Publications by authors named "Christian Grov"

160 Publications

Breaking Inertia: Movement Along the PrEP Cascade in a Longitudinal US National Cohort of Sexual Minority Individuals at Risk for HIV.

J Acquir Immune Defic Syndr 2021 Apr;86(5):e118-e125

CUNY Institute for Implementation Science in Population Health, New York, NY; and.

Background: The pre-exposure prophylaxis (PrEP) cascade outlines sequential steps to maximize PrEP's impact and highlights potential intervention targets to improve PrEP implementation. We evaluate the PrEP cascade in the Together 5000 study (T5K).

Methods: T5K is an internet-based, US national cohort study of PrEP-eligible men and trans persons who have sex with men who were not taking PrEP at enrollment. Using longitudinal data from baseline (2017-2018) and year 1 follow-up (2018-2019, n = 4229), we evaluated 5 steps of the PrEP cascade-PrEP contemplation: believes they are a good candidate for PrEP; PrEParation: plans to initiate PrEP; PrEP action: speaks to a provider about PrEP; PrEP initiation: receives a prescription for PrEP; and PrEP maintenance: continues to take PrEP. We compared the cascade across geographic region and identified factors associated with gaps in the cascade.

Results: After 1 year, 1092 (26%) participants had initiated PrEP, 709 (17%) were still using PrEP, and 177 (4%) were no longer clinically indicated for PrEP. Participants in the South and Midwest were less likely to speak to a provider about PrEP or initiate PrEP. Baseline characteristics associated with lower odds of PrEP initiation at year 1 include: not having a college degree; earning <$20,000/year; not having health insurance; having very low food security; and not having a primary care doctor.

Conclusions: Lack of health care access is a major barrier to PrEP implementation and may exacerbate disparities in PrEP uptake across geographic regions.
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http://dx.doi.org/10.1097/QAI.0000000000002611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942983PMC
April 2021

Recent SARS-CoV-2 seroconversion in a national, community-based prospective cohort of U.S. adults.

medRxiv 2021 Feb 16. Epub 2021 Feb 16.

Epidemiologic risk factors for incident SARS-CoV-2 infection are best characterized via prospective cohort studies, complementing case-based surveillance and cross-sectional seroprevalence studies. In March 2020, we launched the CHASING COVID Cohort Study, a national, community-based prospective cohort study of 6,745 U.S. adults who underwent at-home specimen collection for repeat serologic testing for SARS-CoV-2 antibodies. We identify and quantify several policy-sensitive risk factors for recent SARS-CoV-2 seroconversion, highlight persistent racial/ethnic disparities in incidence, document continued elevated risk among essential workers, and call attention to major gaps in the coverage of public health interventions aimed at testing, isolation, and contact tracing. We conclude that modifiable risk factors and poor reach of public health strategies drive SARS-CoV-2 transmission and inequities across the U.S.
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http://dx.doi.org/10.1101/2021.02.12.21251659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899475PMC
February 2021

Patterns of SARS-CoV-2 testing preferences in a national cohort in the United States.

medRxiv 2020 Dec 24. Epub 2020 Dec 24.

In order to understand preferences about SARS-CoV-2 testing, we conducted a discrete choice experiment among 4793 participants in the Communities, Households, and SARS-CoV-2 Epidemiology (CHASING COVID) Cohort Study from July 30-September 8, 2020. We used latent class analysis to identify distinct patterns of preferences related to testing and conducted a simulation to predict testing uptake if additional testing scenarios were offered. Five distinct patterns of SARS-CoV-2 testing emerged. "Comprehensive testers" (18.9%) ranked specimen type as most important and favored less invasive specimen types, with saliva most preferred, and also ranked venue and result turnaround time as highly important, with preferences for home testing and fast result turnaround time. "Fast track testers" (26.0%) ranked result turnaround time as most important and favored immediate and same day turnaround time. "Dual testers" (18.5%) ranked test type as most important and preferred both antibody and viral tests. "Non-invasive dual testers" (33.0%) ranked specimen type and test type as similarly most important, preferring cheek swab specimen type and both antibody and viral tests. "Home testers" (3.6%) ranked venue as most important and favored home-based testing. By offering less invasive (saliva specimen type), dual testing (both viral and antibody tests), and at home testing scenarios in addition to standard testing scenarios, simulation models predicted that testing uptake would increase from 81.7% to 98.1%. We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options, which consider this heterogeneity, would likely increase testing uptake.

Significance: During the COVID-19 pandemic, diagnostic testing has allowed for early detection of cases and implementation of measures to reduce community transmission of SARS-CoV-2 infection. Understanding individuals' preferences about testing and the service models that deliver tests are relevant in efforts to increase and sustain uptake of SARS-CoV-2 testing, which, despite vaccine availability, will be required for the foreseeable future. We identified substantial differences in preferences for SARS-CoV-2 testing in a discrete choice experiment among a large national cohort of adults in the US. Offering additional testing options that account for or anticipate this heterogeneity in preferences (e.g., both viral and antibody tests, at home testing), would likely increase testing uptake.

Classification: Biological Sciences (major); Psychological and Cognitive Sciences (minor).
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http://dx.doi.org/10.1101/2020.12.22.20248747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781336PMC
December 2020

SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment.

JMIR Public Health Surveill 2020 12 31;6(4):e25546. Epub 2020 Dec 31.

Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States.

Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission.

Objective: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission.

Methods: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider's office or urgent care clinic with results in >5 days.

Results: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test.

Conclusions: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.
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http://dx.doi.org/10.2196/25546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781587PMC
December 2020

Household factors and the risk of severe COVID-like illness early in the US pandemic.

medRxiv 2020 Dec 4. Epub 2020 Dec 4.

Objective: To investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease.

Methods: We used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020.

Results: In logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings.

Conclusion: Early in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease.
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http://dx.doi.org/10.1101/2020.12.03.20243683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724676PMC
December 2020

The relationship between anxiety, health, and potential stressors among adults in the United States during the COVID-19 pandemic.

medRxiv 2020 Nov 4. Epub 2020 Nov 4.

Objective: To estimate the prevalence of anxiety symptoms and the association between moderate or severe anxiety symptoms and health and potential stressors among adults in the U.S. during the COVID-19 pandemic.

Methods: This analysis includes data from 5,250 adults in the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study surveyed in April 2020. Poisson models were used to estimate the association between moderate or severe anxiety symptoms and health and potential stressors among U.S. adults during the COVID-19 pandemic.

Results: Greater than one-third (35%) of participants reported moderate or severe anxiety symptoms. Having lost income due to COVID-19 (adjusted prevalence ratio [aPR] 1.27 (95% CI 1.16, 1.30), having recent COVID-like symptoms (aPR 1.17 (95% CI 1.05, 1,31), and having been previously diagnosed with depression (aPR 1.49, (95% CI 1.35, 1.64) were positively associated with anxiety symptoms.

Conclusions: Anxiety symptoms were common among adults in the U.S. during the COVID-19 pandemic. Strategies to screen and treat individuals at increased risk of anxiety, such as individuals experiencing financial hardship and individuals with prior diagnoses of depression, should be developed and implemented.
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http://dx.doi.org/10.1101/2020.10.30.20221440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654863PMC
November 2020

Higher and Higher? Drug and Alcohol Use and Misuse among HIV-Vulnerable Men, Trans Men, and Trans Women Who Have Sex with Men in the United States.

Subst Use Misuse 2021 5;56(1):111-122. Epub 2020 Nov 5.

CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA.

Background: Substance use (SU) and misuse are disproportionately more common among sexual and gender minority (SGM) individuals compared to their heterosexual peers. Yet, little is known about regional and demographic differences in use and misuse among SGM. In this study, we investigated regional and demographic differences in SU and misuse in a U.S. national, internet-based cohort ( = 6,280) of men and trans persons who have sex with men. : Data collected included the WHO ASSIST (substance) and AUDIT (alcohol) SU scales to estimate recent (≤ 3 months) non-problematic use (≤ 3 ASSIST, ≤ 10 AUDIT) and misuse (≥4 ASSIST, ≥11 AUDIT). We used bivariate and multivariable logistic models to examine demographic and regional factors associated with SU and misuse. : Participants reported using alcohol (85.6%), cannabis (53.9%), and inhalants (39.1%) in the past three months. More than one-third self-reported misuse of cannabis, Gamma-Hydroxybutyrate (GHB), inhalants, methamphetamines, and prescription sedatives. We observed regional differences in substance use for cannabis (Southeast aOR = 0.76, 95% CI: 0.63-0.93; West aOR = 1.27, 95% CI: 1.02-1.59, ref. Northeast) and prescription Stimulants (Midwest aOR = 1.39, 95% CI: 1.00-1.93), as well as for cannabis misuse (Southeast aOR = 0.83, 95% CI: 0.69-0.99). We also observed significant associations between socioeconomic factors with use and misuse. : Findings suggest geographic differences in misuse of certain substances among men and trans persons who have sex with men in the US, and that socio-economic factors, also play a key role in indicating risk.
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http://dx.doi.org/10.1080/10826084.2020.1843057DOI Listing
November 2020

PrEP uptake as a social movement among gay and bisexual men.

Cult Health Sex 2020 Oct 29:1-13. Epub 2020 Oct 29.

Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.

Despite PrEP's effectiveness as an HIV prevention intervention, uptake among gay and bisexual men remains low. Historical involvement in AIDS activism may reveal important ways of mobilising gay and bisexual men to increase PrEP uptake. Data come from a qualitative study to understand New York City gay and bisexual men's experiences with PrEP. Informed by a constructivist grounded theory approach, we assessed ways in which gay and bisexual men's relational experiences concerning PrEP were congruent with features of past AIDS activism. Participants' mean age was 32.5 years, half were men of colour, and over half had been taking PrEP for less than one year. Analysis revealed three primary themes related to AIDS activism strategies: (1) framing, which referenced how participants referred to PrEP as an empowering, liberatory and community-building intervention (2) reactions, which encompassed positive to negative expressions about PrEP and sex; and (3) innovation, which conveyed ways that participants engaged in processes of transferring lay knowledge about PrEP through leadership roles across social and digital encounters. Findings suggest that the ways in which gay and bisexual men communicate about PrEP with peers are consistent with features of AIDS activism. Deploying lay knowledge using framing strategies through peer-based intervention could expand PrEP uptake. However, elements of PrEP stigma must be addressed to engage with the wide-ranging HIV prevention needs of gay and bisexual men.
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http://dx.doi.org/10.1080/13691058.2020.1831075DOI Listing
October 2020

Individual and Partner Characteristics Associated With Intentions to Use PrEP Among Partnered Men, Trans Men, and Trans Women in Sero-Concordant and -Discordant Relationships in the United States.

AIDS Educ Prev 2020 10;32(5):367-377

CUNY Institute for Implementation Science in Population Health, New York, New York.

Despite proven effectiveness in reducing HIV transmission, pre-exposure prophylaxis (PrEP) use remains low among those who meet the recommended CDC guidance for PrEP use. Data are from a U.S. national cohort of men and trans persons who have sex with men (2017-2018). Logistic regression analyses were used to determine individual and partner factors associated with intentions to use PrEP among non-PrEP-using participants reporting a main partner ( = 1,671). Prior PrEP use among participants (14.2%) and their partners (7.7%) was low. Participants' prior PrEP use and main partner's HIV-positive status were both positively associated with intentions to use PrEP. HIV prevention interventions incorporating main partners may be effective in increasing PrEP use.
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http://dx.doi.org/10.1521/aeap.2020.32.5.367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7597370PMC
October 2020

PrEP Uptake and Discontinuation Among a U.S. National Sample of Transgender Men and Women.

AIDS Behav 2021 Apr 15;25(4):1063-1071. Epub 2020 Oct 15.

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health (ISPH), City University of New York, 55 West 125th Street, Room 812, New York, NY, USA.

Pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention efforts by effectively preventing the sexual transmission of HIV infection. Few studies have examined PrEP uptake and discontinuation among transgender individuals who are underserved in HIV prevention efforts. An online U.S. nationwide survey screened 294 HIV-negative transgender people for participation in a larger cohort study. We analyzed associations between demographic characteristics and PrEP use and discontinuation. We conducted thematic analyses of open-ended responses to identify reasons for PrEP discontinuation. Fifty-one participants (17.4%) reported ever receiving a PrEP prescription. Transgender men reported higher PrEP use than transgender women (χ = 18.06; p < 0.0001). PrEP discontinuation was reported by 49.0% of individuals who reported PrEP use. Reasons for PrEP discontinuation were related to side effects, insurance coverage, relationship status, and access to providers. HIV prevention efforts to increase PrEP should include mechanisms for PrEP uptake and re-initiation among transgender individuals.
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http://dx.doi.org/10.1007/s10461-020-03064-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979462PMC
April 2021

Testing, Testing: What SARS-CoV-2 testing services do adults in the United States actually want?

medRxiv 2020 Sep 18. Epub 2020 Sep 18.

Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY); New York City, New York USA.

Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. To determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. : A discrete choice experiment (DCE) was used to assess the relative importance of type of SARS-CoV-2 test, specimen type, testing venue, and results turnaround time. Uptake of an optimized testing scenario was simulated relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal (NP) swab in a provider office or urgent care clinic with results in >5 days. ​ Online survey, embedded in an existing cohort study, conducted during July 30 - September 8, 2020. ​Participants (n=4,793) were enrolled in the CHASING COVID Cohort Study, a national longitudinal cohort of adults >18 years residing in the 50 US states, Washington, DC, Puerto Rico, or Guam. Relative importance of SARS-CoV-2 testing method attributes, utilities of specific attribute levels, and probability of choosing a testing scenario based on preferences estimated from the DCE, the current typical testing option, or choosing not to test. ​Turnaround time for test results had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). Participants preferred fast results on both past and current infection and using a noninvasive specimen, preferably collected at home. Simulations suggested that providing immediate or same day test results, providing both PCR and serology, or collecting oral specimens would substantially increase testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. ​Testing strategies that offer both PCR and serology with non-invasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.
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http://dx.doi.org/10.1101/2020.09.15.20195180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523137PMC
September 2020

Exploration of the Complex Relationships Among Multilevel Predictors of PrEP Use Among Men Who Have Sex with Men in the United States.

AIDS Behav 2021 Mar 18;25(3):798-808. Epub 2020 Sep 18.

Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA.

To explore the relationships among individual-, social-, and contextual- (state-level characteristics, including LBGTQ + and racial inequality) level factors and PrEP use. A cross-sectional survey was conducted in 2015-2016 among a geographically diverse group of men who have sex with men (MSM). Survey data was linked to publicly available state-level data based on participant zip code. Multivariable multilevel logistic regression was used to explore the association between multilevel variables and PrEP use. Of 4165 HIV-negative MSM, 13.4% were taking PrEP. In the regression analysis, several demographic and behavioral factors were associated with higher odds of PrEP use. Importantly, after adjusting for individual- and social-level factors, residents of states with high LGBTQ + equality had significantly higher odds of taking PrEP (OR 1.57; 95% CI 1.119, 2.023) compared to low equality states. LGBTQ + inequality between states may hinder PrEP use. States may need to take proactive measures to reduce LGBTQ + inequality as this may negatively impact the ability to reach the federal administration's stated goal to end the HIV epidemic in the US.
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http://dx.doi.org/10.1007/s10461-020-03039-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886950PMC
March 2021

Experiences Receiving HIV-Positive Results by Phone: Acceptability and Implications for Clinical and Behavioral Research.

AIDS Behav 2021 Mar;25(3):709-720

CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St., 7th Floor Mailroom, New York, NY, 10027, USA.

Improving HIV testing rates and increasing early detection among men who have sex with men (MSM) are critical strategies for enhancing overall health and decreasing HIV transmission. Remote testing and phone delivery of HIV test results may reduce barriers such as geographic isolation or HIV-related stigma. In 2018-19, 50 MSM completed qualitative interviews about their experience receiving a positive HIV test result via phone through their participation in a research study that included remote HIV testing. Interview topics included the acceptability of, and concerns about, phone delivery of HIV results, as well as suggestions for improvement. Interviews were transcribed, coded, and analysed using an inductive thematic approach. Overall, participants reported high acceptability of phone delivery of HIV-positive results. Participants praised the support and information provided by study staff. Benefits identified included increased convenience compared to in-person medical visits, allowing participants to emotionally process their test results privately, as well as receiving the results from supportive and responsive staff members. A few participants indicated drawbacks to phone-based HIV test result delivery, such as logistical concerns about receiving a phone call during the day (e.g., while at work), reduced confidentiality, and the lack of in-person emotional support. Overall, participants described phone delivery of positive HIV-results as acceptable. At-home testing with phone delivery has the potential to increase HIV testing access, especially to geographically isolated or medically underserved patients.
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http://dx.doi.org/10.1007/s10461-020-03027-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483487PMC
March 2021

Awareness and Acceptability of Undetectable = Untransmittable Among a U.S. National Sample of HIV-Negative Sexual and Gender Minorities.

AIDS Behav 2021 Feb;25(2):634-644

Department of Community Health and Health Policy, CUNY Graduate School of Public Health and Health Policy, 55 W. 125th St., 7th Floor Mailroom, New York, NY, 10027, USA.

While the "Undetectable = Untransmittable" (U=U) message is widely endorsed, little is known about its breadth and reach. Our study describes socio-demographic characteristics and sexual behaviors associated with having heard of and trusting in U =U in a U.S. national sample of HIV-negative participants. Data were derived from the Together 5,000 cohort study, an internet-based U.S. national cohort of cis men, trans men and trans women who have sex with men. Approximately 6 months after enrollment, participants completed an optional survey included in the present cross-sectional analysis (n = 3286). Measures included socio-demographic and healthcare-related characteristics; questions pertaining to knowledge of and trust in U=U (dependable variable). We used descriptive statistics and multivariable logistic models to identify characteristics associated with these variables and explored patterns in willingness to engage in condomless anal sex (CAS) with regard to trust in U=U. In total, 85.5% of participants reported having heard of U=U. Among those aware of U=U, 42.3% indicated they trusted it, 19.8% did not, and 38.0% were unsure about it. Latinx, Asian, lower income, and Southern participants were less likely to have heard of U=U. Having had a recent clinical discussion about PrEP or being a former-PrEP user were associated with trust in U=U. Willingness to engage in CAS was positively associated with trust in U=U, and varied based on the partner's serostatus, PrEP use and viral load. Although we found high rates of awareness and low levels of distrust, our study indicated that key communities remain unaware and/or skeptical of U=U.
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http://dx.doi.org/10.1007/s10461-020-02990-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854953PMC
February 2021

Sex workers are returning to work and require enhanced support in the face of COVID-19: results from a longitudinal analysis of online sex work activity and a content analysis of safer sex work guidelines.

Sex Health 2020 08;17(4):384-386

Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY 10032, USA.

Sex workers confront unique challenges in the face of COVID-19. Data from an international sex work website popular with cisgender men and transgender men and women suggest that, after a period of physical distancing, many sex workers are returning to in-person work: from May to August 2020, active sex work profiles increased 9.4% (P < 0.001) and newly created profiles increased by 35.6% (P < 0.001). Analysis of sex work and COVID-19 guidelines published by five community-based organisations found that they focused on altering sexual practices, enhancing hygiene and pivoting to virtual work. To capitalise on these guidelines, funding and research for implementation and evaluation are needed to support COVID-19 risk reduction strategies for sex workers.
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http://dx.doi.org/10.1071/SH20128DOI Listing
August 2020

Contraceptive Use by Women Across Multiple Components of Sexual Orientation: Findings from the 2011-2017 National Survey of Family Growth.

LGBT Health 2020 Aug/Sep;7(6):321-331. Epub 2020 Aug 17.

Department of Community Health and Social Sciences and CUNY Graduate School of Public Health and Health Policy, New York, New York, USA.

We estimated sexual orientation-related disparities in contraceptive outcomes among women across multiple components of sexual orientation. Using pooled National Survey of Family Growth data, 2011-2017, we performed multivariable logistic and multinomial regression analyses (adjusted for race/ethnicity, age, education, and income) to estimate the independent associations between multiple components of sexual orientation (sexual identity, behavior, and attraction) and two contraceptive outcomes-any contraceptive use and type of method used at last intercourse with a male partner. Women who reported any attraction to females had increased odds of having used any contraceptive method compared with those only attracted to males (adjusted odds ratio [AOR] 1.22, 95% confidence interval [CI] 1.03-1.44). For the type of contraception outcome, we present age-stratified results due to effect modification. Among 15- to 25-year-olds, bisexual-identified females had higher odds of having used a low efficacy method compared with heterosexual females (AOR 1.49, 95% CI 1.01-2.19). Among 26- to 35-year-olds, women with male and female partners had increased odds of having used a low efficacy method compared with women with male partners only (AOR 3.31, 95% CI 1.46-7.51). Sexual minority women, defined by sexual identity and sexual behavior, may be at increased risk for unintended pregnancy due to increased use of low efficacy contraceptive methods compared with their non sexual minority peers. These outcomes vary by age group.
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http://dx.doi.org/10.1089/lgbt.2020.0013DOI Listing
August 2020

Factors Associated with Being PrEP-Naïve Among a U.S. National Cohort of Former-PrEP and PrEP-Naïve Participants Meeting Objective Criteria for PrEP Care.

Arch Sex Behav 2020 Aug 13. Epub 2020 Aug 13.

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St., 7th Floor Mailroom, New York, NY, 10027, USA.

There is an urgent need to increase uptake and persistence in HIV pre-exposure prophylaxis (PrEP) in PrEP-eligible candidates. Little is known about the similarities and differences between groups of PrEP-naïve and former users, an important consideration for future interventions. We explored factors associated with being PrEP-naïve in a U.S. national cohort of naïve and former-PrEP users, all of whom met objective criteria for PrEP care at enrollment. Data were derived from the Together 5000 cohort study, an Internet-based U.S. national cohort of cisgender and trans men and trans women who have sex with men. Participants were recruited via ads on men-for-men geosocial networking apps. All participants were not on PrEP at the time of enrollment. We conducted bivariate analysis to explore differences between the two groups and used multivariable logistic regression to assess factors associated with being PrEP-naïve. Of the 6283 participants, 5383 (85.7%) were PrEP-naïve and 900 (14.3%) were former-PrEP users. There were significant differences between PrEP-naïve and former-PrEP users across multiple demographic variables, in addition to PrEP-related and psychosocial variables. Factors associated with being PrEP-naïve included younger age, sexual identity other than gay/queer, lower perception of candidacy for PrEP care, less willingness to take PrEP, lower access to PrEP care, and individual-level barriers such as health- and provider-related concerns. Programs and policies designed to address uptake and persistence of PrEP should be aware of these differences. Providing care in non-traditional LGBTQ-care settings, home-based PrEP interventions, and provision by healthcare providers other than physicians could improve uptake. Future research should investigate mechanisms that can improve uptake and persistence in communities in need of PrEP.
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http://dx.doi.org/10.1007/s10508-020-01791-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881054PMC
August 2020

Applying a social-ecological lens to opinions about HIV self-testing among Kenyan truckers who declined to test: a qualitative study.

Afr J AIDS Res 2020 Jul;19(2):147-155

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA.

HIV prevalence among truckers in Africa is high and testing rates suboptimal. With numerous African countries having approved HIV self-testing kits, more information on how to design acceptable and accessible self-testing programs for high-risk populations is necessary. We explored views about self-testing via in-depth interviews with 24 truckers participating in a randomised controlled trial who refused HIV testing. A social-ecological lens was used to guide data analysis and frame study findings. While most participants said that they would use an HIV self-test, perceived barriers and facilitators were identified at multiple levels. Many participants noted lack of time to test or obtain a self-test kit as a major barrier (intrapersonal) and varied in their views about self-testing with a partner (interpersonal). Participants offered programmatic/policy recommendations, suggesting that they preferred accessing self-test kits in settings where training could be provided. Participants believed they should be able to pick up multiple test kits at the same time and that the test kits should be free or low cost. These study findings will help guide the design of self-testing programs for truckers and other mobile populations.
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http://dx.doi.org/10.2989/16085906.2020.1764070DOI Listing
July 2020

The Crisis We Are Not Talking About: One-in-Three Annual HIV Seroconversions Among Sexual and Gender Minorities Were Persistent Methamphetamine Users.

J Acquir Immune Defic Syndr 2020 11;85(3):272-279

CUNY Institute for Implementation Science in Population Health, New York, NY.

Introduction: Methamphetamine use is once again on the rise among sexual and gender minorities who have sex with men (SGMSM).

Methods: Baseline and 12-month data are taken from an ongoing cohort study of n = 4786 SGMSM aged 16-49 at risk for HIV from across the United States. Participants completed annual online surveys and at-home HIV testing (oral fluid samples returned through mail).

Results: Overall, 2.47 per 100 persons seroconverted over 12 months. In addition, 13.8% of participants reported any methamphetamine use over the 12-month study period. Nearly three-fourths (74.7%; 422 of 565) of those who reported using methamphetamine at baseline were persistent users at 12 months. In adjusted analyses, compared with those who did not use methamphetamine, incident methamphetamine users (ie, those who indicated use between baseline and follow-up) and persistent methamphetamine users had significantly higher odds of HIV seroconverting (adjusted odds ratio = 3.95, 95% confidence interval: 1.64 to 9.47; and 7.11, 4.53 to 11.17, respectively). Persistent methamphetamine users accounted for one-third of all observed HIV seroconversions (41 of 115).

Discussion: Among SGMSM at elevated risk for HIV, persistent methamphetamine use was prevalent and associated with substantially amplified risk for HIV seroconversion. Expanded efforts are needed to test implementation strategies for scalable, evidence-based interventions to reduce HIV risk in SGMSM who use methamphetamine.
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http://dx.doi.org/10.1097/QAI.0000000000002461DOI Listing
November 2020

Marketing of Tenofovir Disoproxil Fumarate (TDF) Lawsuits and Social Media Misinformation Campaigns' Impact on PrEP Uptake Among Gender and Sexual Minority Individuals.

AIDS Behav 2020 Jul 29. Epub 2020 Jul 29.

New York City Department of Health and Mental Hygiene, New York, NY, USA.

There has been an influx of ads on social media seeking plaintiffs in lawsuits for harms/side-effects caused by tenofovir disoproxil fumarate/Emtricitabine (TDF/FTC, Truvada) for PrEP. Community groups and researchers have suggested these ads may be undermining efforts to disseminate PrEP to key populations. In October 2019, we began assessing the impact of injury lawsuit ads on social media platforms in an ongoing U.S. national cohort study of HIV-negative cis men, trans men, and trans women who have sex with men. Although assessments are ongoing, given the alarming nature of our findings, we report data collected as of March 2020 (n = 2078). Most (59.9%) said they had seen ads for TDF-related lawsuits on social media. Twenty-eight percent said they would probably or definitely not start PrEP and 22.1% said they would not stay on PrEP (were they on it) as a result of seeing these ads. Next, 38.2% agreed or strongly agreed that seeing these ads made them think that TDF/FTC for PrEP was not safe. Black, Latinx, and/or multiracial individuals were most likely to be negatively impacted by the ads including perceptions that these ads made them think PrEP is not safe. In contrast, past year experience taking PrEP was positively associated with intentions to start and/or stay on PrEP despite seeing the ads. Due to forthcoming affordable/generic options, TDF/FTC is projected to become the most scalable option for disseminating PrEP to key populations. Results suggest that ads for TDF lawsuits on social media are having a negative impact on individual PrEP decision-making. Our findings highlight the urgency for accurate and balanced messaging on the benefits and risks of PrEP, so that individuals can make informed choices about whether PrEP is right for them.
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http://dx.doi.org/10.1007/s10461-020-02977-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854969PMC
July 2020

Reducing the Discussion Divide by Digital Questionnaires in Health Care Settings: Disruptive Innovation for HIV Testing and PrEP Screening.

J Acquir Immune Defic Syndr 2020 11;85(3):302-308

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy; the CUNY Institute for Implementation Science in Population Health, New York, NY.

Background: Health care provider assessment of patient sexual behavior and substance use is essential for determining appropriate prevention interventions-including HIV pre-exposure prophylaxis (PrEP)-for sexual minority men (SMM). We sought to explore acceptability and utility of using electronic surveys to conduct health behavior assessments in clinical settings among SMM.

Methods: Among a US nationwide sample of SMM (n = 4187; mean age = 38.3 years; 60% white; 82% HIV-negative), we examined associations of demographics, recruitment venue, sexual behavior characteristics, and recent substance use with participants' comfort communicating verbally and through electronic survey with a health care provider about sexual and substance use behavior.

Results: On average, SMM had greater comfort communicating through electronic survey vs. verbally. In our fully adjusted analysis, preference favoring electronic surveys more strongly than verbal communication differed by age (β = -0.07, P ≤ 0.001). SMM with a bachelor's degree or more (β = 0.04, P < 0.05), those recruited from nonclinical settings (β = 0.06, P ≤ 0.001), and those without primary care providers (β = 0.04, P < 0.05) favored electronic surveys more strongly in the fully adjusted multivariable model. SMM who reported any recent casual sex partners (β = 0.05, P < 0.01), those never tested for HIV (β = 0.03, P < 0.05), and HIV-negative/unknown men not on PrEP (compared with PrEP users; β = 0.09, P ≤ 0.001) also favored electronic surveys in the fully adjusted model.

Conclusions: Reducing communication barriers by incorporating electronic surveys into patient assessments could help identify HIV testing and PrEP needs for SMM most susceptible to HIV acquisition. Nonetheless, no one screening strategy is likely to work for most SMM, and multiple approaches are needed.
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http://dx.doi.org/10.1097/QAI.0000000000002459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572720PMC
November 2020

Dimensions of Sexual Orientation as Predictors of STI-Related Outcomes Among Women: An Examination of 2011-2017 National Survey of Family Growth Data.

J Womens Health (Larchmt) 2020 11 30;29(11):1385-1391. Epub 2020 Jun 30.

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA.

To estimate sexual orientation associated disparities in sexually transmitted infection (STI)-related outcomes across multiple dimensions of sexual orientation. Using pooled 2011-2017 National Survey of Family Growth data ( = 16,854), we performed bivariate and multivariable logistic and multinomial regression analyses to estimate associations between sexual identity, behavior in the past 12 months, and attraction, and past-year STI treatment, receipt of the human papillomavirus (HPV) vaccine, and age at first HPV vaccination in cisgender women. Bisexual-identified women (adjusted odds ratio [AOR] = 1.53, 95% confidence interval [CI] = 1.10-2.14) and who were sexually active with both men and women in the past 12 months (AOR = 1.64, 95% CI = 1.03-2.55) had significantly higher odds of past-year STI treatment, compared with their nonsexual minority counterparts. Lesbian-identified women (AOR = 0.44, 95% CI = 0.27-0.75) and women with female partners only (AOR = 0.32, 95% CI = 0.12-0.87) had significantly decreased odds of having initiated the HPV vaccine compared with their heterosexual counterparts. Women with both male and female partners who initiated the HPV vaccine had significantly higher odds of having received the vaccine during the latest age range, 18-25 years old (AOR = 2.32, 95% CI = 1.21-4.45) compared with women with male partners only. Sexual minority women continue to be at risk for poor sexual health outcomes, and these outcomes differ by specific components of sexual orientation.
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http://dx.doi.org/10.1089/jwh.2019.8289DOI Listing
November 2020

Investigating the effects of COVID-19 on global male sex work populations: a longitudinal study of digital data.

Sex Transm Infect 2021 03 26;97(2):93-98. Epub 2020 Jun 26.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

Objectives: Recommendations of 'social distancing' and home quarantines to combat the global COVID-19 pandemic have implications for sex and intimacy, including sex work. This study examined the effects of COVID-19 on male sex work globally and investigated how men who sold sex responded to and engaged with the virus in the context of work.

Methods: This study made use of an existing database of deidentified data extracted from the online profiles maintained by male sex workers on a large, international website. Website engagement metrics were calculated for the periods before (September to December 2019) and during COVID-19 (January to May 2020); Poisson regression analyses were used to assess changes over time before and after, while a content analysis was undertaken to identify modes of engagement with the virus.

Results: Data were collected from 78 399 profiles representing 19 388 individuals. In the 'before' period, the number of active profiles was stable (inter-rate ratio (IRR)=1.01, 95% CI 0.99 to 1.01, p=0.339) but during COVID-19 decreased by 26.3% (IRR=0.90, 95% CI 0.89 to 0.91, p<0.001). Newly created profiles also decreased during COVID-19 (59.4%; IRR=0.71, 95% CI 0.69 to 0.74, p<0.001) after a period of stability. In total, 211 unique profiles explicitly referenced COVID-19; 185 (85.8%) evoked risk reduction strategies, including discontinuation of in-person services (41.2%), pivoting to virtual services (38.9%), COVID-19 status disclosure (20.9%), enhanced sanitary and screening requirements (12.3%) and restricted travel (5.2%). Some profiles, however, seemed to downplay the seriousness of COVID-19 or resist protective measures (14.7%).

Conclusions: These findings support the contention that COVID-19 has dramatically impacted the sex industry; globally, male sex workers may be facing considerable economic strain. Targeted education and outreach are needed to support male sex workers grappling with COVID-19, including around the most effective risk reduction strategies. Those involved with the sex industry must have access to state-sponsored COVID-19 financial and other aid programmes to support individual and public health.
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http://dx.doi.org/10.1136/sextrans-2020-054550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371479PMC
March 2021

Willingness to Distribute HIV Self-Testing Kits to Recent Sex Partners Among HIV-Negative Gay and Bisexual Men and an Examination of Free-Response Data from Young Men Participating in the Nationwide Cohort.

Arch Sex Behav 2020 08 3;49(6):2081-2089. Epub 2020 Jun 3.

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, The CUNY Institute for Implementation Science in Population Health, 55 West 125th Street, New York, NY, 10027, USA.

Sexual minority men (SMM)-and young SMM in particular-are disproportionately affected by HIV. Secondary distribution of HIV self-testing (HIVST) kits-wherein patients deliver kits to partners-is a novel strategy to increase HIV testing access. Using quantitative data, we assessed willingness to distribute HIVST kits to recent sex partners among a U.S. national sample of HIV-negative SMM (n = 786). A thematic analysis was then conducted to identify barriers and facilitators of kit distribution to partners among young SMM (M age = 25.75 years; range: 20-29; n = 165). Overall, 93.5% of SMM (and 97.0% of young SMM) were willing to deliver HIVST kits to recent sex partners. Among young SMM, main barriers and facilitators included concerns about their partners' reaction, availability and cost, protection beliefs for others, HIV stigma and perceived infidelity, packaging and support, communication skill needs, inability to contact partners, requests for anonymity, and dyadic self-testing with their partners. The findings highlight the need for supportive intervention strategies such as informational content for HIVST, using motivational interviewing when providing the testing kits to index clients and providing skills-based training through role-playing exercises. Secondary distribution of HIVST kits through index patients is a potentially acceptable approach that could be used to expand access to HIV testing and aid in efforts to end the HIV epidemic in the U.S.
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http://dx.doi.org/10.1007/s10508-020-01752-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366497PMC
August 2020

Prior HIV testing behaviour is associated with HIV testing results among men, trans women and trans men who have sex with men in the United States.

J Epidemiol Community Health 2020 09 20;74(9):741-753. Epub 2020 May 20.

CUNY School of Public Health, New York, New York, USA.

Background: Among those at high risk for HIV, it is important to examine the ways in which someone who has recently tested for HIV might differ from someone who has not.

Methods: In 2017-2018, a total of 5001 men, trans women and trans men who have sex with men from across the United States completed an online survey about their recent testing behaviour as well as self-collected oral samples for HIV testing.

Results: In total, 3.8% tested HIV-positive and-among those with positive results-35% were recent HIV infections (ie, self-reported an HIV-negative test result within the 12 months prior to enrollment). Those with HIV-positive results-regardless of how recent their HIV test was prior to enrollment-differed from those with negative results in ways that are known to be associated with HIV risk: racial and income disparities, housing instability, recent transactional sex and recent methamphetamine use. Among those with HIV-positive results at enrollment, only having a primary care physician distinguished those who recently tested negative prior to enrollment versus not. Among those with HIV-negative results, there were numerous differences between those who had recently tested for HIV prior to enrollment, versus not, such that those who had not recently tested were significantly more likely to report being at higher risk for HIV.

Conclusion: Strategies aimed at improving more frequent HIV testing among HIV-negative persons at high risk for HIV should address other needs including stable housing, transactional sex, access to a primary care provider and methamphetamine use.
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http://dx.doi.org/10.1136/jech-2019-213493DOI Listing
September 2020

Recruiting young women of color into a pilot RCT targeting sexual health: Lessons learned and implications for applied health technology research.

J Am Coll Health 2020 Apr 28:1-9. Epub 2020 Apr 28.

Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy & the CUNY Institute for Implementation Science in Population Health, New York, New York, USA.

To evaluate different recruitment methods to enroll participants into a mHealth pilot RCT: banner ads on Facebook and OkCupid, and targeted electronic outreach (e.g., emails to community-based organizations and to professors at local colleges). Between October 2015 and May 2016, 114 college-aged Black and Latina women 18 to 24 participated in the study. Recruitment methods compared online banner ads on social media to targeted electronic outreach. Individual banner ad images were compared by impressions, clicks, and cost by enrolled participants. More targeted electronic recruited participants enrolled than via banner advertisements. Banner ads with images of women yielded a higher click-through-rate and was more cost effective versus the logo alone. Recruiting young women of color may be facilitated through known and trusted adults, such as college professors, rather than through anonymous banner advertisements on social media.
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http://dx.doi.org/10.1080/07448481.2020.1746663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606544PMC
April 2020

Characteristics Associated with Trust in and Disclosure of Sexual Behavior to Primary Care Providers Among Gay, Bisexual, and Other Men Who Have Sex with Men in the United States.

LGBT Health 2020 May/Jun;7(4):208-213. Epub 2020 Apr 20.

Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Characteristics associated with having a primary care provider (PCP), patient-provider trust, and sexual behavior disclosure were examined among men who have sex with men (MSM). MSM ( = 4239) were surveyed regarding demographic, behavioral, and medical characteristics. Multivariable logistic regression analyses were used. Among 86.3% of MSM with a PCP, characteristics associated with lower patient-provider trust included younger age, Asian, bisexual, HIV-negative-not-on-pre-exposure prophylaxis, HIV-unknown, and lower medical literacy; with nondisclosure: Asian, bisexual, straight, HIV-negative, HIV-unknown, fewer partners, recruitment source, lower medical literacy, and lower patient-provider trust. Medical literacy and patient-provider trust are promising points of intervention to improve health outcomes among MSM.
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http://dx.doi.org/10.1089/lgbt.2019.0214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301311PMC
April 2020

Are we on the precipice of a new epidemic? Risk for hepatitis C among HIV-negative men-, trans women-, and trans men- who have sex with men in the United States.

AIDS Care 2020 05 15;32(sup2):74-82. Epub 2020 Mar 15.

CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.

Emerging data from Europe have documented increases in diagnoses of acute hepatitis C virus (HCV) infection among HIV-negative men who have sex with men. We investigated risk factors for HCV and their correlates in the study, a U.S. national cohort study of HIV-negative men (= 6089), transgender women (= 40), and transgender men (= 42) who have sex with men. We used bivariate and multivariable analyses to determine demographic and behavioral factors associated with high risk for acute HCV infection (using the HCV-MOSAIC risk indicator with a score ≥ 2.0). Mean HCV risk score was 1.38 (SD = 1.09) and 27.3% of participants had HCV risk scores ≥ 2.0. In multivariable modeling, being cisgender male (vs. not) was associated with having a lower HCV-MOSAIC risk score. Meanwhile, being white, having been incarcerated, prior use of HIV pre- or post-exposure prophylaxis, having ever been tested for HIV, and recent methamphetamine use were associated with high risk for HCV. More than one-in-four participants exceeded the threshold score for HCV risk. Those with high HCV-MOSAIC risk scores were more likely to have been in settings where they be tested for acute HCV (i.e., HIV testing, PrEP care, PEP care, incarceration), suggesting to engage them in HCV screening, prevention, and treatment.
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http://dx.doi.org/10.1080/09540121.2020.1739204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312766PMC
May 2020