Identifying Strategies for Improving Pre-exposure Prophylaxis Adherence: Perspectives from a Sample of Highly Adherent Young Men Who have Sex with Men.

Most research on pre-exposure prophylaxis (PrEP) adherence and persistence uses a deficit-based approach to identify negative influences on PrEP adherence; however, an alternative set of approaches (such as resilience, asset-based, and positive variation) may identify equally important positive influences on PrEP adherence. Thus, the current study presents qualitative perspectives of PrEP adherence strategies from a sample of adherent YMSM. PrEP-using YMSM living in the Chicago area from a larger cohort study were recruited into a 90-day diary study that measured sexual health behaviors including PrEP use. A subset (n = 28) were then recruited for in-depth interviews between April and September 2020 covering topics of PrEP use and adherence. Thematic analysis was used to interpret patterns within the data. The analytic sample (n = 19) consistently reported high levels of adherence. Adherence strategies were organized into three broader categories: psychological (e.g. mindfulness, pill auditing), technical/instrumental (e.g. automated reminders, pill organizers), and social strategies (e.g. checking in with friends, or getting suggestions from friends). The majority of participants described using multiple strategies and changing strategies to respond to barriers to adherence. Other themes that were related to adherence included having a daily medication history and a generally positive outlook toward the PrEP regimen. Those who had medication histories were able to draw from experience to develop strategies for PrEP adherence. Findings suggest the need for pre-emptive counseling for PrEP-initiators on the use of multiple strategies, how to prepare for PrEP adherence, to adapt to challenges, and to adopt a range of potential strategies for adherence.

RESUMEN: La mayoría de las investigaciones sobre el cumplimiento y la persistencia de la profilaxis pre-exposición (PrEP) utiliza un enfoque basado en el déficit para identificar las influencias negativas en el cumplimiento de la PrEP; sin embargo, un conjunto alternativo de enfoques (como resiliencia, basado en en las capacidades o recursos, y variación positiva) puede identificar influencias positivas igualmente importantes en la adherencia a la PrEP. Por lo tanto, el estudio actual presenta perspectivas cualitativas de las estrategias de adherencia a la PrEP de una muestra de los hombres jóvenes que tienen sexo con hombres (YMSM) adherentes. Los YMSM que usaban PrEP que vivían en la región de Chicago de un estudio de cohorte más grande fueron reclutados en un estudio diario de 90 días que midió los comportamientos de salud sexual, incluido el uso de PrEP. Luego se reclutó un subconjunto (n = 28) para entrevistas en profundidad entre abril y septiembre de 2020 que cubrieron temas de uso y adherencia a la PrEP. El análisis temático se utilizó para interpretar patrones dentro de los datos. La muestra analítica (n = 19) reportó consistentemente altos niveles de adherencia. Las estrategias de adherencia se organizaron en tres categorías más amplias: psicológicas (p. ej., atención plena, auditoría de píldoras), técnicas/instrumentales (p. ej., recordatorios automáticos, organizadores de píldoras) y estrategias sociales (p. ej., ponerse en contacto con amigos o recibir sugerencias de amigos). La mayoría de los participantes describieron el uso de múltiples estrategias y el cambio de estrategias para responder a las barreras a la adherencia. Otros temas relacionados con la adherencia incluyeron tener un historial de medicación diario y una perspectiva generalmente positiva hacia el régimen de PrEP. Aquellos que tenían antecedentes de medicación pudieron aprovechar la experiencia para desarrollar estrategias para la adherencia a la PrEP. Los hallazgos sugieren la necesidad de asesoramiento preventivo para los iniciadores de la PrEP sobre el uso de múltiples estrategias, cómo prepararse para la adherencia a la PrEP, cómo adaptarse a los desafíos y adoptar una variedad de posibles estrategias para la adherencia.

Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV.

Retention in care and sustained viral suppression are integral outcomes in the care continuum for people living with HIV (PLWH) and HIV prevention; however, less is known about how substance use predicts sustained viral suppression over time. This study seeks to examine the predictive effects of substance use on sustained viral suppression in a sample of cisgender sexual minority men and gender minority PLWH (n = 163) drawn from a longitudinal sample in the Chicago area collected 2015-2019. Using data from 3 visits separated by 6 months, participants were coded persistently detectable, inconsistently virally suppressed, and consistently virally suppressed (< 40 copies/mL at all visits). Multinomial logistic regressions were utilized. About 40% of participants had sustained viral suppression. In multinomial logistic regressions, CUDIT-R predicted persistent detectable status and stimulant use was associated with inconsistent viral suppression. Substance use may create challenges in achieving sustained viral suppression, which has important implications for care and prevention.

RESUMEN: Retención en el cuidado de la salud y supresión viral sostenida son resultados integrales en la cascada del tratamiento de VIH para personas viviendo con el virus del SIDA (PVVS) y prevención del VIH. Sin embargo, no se sabe mucho acerca de cómo el uso de substancias predice la supresión viral sostenida a través del tiempo. Este estudio busca examinar los efectos predictivos del uso de substancias en la supresión viral sostenida en una muestra de minoría de hombres cisgéneros y minorías de género PVVS (n = 163) basada en una muestra longitudinal en la región de Chicago obtenida en 2015­2019. Utilizando datos de 3 visitas con un intervalo de 6 meses, participantes fueron identificados como detectables persistentemente, inconsistentemente viralmente suprimido, y consistentemente viralmente suprimido (< 40 copias/mL en todas las visitas). Regresión logística multinomial fue utilizada. Cerca de 40% de los participantes tenían supresión viral sostenida. En regresión logística multinomial, CUDIT-R predicho status detectable persistente y uso de estimulantes fueron asociados a la supresión viral inconsistente. Uso de substancias crean desafíos para lograr la supresión viral sostenida, lo que tiene importante trascendencia para el cuidado y prevención.

Examining minority stress, dyadic coping, and internalizing symptoms among male same-sex couples using actor-partner interdependence models.

Minority stress processes have been consistently linked to increased internalizing symptoms among sexual minority individuals. However, very little research has studied the impact of minority stress on the mental health of same-sex couples. The present study examined associations of actor and partner heterosexist microaggressions and internalized heterosexism with internalizing symptoms, moderated by dyadic coping, among male same-sex couples. Participants were 774 men who have sex with men (387 dyads). Results of actor-partner interdependence models showed that actor, but not partner, minority stress was positively associated with internalizing symptoms. Dyadic coping moderated the association of actor heterosexist microaggressions on internalizing symptoms such that for those who engaged in more dyadic coping, the association of heterosexist microaggressions with internalizing symptoms was weaker. Dyadic coping also moderated the association of partner internalized heterosexism on internalizing symptoms. For those who engaged in more dyadic coping, their partner's internalized heterosexism was associated with greater internalizing symptoms. Although dyadic coping may buffer the effects of minority stress on internalizing symptoms, if partners rely too heavily on one another to cope with stress, it may be detrimental to their mental health. Implications for relationship education interventions for same-sex couples are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Reassessing the Importance of PrEP Use Given Reduced Sex During the COVID-19 Pandemic: Perspectives From a Sample of Young Sexual Minority Men.

Research has begun to examine sexual behavior during the COVID-19 pandemic using quantitative methods, but less is known about the context surrounding these changes using qualitative methods, including corresponding changes in risk reduction methods. This qualitative study, guided by the Integrated Behavioral Model, examines the pandemic's impact on PrEP adherence among young men who have sex with men in Chicago. PrEP-using participants from a cohort study were recruited into a 90-day diary study measuring sexual behaviors and PrEP use. Between April and September 2020, a subset of participants was recruited for qualitative interviews (n = 28) exploring prevention strategies, including the impact of the pandemic. Although most were highly adherent pre-pandemic, many took fewer pills or discontinued during the pandemic due to decreased sex. Findings suggest the importance of counseling for PrEP reinitiation as "seasons of HIV risk" increase, as well as use of telehealth as a facilitator of PrEP use throughout the pandemic.

Post-migration HIV acquisition among african immigrants in the U.S.

BACKGROUND: African immigrants in the U.S. are more likely to have a late HIV diagnosis than U.S.-born people, potentially leading to onward transmission. We sought to determine the proportion of African-born people living with HIV (APLWH) who (1) had tested HIV negative prior to diagnosis, and (2) likely acquired HIV in the U.S. METHODS: We interviewed APLWH from 2014 to 2017 and estimated the proportion with post-migration HIV acquisition based on clinical data, HIV testing history, immigration date, and behavioral data. RESULTS: Of 179 participants, 113 (63%) were women. Less than half (44%) reported a negative HIV test prior to diagnosis. Among 142 (79%) participants with sufficient data to evaluate post-migration HIV acquisition, we estimate that 29% acquired HIV post-migration. Most APLWH acquire HIV prior to immigration. DISCUSSION: Approximately one-quarter of APLWH acquire HIV post-migration and HIV testing is infrequent, highlighting the need for prevention efforts for African immigrants in the U.S.

Longitudinal Analysis of SARS-CoV-2 Vaccine Breakthrough Infections Reveals Limited Infectious Virus Shedding and Restricted Tissue Distribution.

Background: The global effort to vaccinate people against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during an ongoing pandemic has raised questions about how vaccine breakthrough infections compare with infections in immunologically naive individuals and the potential for vaccinated individuals to transmit the virus. Methods: We examined viral dynamics and infectious virus shedding through daily longitudinal sampling in 23 adults infected with SARS-CoV-2 at varying stages of vaccination, including 6 fully vaccinated individuals. Results: The durations of both infectious virus shedding and symptoms were significantly reduced in vaccinated individuals compared with unvaccinated individuals. We also observed that breakthrough infections are associated with strong tissue compartmentalization and are only detectable in saliva in some cases. Conclusions: Vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.

Longitudinal analysis of SARS-CoV-2 vaccine breakthrough infections reveal limited infectious virus shedding and restricted tissue distribution.

The global effort to vaccinate people against SARS-CoV-2 in the midst of an ongoing pandemic has raised questions about the nature of vaccine breakthrough infections and the potential for vaccinated individuals to transmit the virus. These questions have become even more urgent as new variants of concern with enhanced transmissibility, such as Delta, continue to emerge. To shed light on how vaccine breakthrough infections compare with infections in immunologically naive individuals, we examined viral dynamics and infectious virus shedding through daily longitudinal sampling in a small cohort of adults infected with SARS-CoV-2 at varying stages of vaccination. The durations of both infectious virus shedding and symptoms were significantly reduced in vaccinated individuals compared with unvaccinated individuals. We also observed that breakthrough infections are associated with strong tissue compartmentalization and are only detectable in saliva in some cases. These data indicate that vaccination shortens the duration of time of high transmission potential, minimizes symptom duration, and may restrict tissue dissemination.