and contexts across multiple domains of life. Stigma subsequently complicated disclosure decisions and made it difficult for women to feel supported in particular social, professional and medical settings that are generally regarded as safe spaces for noninfected individuals. Findings suggest that the debilitating and compounded effect of multilevel HIV/AIDS stigma on HIV-positive African American women in the South warrants closer examination to tailor approaches that effectively address the unique needs of this population.

"Out of All of this Mess, I Got a Blessing": Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV.

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N = 42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

Connecting and Collaborating: Developing National Dental PBRN Study Concepts Through POD Engagement.

PURPOSE: This article illustrates the process by which the Southwest Region of the National Dental Practice-Based Research Network (www.NationalDentalPBRN.org) fosters collaboration among practitioners and researchers in study concept development through protocol development groups (PODs). The Southwest Region begins this process by engaging PODs, which comprise dentists, hygienists, and/or academic faculty who share research interests related to improving dental care. METHOD: The PODs use the Tuckman four-stage model of group development (forming, storming, norming, and performing) to develop study concepts. This well-structured model encourages engagement among group members and enables quality discussion through organized sessions. This model provides milestones for the group's progression and for the members' interactions. The Southwest Region Directors play a crucial role in guiding and directing the development of PODs by aligning the members' research interests with the goals of the National Network. RESULTS: POD engagement using Tuckman's stages has been successful in developing study concepts for submission to the National Network. Between 2012 and 2014, the Southwest Region has developed 14 PODs from 275 research ideas. Five of these study concepts have been submitted to the National Network for approval, including the Novel Tobacco Products POD, which showcases the applicability of Tuckman's model. CONCLUSION: Overall, the POD concept is a collaborative effort that brings together practitioners and academicians through shared research interests and capitalizes on participants' expertise and experiences. The Southwest Region will continue to develop PODs to foster new ideas for future studies in the Network.

The role of BMI change on smoking abstinence in a sample of HIV-infected smokers.

The prevalence of cigarette smoking among persons living with HIV/AIDS (PLWHA) is approximately 40%, significantly higher than that of the general population. Identifying predictors of successful smoking cessation for PLWHA is necessary to alleviate the morbidity and mortality associated with smoking in this population. Weight gain has been associated with smoking relapse in the general population, but has not been studied among PLWHA. Data from 474 PLWHA enrolled in a smoking cessation randomized clinical trial were analyzed to examine the effect of BMI change, from baseline to 3-month follow-up, on smoking outcomes using multiple logistic regression. The odds of 7-day smoking abstinence at 3-month follow-up were 4.22 (95% CI = 1.65, 10.82) times higher for participants classified as BMI decrease and 4.22 (95% CI = 1.62, 11.01) times higher for participants classified as BMI increase as compared to participants with a minimal increase or decrease in BMI. In this sample, both weight gain and loss following smoking cessation were significantly associated with abstinence at 3-month follow-up among HIV-infected smokers. Further research and a better understanding of predictors of abstinence will encourage more tailored interventions, with the potential to reduce morbidity and mortality.

Generating National Dental PBRN Research Ideas Through the ToP Consensus Method Workshop.

PURPOSE: The purpose of this article is to illustrate the research idea generation process employed by the Southwest Region of the National Dental Practice-Based Research Network (PBRN; www.NationalDentalPBRN.org) based on the Technology of Participation (ToP) Consensus Method Workshop. This method encourages a high level of participation in the decision-making process through individual, small group, and large group discussions. This approach to idea generation has predominately been used by nonprofit organizations and community groups both nationally and internationally, but offers great potential to study concept development for PBRNs. METHOD: Five independent workshops were designed over a 12-month period. Workshops were held at three academic institutions, one National Dental PBRN meeting, and one as part of a continuing education program. The sessions were directed at general dentists, dental hygienists, and dental researchers to identify research ideas appropriate for examination through the PBRN mechanism. RESULT: Five groups ranging in size from 11 to 53 (197 participants total) participated in the consensus workshops and generated 205 research ideas. Ideas across the five sessions were collated into novel and common categories of interest, and identified key participants interested in developing research concepts. Participant reaction to the sessions was positive based on evaluation comments and personal interactions. IMPLICATIONS: Practitioners effectively generated research ideas based on their current needs and daily clinical experience. The experiences presented in this article suggest continued use of the ToP consensus workshop methods within the PBRNs may help bridge the gap between research and practice.

A mixed-methods approach to understanding barriers to postpartum retention in care among low-income, HIV-infected women.

Optimal retention in HIV care postpartum is necessary to benefit the health and wellbeing of mothers and their infants. However, postpartum retention in HIV care among low-income women is suboptimal, particularly in the Southern United States. A mixed-methods study was conducted to identify factors associated with postpartum retention in care among HIV-infected women. Participants (n=35) were recruited during pregnancy at two county clinics and completed self-report demographic and psychosocial surveys. Twenty-two women who returned for a postpartum appointment completed a semi-structured interview about lifestyle factors and retention in care. Of the participants enrolled at baseline, 71.4% completed a follow-up with an obstetrician (OB), while 57.1% completed a follow-up with a primary care physician (PCP). High CD4 count at delivery, low viral load at baseline, low levels of depression, high interpersonal social support, and fewer other children were significantly associated with completion of postpartum follow-up. Barriers and facilitators to retention identified during qualitative interviews included competing responsibilities for time, lack of social support outside of immediate family members, limited transportation access, experiences of institutionalized stigma, knowledge about the benefits of adherence, and strong relationships with healthcare providers. OB and PCP follow-up postpartum was suboptimal in this sample. Findings underscore the importance of addressing depressive symptoms, social support, viral suppression, competing responsibilities for time, institutionalized stigma, and transportation issues in order to reduce the barriers that inhibit women from seeking postpartum HIV care.

Perceptions of barriers and facilitators to cervical cancer screening among low-income, HIV-infected women from an integrated HIV clinic.

Significantly elevated rates of cervical cancer and low rates of Papanicolaou (Pap) smear screening have been documented among HIV-infected women. However, little is known about women's perceptions of cervical cancer screening utilization. Hence, this study describes barriers and facilitators related to cervical cancer screening in a sample of HIV-infected women seeking care at an integrated HIV clinic in Houston, Texas. Using an inductive qualitative methodological approach, data were obtained from five focus group discussions with a total of 33, HIV-infected women. The majority of the study sample consisted of women who self-identified as Black (69.7%), and reported heterosexual contact as the mode of HIV acquisition (75.8%). Barriers to cervical cancer screening were described as pain and discomfort associated with receiving Pap smears and subsequent procedures; lack of awareness of cervical cancer as a preventable disease; limited transportation access; and systemic issues as it relates to scheduling gynecological appointments. Facilitators were described as awareness of HIV-infected women's increased risk of cervical cancer and strong provider-patient relationships. To address disparities in cervical cancer screening among low-income HIV-infected women, programs should capitalize on the identified facilitators and alleviate modifiable barriers using multilevel strategies.

The influence of HIV disease events/stages on smoking attitudes and behaviors: project STATE (Study of Tobacco Attitudes and Teachable Events).

BACKGROUND: Given the increase in life expectancy among HIV-positive individuals attributable to antiretroviral therapies, cigarette smoking now represents one of the most salient health risks confronting the HIV-positive population. Despite this risk, very few efforts to date have been made to target persons living with HIV for smoking cessation treatment, and no efforts have been made to explore the role of cognitions and HIV disease events/stages on smoking outcomes. The purpose of the study, Project STATE (Study of Tobacco Attitudes and Teachable Events), is to prospectively examine the relationship between HIV events/stages, perceived impact of HIV disease, attitudes about cigarette smoking, and smoking behaviors. METHODS/DESIGN: This study employs a prospective design. Patients are recruited at the time of their first physician visit at a large inner city HIV-clinic--Thomas Street Health Center (TSHC). Consenting participants then complete a baseline assessment. All participants are offered standard care smoking cessation treatment. Follow-up assessments are completed on four subsequent occasions: 3, 6, 9, and 12 months post-baseline. These follow-up assessments are scheduled to coincide with routine clinic appointments with their TSHC physicians. In addition, each participant is given a prepaid cell phone at the time of enrollment and asked to complete brief phone assessments weekly for the first three months of the study period. DISCUSSION: By evaluating events/stages of HIV disease as potential teaching moments for smoking cessation, findings from this study could be used to develop treatments tailored to an individual's stage of HIV disease. This study design will enable us to carefully track changes in smoking behavior over time, and to link these changes to both the course of HIV disease and/or to the participant's' perceived impact of HIV. By identifying optimal time points for intervention, the findings from this study will have the potential to maximize the efficiency and efficacy of cessation treatments delivered in resource-limited settings. In addition, the findings will be instrumental in identifying specific constructs that should be targeted for intervention and will provide a strong foundation for the development of future cessation interventions targeting smokers living with HIV/AIDS.

Cervical cancer screening adherence among HIV-positive female smokers from a comprehensive HIV clinic.

HIV-positive women are at elevated risk for developing cervical cancer. While emerging research suggests that gynecologic health care is underutilized by HIV-positive women, factors associated with adherence to Pap testing, especially among HIV-positive female smokers are not well known. We utilized baseline data from a smoking cessation trial and electronic medical records to assess Pap smear screening prevalence and the associated characteristics among the HIV-positive female participants (n = 138). 46 % of the women had at least 1 Pap test in the year following study enrollment. Multiple logistic regression analysis indicated that younger age, African American race, hazardous drinking, increased number of cigarettes smoked per day, and smoking risk perception were associated with non-adherence to Pap smear screening. Cervical cancer screening was severely underutilized by women in this study. Findings underscore the importance of identifying predictors of non-adherence and addressing multiple risk factors and behavioral patterns among HIV-positive women who smoke.