Publications by authors named "Larry Brown"

200 Publications

Decreasing early hypoglycemia frequency in at-risk newborns after implementing a new hypoglycemia screening algorithm.

J Perinatol 2021 Nov 17. Epub 2021 Nov 17.

University of Texas Southwestern Medical Center, Dallas, TX, USA.

Background: Neonatal hypoglycemia may affect long-term neurodevelopment.

Methods: Quality improvement (QI) initiative for Mother-Baby-Unit (MBU) admissions (birthweight ≥ 2100 g; ≥35 weeks' gestation) over two epochs from 2016-2019 to reduce the frequency of early (≤3 h) neonatal hypoglycemia in small and large newborns.

Intervention: New algorithm using Olsen's growth curves, hypoglycemia thresholds of <2.22 mmol/L [40 mg/dL] (0-3 h) and <2.61 mmol/L [47 mg/dL] (>3 to 24 h), feeding optimization and 24-hour glucose checks for small for gestational age and preterm newborns.

Results: Among 39,460 newborns, using subsets with identical screening criteria, early hypoglycemia decreased significantly after QI implementation among large for gestational age newborns with birthweight >3850 g (66%) and small for gestational age newborns with birthweight <2500 g (70%). Among all MBU admissions, the adjusted odds of any hypoglycemia in 24 h decreased (P < 0.001).

Conclusions: Feeding optimization may decrease early hypoglycemia frequency in large and small newborns.
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http://dx.doi.org/10.1038/s41372-021-01263-8DOI Listing
November 2021

VOICES: An efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history.

Drug Alcohol Depend 2021 Nov 28;228:108934. Epub 2021 Jul 28.

The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St, Providence, RI, 02903, United States. Electronic address:

Background: Girls have unique developmental pathways to substance use and justice system involvement, warranting gender-responsive intervention. We tested the efficacy of VOICES (a 12-session, weekly trauma-informed, gender-responsive substance use intervention) in reducing substance use and HIV/STI risk behaviors among justice- and school-referred girls.

Methods: Participants were 113 girls (M = 15.7 years, SD = 1.4; 12 % White, 19 % Black, 15 % multi-racial; 42 % Latinx) with a history of substance use referred from juvenile justice (29 %) and school systems (71 %). Study assessments were completed at baseline, 3-, 6- and 9-months follow-up. Primary outcomes included substance use and HIV/STI risk behaviors; secondary outcomes included psychiatric symptoms (including posttraumatic stress) and delinquent acts. We hypothesized that girls randomized to the VOICES (n = 51) versus GirlHealth (attention control; n = 62) condition would report reduced alcohol, cannabis and other substance use, HIV/STI risk behaviors, psychiatric symptoms, and delinquent acts.

Results: Girls randomized to VOICES reported significantly less cannabis use over 9-month follow-up relative to the control condition (time by intervention, p < .01), but there were no between group differences over time in HIV/STI risk behavior. Girls in both conditions reported fewer psychiatric symptoms and delinquent acts over time.

Conclusions: Data support the use of a trauma-informed, gender-responsive intervention to reduce cannabis use among girls with a substance use history and legal involvement; reducing cannabis use in this population has implications for preventing future justice involvement and improving public health outcomes for girls and young women, who are at disproportionate health and legal risk relative to their male counterparts.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108934DOI Listing
November 2021

Correction to: A Review of Interventions to Enhance HIV Medication Adherence.

Curr HIV/AIDS Rep 2021 Oct;18(5):458

Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.

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http://dx.doi.org/10.1007/s11904-021-00573-yDOI Listing
October 2021

Early Use of Transcranial Doppler Ultrasonography to Stratify Neonatal Encephalopathy.

Pediatr Neurol 2021 Nov 8;124:33-39. Epub 2021 Jul 8.

Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, Texas. Electronic address:

Background: The dynamic nature of neonatal hypoxic-ischemic encephalopathy (HIE) after birth necessitates reliable biomarkers to identify infants with evolving brain injury. This prospective cohort aims to use serial Doppler ultrasonography (US) to measure cerebral blood flow velocity and resistance index (RI) to help detect the time and evolution of the clinical encephalopathy.

Methods: A total of 60 neonates were enrolled all ≥36 weeks' gestation with perinatal acidemia, defined as a blood gas pH ≤ 7.0 or base deficit ≥16 mmol/L and encephalopathy including a matched control group without encephalopathy. Each neonate received one to three serial Doppler recordings starting at six to 24 hours of life. Mean RI ≤ 0.55 was considered abnormal.

Results: Mean RIs obtained shortly after birth were significantly lower with increasing severity of encephalopathy. On the first Doppler recordings, abnormal mean RIs were seen in 11 of 18 (61%) neonates with mild, 13 of 17 (76%) with moderate, and two of two (100%) with severe HIE. Of the neonates with mild HIE and abnormal mean RIs, congruity abnormal amplitude electroencephalography (45%), brain magnetic resonance imaging (45%), and abnormal head ultrasound (44%) are here reported.

Conclusions: Doppler measurements can provide bedside adjunct biomarkers indicating the time and severity of neonatal HIE.
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http://dx.doi.org/10.1016/j.pediatrneurol.2021.07.004DOI Listing
November 2021

Site-Randomized Controlled Trial of a Combined Cognitive Behavioral Therapy and a Medication Management Algorithm for Treatment of Depression Among Youth Living With HIV in the United States.

J Acquir Immune Defic Syndr 2021 Dec;88(5):497-505

Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA.

Background: Depression is frequent among youth living with HIV (YLWH). Studies suggest that manualized treatment guided by symptom measurement is more efficacious than usual care.

Setting: This study evaluated manualized, measurement-guided depression treatment among YLWH, aged 12-24 years at 13 US sites of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network.

Methods: Using restricted randomization, sites were assigned to either a 24-week, combination cognitive behavioral therapy and medication management algorithm (COMB-R) tailored for YLWH or to enhanced standard of care, which provided standard psychotherapy and medication management. Eligibility included diagnosis of nonpsychotic depression and current depressive symptoms. Arm comparisons used t tests on site-level means.

Results: Thirteen sites enrolled 156 YLWH, with a median of 13 participants per site (range 2-16). At baseline, there were no significant differences between arms on demographic factors, severity of depression, or HIV status. The average site-level participant characteristics were as follows: mean age of 21 years, 45% male, 61% Black, and 53% acquired HIV through perinatal transmission. At week 24, youth at COMB-R sites, compared with enhanced standard of care sites, reported significantly fewer depressive symptoms on the Quick Inventory for Depression Symptomatology Self-Report (QIDS-SR score 6.7 vs. 10.6, P = 0.01) and a greater proportion in remission (QIDS-SR score ≤ 5; 47.9% vs. 17.0%, P = 0.01). The site mean HIV viral load and CD4 T-cell level were not significantly different between arms at week 24.

Conclusions: A manualized, measurement-guided psychotherapy and medication management algorithm tailored for YLWH significantly reduced depressive symptoms compared with standard care at HIV clinics.
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http://dx.doi.org/10.1097/QAI.0000000000002790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585710PMC
December 2021

The prospective impact of adverse childhood experiences on justice-involved youth's psychiatric symptoms and substance use.

J Consult Clin Psychol 2021 Jun;89(6):483-498

Department of Psychiatry and Behavioral Sciences.

Objective: Justice-involved youth report high rates of adverse childhood experiences (ACEs; abuse, neglect, household dysfunction) and are at high risk for elevated behavioral health needs (i.e., substance use, psychiatric symptoms). Research with broad samples of adolescents shows ACEs predict behavioral health outcomes, yet most research on the impact of ACEs among justice-involved youth focuses on recidivism. The present study addresses this gap by examining the prospective association between ACEs and psychiatric symptoms, substance use, and substance-related problems (i.e., consequences of use) among first-time justice-involved youth.

Method: First-time justice-involved youth (n = 271; 54.3% male; M age = 14.5 years; 43.5% Latinx; non-Latinx: 34.2% White, 8.6% Black, 7.1% Other, 6.7% Multiracial) and their caregivers were assessed at youth's first court contact and 4- and 12-month follow-ups. Youth and caregivers reported youth's exposure to ACEs through a series of instruments at baseline and 4-months (e.g., Childhood Trauma Questionnaire Short-Form; Traumatic Life Events Inventory). Primary outcomes included youth alcohol and cannabis use (Adolescent Risk Behavior Assessment), consequences of use (Brief Young Adult Alcohol Consequences Questionnaire; Brief Marijuana Consequences Scale), and psychiatric symptoms (Behavior Assessment System for Children; National Stressful Events Survey PTSD Short Scale).

Results: Youth were exposed to three ACEs, on average, prior to first justice contact (M = 3). Exposure to more ACEs, particularly abuse, predicted substance use and psychiatric outcomes. Gender differences emerged for cannabis use and internalizing symptoms.

Conclusions: Implications for trauma-responsive juvenile justice reform are discussed, including screening for ACEs and their sequelae at first court contact and considering the role of masculine norms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000655DOI Listing
June 2021

Causally Interpretable Meta-analysis: Application in Adolescent HIV Prevention.

Prev Sci 2021 Jul 9. Epub 2021 Jul 9.

Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.

Endowing meta-analytic results with a causal interpretation is challenging when there are differences in the distribution of effect modifiers among the populations underlying the included trials and the target population where the results of the meta-analysis will be applied. Recent work on transportability methods has described identifiability conditions under which the collection of randomized trials in a meta-analysis can be used to draw causal inferences about the target population. When the conditions hold, the methods enable estimation of causal quantities such as the average treatment effect and conditional average treatment effect in target populations that differ from the populations underlying the trial samples. The methods also facilitate comparison of treatments not directly compared in a head-to-head trial and assessment of comparative effectiveness within subgroups of the target population. We briefly describe these methods and present a worked example using individual participant data from three HIV prevention trials among adolescents in mental health care. We describe practical challenges in defining the target population, obtaining individual participant data from included trials and a sample of the target population, and addressing systematic missing data across datasets. When fully realized, methods for causally interpretable meta-analysis can provide decision-makers valid estimates of how treatments will work in target populations of substantive interest as well as in subgroups of these populations.
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http://dx.doi.org/10.1007/s11121-021-01270-3DOI Listing
July 2021

A Review of Interventions to Enhance HIV Medication Adherence.

Curr HIV/AIDS Rep 2021 10 21;18(5):443-457. Epub 2021 Jun 21.

Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.

Purpose Of Review: Adherence to antiretroviral treatment (ART) is crucial for the successful treatment of HIV. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed.

Recent Findings: There is great variability among interventions in terms of quality, sample, measures, and outcome characteristics. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Interventions that focus on individual and interpersonal factors have been effective for improving ART adherence; however, the improvement in adherence tends to be short-lived. Additionally, interventions are most successful when tailored to those at risk for poor adherence. Finally, theory-based interventions are more likely to be effective than non-theory-based interventions. A variety of individual-level psychological interventions have been shown to be effective in improving ART adherence in the short term. Digital and mobile interventions have the potential to improve dissemination and implementation of these evidence-based interventions and could be used to extend intervention effects. Future interventions that address issues of accessibility, inequality, structural and institutional barriers to ART adherence should also be tested and prioritized. Implementation science frameworks can be used to assess and address issues of accessibility and systematic barriers to care.
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http://dx.doi.org/10.1007/s11904-021-00568-9DOI Listing
October 2021

Predictors of cannabis use among first-time justice-involved youth: A cohort study.

Drug Alcohol Depend 2021 08 21;225:108754. Epub 2021 May 21.

The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St, Providence, RI, 02903, USA; Rhode Island Hospital, Division of Child and Adolescent Psychiatry, Coro West, 1 Hoppin Street, Providence, RI 02903. Electronic address:

Background: Justice-involved youth use cannabis at higher rates than their same-aged peers increasing likelihood of adverse behavioral health consequences and continued legal involvement. This study examined individual level predictors of early onset use cannabis use (<13 years of age) and cannabis use initiation in the 12 months following first court contact.

Methods: Participants were 391 first-time justice-involved youth (56.9 % male; M = 14.6 years; 32.1 % White, 11.1 % Black, 14.7 % Other/Multi-racial, 42.2 % Latinx) and an involved caregiver (87.2 % female; M = 41.0 years). Baseline assessments captured individual level factors; cannabis use was assessed every four months post-baseline for 12 months. Primary analyses involved multivariable modified Poisson regressions and survival analysis.

Results: In multivariable models, youth who reported lifetime cannabis use (n = 188, 48.1 %) were older, reported alcohol use and positive cannabis use expectancies. Greater self-control and self-concept were associated with lower likelihood of lifetime cannabis use. Youth who initiated cannabis during the 12-month follow-up (n = 30, 14.8 %) tended to be older, White/non-Latinx, and to report more psychiatric symptoms (posttraumatic stress, externalizing, internalizing, and affect dysregulation), delinquent behavior, lower levels of self-control, poorer self-concept, greater drug use intentions and positive cannabis expectancies. In the multivariable survival analysis, affect dysregulation, internalizing symptoms, and more positive cannabis expectancies remained independently and positively associated with cannabis initiation.

Conclusions: There is a critical and unique window of opportunity to prevent cannabis use initiation among first-time justice-involved youth. Research is needed to determine whether brief interventions that aim to modify expectancies about cannabis use reduce rates of cannabis initiation in this underserved population.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282753PMC
August 2021

The Impact of a Mobile Gaming Intervention to Increase Adherence to Pre-exposure Prophylaxis.

AIDS Behav 2021 Jun 22;25(6):1884-1889. Epub 2021 Jan 22.

Residence Training Program, Warren Alpert Medical School, Brown University, 345 Blackstone Boulevard, Providence, RI, 02906, USA.

Pre-exposure prophylaxis is effective in preventing HIV, but data show that its effectiveness is compromised by suboptimal adherence. This randomized controlled trial (n = 69) tested the impact of an iPhone game, Viral Combat, on PrEP adherence over 24 weeks. Tenofovir-diphosphate in red blood cells was collected as a biological outcome of adherence. At 24-weeks, intervention participants were 3.75 (95% CI: 1.20-11.77; p = 0.02) times as likely to engage in optimal PrEP dosing compared to controls. Viral Combat showed preliminary efficacy in improving PrEP adherence for diverse young men who have sex with men.
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http://dx.doi.org/10.1007/s10461-020-03118-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085097PMC
June 2021

MRI Score Ability to Detect Abnormalities in Mild Hypoxic-Ischemic Encephalopathy.

Pediatr Neurol 2021 03 28;116:32-38. Epub 2020 Nov 28.

Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center, Dallas, Texas. Electronic address:

Background: Magnetic resonance imaging (MRI) scores have been well validated in moderate/severe hypoxic-ischemic encephalopathy (HIE). Infants with mild HIE can have different patterns of injury, yet different scores have not been compared in this group of infants. Our objective was to compare the ability of three = MRI scores to detect abnormalities in infants with mild HIE, and infants with moderate/severe HIE were included for comparison.

Methods: This is a single-center prospective cohort study of infants ≥36 weeks' gestation with HIE born at a level III neonatal intensive care unit from 2017 to 2019. All infants with HIE underwent an MRI, but only infants with moderate/severe HIE underwent therapeutic hypothermia. At least two experienced MRI readers who were unaware of all clinical variables independently assigned three scores (Barkovich, NICHD NRN, and Weeke).

Results: A total of 42 newborns with varying HIE severity underwent MRI on day five of life. In the overall cohort, abnormalities were reported in three (7%) infants using the Barkovich, in 10 (24%) using the NICHD NRN, and in 24 (57%) using the Weeke score. Agreement was excellent for each score: Barkovich score (k = 1.0), NICHD NRN (k = 0.92), and Weeke score (k = 0.9).

Conclusions: Subtle injury due to mild HIE was detected with the highest frequency using the Weeke score, while inter-rater reliability was excellent for all three scores. These findings suggest that infants with mild HIE and subtle MRI abnormalities may benefit from detailed scoring systems, which is important for studies investigating the benefit of hypothermia in mild HIE.
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http://dx.doi.org/10.1016/j.pediatrneurol.2020.11.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087244PMC
March 2021

Neuroprotection mediated by ST266 requires full complement of proteins secreted by amnion-derived multipotent progenitor cells.

PLoS One 2021 6;16(1):e0243862. Epub 2021 Jan 6.

Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.

ST266 is the biological secretome of cultured Amnion-derived Multipotent Progenitor cells containing multiple growth factors and cytokines. While intranasally-administered ST266 improves the phenotype in experimental optic neuritis, specific ST266 components mediating these effects are not known. We compared the effects of ST266 with and without removal of large molecular weight proteins both in vitro and in the multiple sclerosis model experimental autoimmune encephalomyelitis (EAE) in C57BL/6J mice. Mice were treated daily with intranasal vehicle, ST266 or lower molecular weight fraction of ST266. Retinal ganglion cells were counted in isolated retinas, and optic nerves were assessed for inflammation and demyelination. ST266 treatment significantly improved retinal ganglion cell survival and reduced optic nerve demyelination in EAE mice. The lower molecular weight ST266 fraction significantly improved optic nerve demyelination, but only showed a trend towards improved retinal ganglion cell survival. ST266 fractions below 50kDa increased Schwann cell proliferation in vitro, but were less effective than non-fractionated ST266. Demyelination attenuation was partially associated with the lower molecular weight ST266 fraction, but removal of higher molecular weight biomolecules from ST266 diminishes its neuroprotective effects, suggesting at least some high molecular weight proteins play a role in ST266-mediated neuroprotection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243862PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787369PMC
April 2021

Resistance and resilience of pelagic and littoral fishes to drought in the San Francisco Estuary.

Ecol Appl 2021 03 22;31(2):e02243. Epub 2021 Jan 22.

Delta Stewardship Council, 980 9th Street, Sacramento, California, 95814, USA.

Many estuarine ecosystems and the fish communities that inhabit them have undergone substantial changes in the past several decades, largely due to multiple interacting stressors that are often of anthropogenic origin. Few are more impactful than droughts, which are predicted to increase in both frequency and severity with climate change. In this study, we examined over five decades of fish monitoring data from the San Francisco Estuary, California, USA, to evaluate the resistance and resilience of fish communities to disturbance from prolonged drought events. High resistance was defined by the lack of decline in species occurrence from a wet to a subsequent drought period, while high resilience was defined by the increase in species occurrence from a drought to a subsequent wet period. We found some unifying themes connecting the multiple drought events over the 50-yr period. Pelagic fishes consistently declined during droughts (low resistance), but exhibit a considerable amount of resiliency and often rebound in the subsequent wet years. However, full recovery does not occur in all wet years following droughts, leading to permanently lower baseline numbers for some pelagic fishes over time. In contrast, littoral fishes seem to be more resistant to drought and may even increase in occurrence during dry years. Based on the consistent detrimental effects of drought on pelagic fishes within the San Francisco Estuary and the inability of these fish populations to recover in some years, we conclude that freshwater flow remains a crucial but not sufficient management tool for the conservation of estuarine biodiversity.
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http://dx.doi.org/10.1002/eap.2243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988542PMC
March 2021

Neonatal delivery room CPR: An analysis of the Get with the Guidelines®-Resuscitation Registry.

Resuscitation 2021 01 17;158:236-242. Epub 2020 Oct 17.

Division of Neonatal Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA.

Background: Cardiopulmonary resuscitation (CPR) in the delivery room (DR) after birth is rare. We hypothesized that factors related to maternal, delivery, infant and resuscitation event characteristics associated with outcomes could be identified. We also hypothesized there would be substantial variation from the Neonatal Resuscitation Program (NRP) algorithm.

Methods: Retrospective review of all neonates receiving chest compressions in the DR from the AHA Get With The Guidelines-Resuscitation registry from 2001 to 2014. The primary outcome was return of spontaneous circulation (ROSC) in the DR. Secondary outcome was survival to hospital discharge. Descriptive statistics were used to characterize data. Odds ratios with confidence intervals were calculated as appropriate to compare survivors and non-survivors.

Results: There were 1153 neonates who received chest compressions in the DR. ROSC was achieved in 968 (84%) newborns and 761 (66%) survived to hospital discharge. Fifty-one percent of the cohort received chest compressions without medications. Cardiac compressions were initiated within the first minute of life in 76% of the events, and prior to endotracheal intubation in 79% of the events. In univariate analysis, factors such as prematurity, number of endotracheal intubation attempts, increased time to first adrenaline dose, and CPR duration were associated with decreased odds of ROSC in the DR. Longer CPR duration was associated with decreased odds of ROSC in multivariate analysis.

Conclusion: In this cohort of infants receiving chest compressions following delivery, recognizable pre-birth risk factors as well as resuscitation interventions associated with increased and decreased odds of achieving ROSC were identified. Chest compressions were frequently initiated in the first minute of the event and often prior to endotracheal intubation. Further investigations should focus on methods to decrease time to critical resuscitation interventions, such as successful endotracheal intubation and administration of the first dose of adrenaline, in order to improve DR-CPR outcomes.
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http://dx.doi.org/10.1016/j.resuscitation.2020.10.007DOI Listing
January 2021

Amnion-Derived Multipotent Progenitor Cells Suppress Experimental Optic Neuritis and Myelitis.

Neurotherapeutics 2021 01 16;18(1):448-459. Epub 2020 Oct 16.

Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA.

The human amnion has been used for decades in wound healing, particularly burns. Amnion epithelial cells (AECs) have been the focus of extensive research based on their possible pluripotent differentiation ability. A novel, cultured cell population derived from AECs, termed human amnion-derived multipotent progenitor (AMP) cells, secrete numerous cytokines and growth factors that enhance tissue regeneration and reduce inflammation. This AMP cell secretome, termed ST266, is a unique biological solution that accumulates in eyes and optic nerves following intranasal delivery, resulting in selective suppression of optic neuritis in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis, but not myelitis at the administered dose. We tested the hypothesis that systemic AMP cell administration could suppress both optic neuritis and myelitis in EAE. Intravenous and intraperitoneal administration of AMP cells significantly reduced ascending paralysis and attenuated visual dysfunction in EAE mice. AMP cell treatment increased retinal ganglion cell (RGC) survival and decreased optic nerve inflammation, with variable improvement in optic nerve demyelination and spinal cord inflammation and demyelination. Results show systemic AMP cell administration inhibits RGC loss and visual dysfunction similar to previously demonstrated effects of intranasally delivered ST266. Importantly, AMP cells also promote neuroprotective effects in EAE spinal cords, marked by reduced paralysis. Protective effects of systemically administered AMP cells suggest they may serve as a potential novel treatment for multiple sclerosis.
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http://dx.doi.org/10.1007/s13311-020-00949-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116466PMC
January 2021

Cultural context matters: Testing the minority stress model among Chinese sexual minority men.

J Couns Psychol 2021 Oct 8;68(5):526-537. Epub 2020 Oct 8.

Department of Psychiatry and Human Behavior.

Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men ( = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/cou0000535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026770PMC
October 2021

A Mobile Gaming Intervention for Persons on Pre-Exposure Prophylaxis: Protocol for Intervention Development and Randomized Controlled Trial.

JMIR Res Protoc 2020 Sep 14;9(9):e18640. Epub 2020 Sep 14.

Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.

Background: In the United States, young minority men who have sex with men (MSM) are the most likely to become infected with HIV. Pre-exposure prophylaxis (PrEP) is an efficacious and promising prevention strategy. However, PrEP's safety and effectiveness can be greatly compromised by suboptimal adherence to treatment. To maximize the positive impact of PrEP, it is necessary to combine its prescription with cost-effective behavioral interventions that promote adherence and decrease HIV risk behaviors. In this project, we developed a theoretically informed app/gaming intervention to engage young MSM in learning information, practicing behaviors, and improving motivation for HIV preventative behaviors and PrEP adherence.

Objective: The goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior.

Methods: This study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60).

Results: Institutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing.

Conclusions: This app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings.

Trial Registration: ClinicalTrials.gov RCT02611362; https://tinyurl.com/y65gkuwr.

International Registered Report Identifier (irrid): DERR1-10.2196/18640.
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http://dx.doi.org/10.2196/18640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522735PMC
September 2020

Brief Report: HIV Testing and Risk Among Justice-Involved Youth.

AIDS Behav 2021 May;25(5):1405-1410

UCSF Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.

Justice-involved youth have a number of risk factors for HIV infection, including high rates of substance use, psychiatric comorbidities, and risky sexual behaviors. Although detained youth are likely to receive health care-which may include HIV testing-court-involved, non-incarcerated (CINI) youth may be unlikely to receive HIV testing services either before or during their justice involvement. However, the relationship between risk factors and HIV testing among CINI youth is largely unknown. We explored the association between HIV testing and factors commonly associated with both HIV testing and HIV risk among 173 CINI youth with identified behaviors that put them at risk for HIV acquisition. Only 15.6% of participants reported a lifetime history of HIV testing, despite high rates of sexual and substance use risk behaviors. Age (older), gender (female), sexual orientation (non-heterosexual), recent marijuana use, lifetime use of other drugs, history of a sexually transmitted infection, pap smear in the past year and history of mental health/substance use treatment were all significantly associated with lifetime HIV testing. The extremely low testing rates in this sample emphasize that the juvenile justice system outside of detention is not adequately addressing youths' needs related to HIV testing or ensuring access to testing services for youth at risk of contracting HIV. Results suggest that additional efforts are needed to connect justice-involved youth to healthcare more broadly and HIV testing in particular.
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http://dx.doi.org/10.1007/s10461-020-02978-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855554PMC
May 2021

Challenges to HIV Care and Psychological Health During the COVID-19 Pandemic Among People Living with HIV in China.

AIDS Behav 2020 10;24(10):2764-2765

Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.

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http://dx.doi.org/10.1007/s10461-020-02903-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203543PMC
October 2020

Risk and protective factors for use among adolescents in South Africa.

Addict Behav Rep 2020 Jun 21;11:100277. Epub 2020 Apr 21.

Brown University School of Public Health, Department of Behavioral and Social Sciences Brown University School of Public Health, 121 S Main St, Providence, Rhode Island 02903, USA.

Background: Antiretroviral therapy (ART) is publicly available in South Africa in response to the urgent need to address HIV and AIDS. Off-label use of ARV medication alone or in combination with other substances is known as "" and "" in South Africa. Diversion of ARVs for whoonga use is not well understood, especially among adolescents. This secondary analysis explores risk and protective factors for adolescent use in a community-based HIV endemic setting.

Methods: Data on use were derived from a baseline survey of N = 200 adolescents recruited for participation in a randomized controlled trail to reduce adolescent HIV risk behaviors and depression. Risk and protective factors for adolescent use were explored using an ecological systems framework using one-way ANOVAs, chi-squared tests and hierarchical regression.

Results: Individual level factors increased the odds of use or known use such as child age OR:1.22 (95% CI, 1.03-1.43), hazardous drug use OR:1.62 (95% CI, 1.02-2.59), and hazardous alcohol OR:1.80 (95% CI, 1.05-3.09). Food insecurity appears to have a slightly protective effect on the odds of use or reports of use among people adolescents knew OR:0.649 (95% CI, 0.541-0.779).

Conclusions: Larger epidemiological studies should expand the surveillance of hazardous alcohol use and illicit drug use, specifically for recreational use of prescription medication. Granular data is warranted to characterize the patters of use, especially among highly vulnerable populations. Future surveillance studies that explore these multi-level relationships are warranted to further understand this phenomenon among teens in South Africa.
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http://dx.doi.org/10.1016/j.abrep.2020.100277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195513PMC
June 2020

Latino STYLE: Preliminary Findings From an HIV Prevention RCT Among Latino Youth.

J Pediatr Psychol 2020 05;45(4):411-422

Department of Psychiatry and Human Behavior, Rhode Island Hospital, Brown University.

Objective: Latino STYLE is a family-centered, HIV-focused intervention (HIV) emphasizing cultural factors and parent-adolescent communication. We hypothesized that, compared with a general health promotion (HP) intervention, the HIV arm would improve caregiver and adolescent HIV knowledge, attitudes, parental monitoring, sexual communication, and family relationships after a 3-month postintervention period. This article reports on the short-term findings of the longer trial.

Methods: A single-site, two-arm, parallel, family-based, randomized, controlled trial was conducted; eligible participants were Latino adolescents aged 14-17 and their primary caregiver. The study was conducted at the University of South Florida with 227 adolescent-caregiver dyads allocated to the HIV (n = 117) or HP (n = 110) intervention after completing a baseline assessment. Interim measures at 3-month follow-up included demographics, HIV knowledge, self-efficacy, parental monitoring, sexual communication, family relationships, and adolescent sexual behavior.

Results: Adolescents in the HIV group reported small effects in parental permissiveness and the HP group reported small effects for family support. Caregivers in both groups reported decreases in all outcomes. Incidence of past 90-day sexual intercourse decreased in both treatment arms. Among those who were sexually active over the past 90 days, the number of sex acts decreased from baseline, particularly in the HIV group. The percentage of condom-protected sex acts increased in the HIV group and decreased in the HP group, but did not reach statistical significance.

Conclusions: The HIV Latino STYLE intervention was not efficacious in improving hypothesized outcomes over a 3-month period. However, exploratory analyses revealed moderate effects for decreases in adolescent sexual risk behavior, particularly in the HIV group.
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http://dx.doi.org/10.1093/jpepsy/jsaa019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182404PMC
May 2020

Acceptability, Feasibility, and Preliminary Efficacy of a Resilience-Oriented Family Intervention to Prevent Adolescent HIV and Depression: A Pilot Randomized Controlled Trial.

AIDS Educ Prev 2020 02;32(1):67-81

Alpert Medical School of Brown University, Providence, Rhode Island, and the Providence/Boston Center for AIDS Research.

We tested the acceptability, feasibility, and preliminary efficacy of Our Family Our Future, a resilience-oriented intervention engaging families in prevention of adolescent HIV and depression. South African adolescents, 13-15 years of age, with mild depressive symptoms, were randomized to intervention or wait-list using parallel assignment in a single-blind trial. HIV risk behavior and depression were evaluated at baseline, 1, and 3 months. We examined intervention satisfaction, fidelity, trial retention, and preliminary efficacy. One hundred-ninety-six adolescent-parent dyads completed eligibility screening and baseline, and n = 73 dyads were randomized. All families ranked intervention quality as good or excellent. Over 90% were satisfied with content. Facilitators were adherent to intervention protocol. All families were retained in post-intervention assessments. Intervention recipients reported diminished depressive symptoms, inconsistent condom use, and sexual activity, as well as increased HIV testing. Our Family Our Future is highly acceptable and feasible and should be tested in a future efficacy trial.
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http://dx.doi.org/10.1521/aeap.2020.32.1.67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250140PMC
February 2020

Adherence to HIV Care and Associated Health Functioning among Youth Living with HIV in Sub-Saharan Africa.

AIDS Rev 2020 07 8;22(2):93-102. Epub 2020 Jul 8.

Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island.

Older adolescents and young adults (youth) living with HIV (YLH) in sub-Saharan Africa (SSA) are at high risk for poor HIV treatment adherence and associated negative health outcomes including viral nonsuppression. To describe this risk, we conducted a comprehensive review of studies involving YLH. Eligible studies compared youth adherence or adherence-related health functioning to older or younger samples, examined factors associated with adherence or health outcomes among YLH, or evaluated adherence interventions with YLH. Databases searched included MEDLINE, Web of Science, Global Health, CINAHL, Africa-Wide Information, PsycINFO, and the Cochrane Library. Of the 7054 articles found, 156 were reviewed and 130 were eligible. Across 16 adherence-related behaviors or health outcomes such as lost to follow-up, retention in care, antiretroviral use, CD4 count, viral suppression, and mortality, 73% of studies comparing YLH to other age groups (n = 106) found worse outcomes among YLH. In 22 studies, barriers and facilitators to adherence were identified, some unique to YLH (e.g., conflicting treatment expectations of providers) and some common to other age groups. Finally, of the eight adherence interventions with YLH reviewed, five showed evidence of being effective. Our findings suggest that YLH in SSA faces numerous obstacles to engaging in HIV treatment across a range of shifting social contexts. Accounting for this group's transition to treatment self-management, developmentally tailored and holistic interventions should be the focus of adherence promotion efforts.
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http://dx.doi.org/10.24875/AIDSRev.20000101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517615PMC
July 2020

Recreational Use of HIV Antiretroviral Medication and Implications for HIV Pre-exposure Prophylaxis and Treatment.

AIDS Behav 2020 Sep;24(9):2650-2655

Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02912, USA.

Diversion of antiretroviral therapy (ART) for recreational use is concerning for countries with high HIV prevalence. This paper presents reports of recreational use of ART among adolescents from two HIV prevention studies in South Africa: (1) a cross-sectional survey of N = 200 adolescents and (2) a qualitative study of pre-exposure prophylaxis with N = 57 adolescents and N = 25 clinicians. Among adolescents, 3% used and 14% knew someone who used non-prescribed ART for recreational purposes. Administration included smoking (71%), snorting (15%), injecting (15%), ingesting (15%), and inserting (3%). Participants predicted increased crime as recreational use of ART increased. Future studies should investigate prevalence, composition, and diversion of ART from HIV prevention and treatment.
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http://dx.doi.org/10.1007/s10461-020-02821-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725396PMC
September 2020

An evaluation and review of English language pre-exposure prophylaxis websites and YouTube videos.

Int J STD AIDS 2020 04 4;31(5):460-466. Epub 2020 Mar 4.

Warren Alpert Medical School of Brown University, Providence, RI, USA.

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http://dx.doi.org/10.1177/0956462420905271DOI Listing
April 2020

A Mobile Intervention to Improve Uptake of Pre-Exposure Prophylaxis for Southern Black Men Who Have Sex With Men: Protocol for Intervention Development and Pilot Randomized Controlled Trial.

JMIR Res Protoc 2020 Feb 20;9(2):e15781. Epub 2020 Feb 20.

Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States.

Background: The uptake of pre-exposure prophylaxis (PrEP) has been slow for young black men who have sex with men (BMSM) living in the southern United States. This is a significant issue because 8 of the 10 states with the highest rates of new HIV infections are in the South. Jackson, Mississippi (MS), the site of this project, has the second highest AIDS diagnosis rate in the nation and the highest rate of HIV infection for young, urban BMSM. This study will develop and test an engaging, interactive, and cost-effective mobile messaging intervention to improve engagement in PrEP care for BMSM aged 18 to 35 years living in Jackson, MS.

Objective: The goals of this mixed methods study are to (1) conduct qualitative interviews with young BMSM in Jackson, MS, to understand individual, community, and structural barriers affecting engagement in PrEP-related care, (2) assemble a PrEP mobile messaging intervention that includes text messages with publicly available internet content (websites and YouTube videos) that provide factual information, motivational materials, and behavioral skills related to PrEP and HIV prevention, and (3) evaluate the preliminary efficacy of the intervention in a randomized controlled study with PrEP-eligible BMSM receiving care in STI/HIV testing clinics in Jackson, MS.

Methods: This research protocol will be conducted in 2 phases. A development phase will involve in-depth interviews (n=30) with PrEP-eligible BMSM who receive care in STI/HIV testing clinics in MS. These interviews will allow researchers to select the texted material that will be sent out during the intervention. The second phase will consist of an unblinded, small, randomized controlled trial among 66 new participants to examine the preliminary efficacy of the intervention compared with enhanced standard of care (ESC) on attendance at a PrEP services appointment (the first step in initiating PrEP care) and receipt of a PrEP prescription, based on self-report and electronic medical records. The free, publicly available material will be sent to PrEP-eligible BMSM in 8 to 16 interactive text messages over 4 weeks. Study assessments will occur at enrollment and at 4- and 16-weeks postenrollment and can be completed online or in person. All participants will be recruited from a local clinic.

Results: Institutional review board approval was received on January 16, 2017, and research activities, subsequently, began in February 2018. Recruitment for the study concluded in November 2019. In total, 65 participants were randomized with 33 being assigned to the intervention and 32 to ESC. Collection of follow-up data is ongoing.

Conclusions: This PrEP mobile messaging intervention aims to increase uptake of PrEP by BMSM in the southern United States. This intervention uses interactive, tailored text messaging and appealing free Web content (publicly accessible educational websites and YouTube videos) to promote linkage to PrEP care and increase HIV preventative behaviors. A cost-effective PrEP mobile messaging intervention has great potential to improve information about PrEP, improve motivation to use PrEP, and decrease stigma and structural barriers that often prevent engagement in PrEP-related medical care.

Trial Registration: ClinicalTrials.gov NCT03308097; https://clinicaltrials.gov/ct2/show/NCT03308097.

International Registered Report Identifier (irrid): DERR1-10.2196/15781.
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http://dx.doi.org/10.2196/15781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059079PMC
February 2020

Neighborhood Stress and Life Satisfaction: Is there a Relationship for African American Adolescents?

Appl Res Qual Life 2020 Mar;15(1):273-296

Department of Psychology, Center for Health and Behavior, Syracuse University, Syracuse, NY 13244 USA.

This study identified associations between perceived neighborhood stress and adolescents' perceptions of life satisfaction. African American adolescents aged 13-18 (=1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.
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http://dx.doi.org/10.1007/s11482-018-9679-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7009313PMC
March 2020

Can a Multilevel STI/HIV Prevention Strategy for High Risk African American Adolescents Improve Life Satisfaction?

J Happiness Stud 2020 Feb 19;21(2):417-436. Epub 2019 Feb 19.

Department of Psychology, Center for Health and Behavior, Syracuse University, Syracuse, NY, USA.

Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected ( = 5.19, = .02, = .03), along with three interactions: between experimental condition and media intervention ( = 7.96, = .005, = .04); experimental condition, sex, and media intervention ( = 6.51, = .01, = .04); and experimental condition, sex, assessment point, and media intervention ( = 3.23, = .01, = .02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants' life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.
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http://dx.doi.org/10.1007/s10902-019-00084-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023228PMC
February 2020

Does Initiating Vaginal Sexual Intercourse During a Safer Sex Media Campaign Influence Life Satisfaction Among African American Adolescents?

J Adolesc Health 2020 07 23;67(1):40-45. Epub 2019 Nov 23.

Department of Psychology, Center for Health & Behavior, Syracuse University, Syracuse, New York.

Purpose: Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787).

Methods: Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender.

Results: A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased -.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males.

Conclusions: Although Project iMPPACS was not designed with the intent on improving participants' life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time.
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http://dx.doi.org/10.1016/j.jadohealth.2019.09.001DOI Listing
July 2020

Intervention Messaging About Pre-Exposure Prophylaxis Use Among Young, Black Sexual Minority Men.

AIDS Patient Care STDS 2019 11;33(11):473-481

Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, Rhode Island.

Approximately 1.1 million individuals in the United States are living with HIV/AIDS. HIV disproportionately affects young, black men who have sex with men (YBMSM). Recent biomedical advances, including the use of antiretroviral therapy as pre-exposure prophylaxis (PrEP), hold promise for preventing HIV infections. However, PrEP uptake remains slow among those most at-risk. To develop and test an intervention to address HIV disparities in YBMSM, we conducted qualitative interviews with 29 YBMSM from Jackson, Mississippi, to learn more about their views of PrEP. Twenty-nine PrEP-eligible YBMSM were enrolled and participated in either semistructured interviews or focus groups. They were asked about PrEP use, messaging, and promotion. Data were coded based on an iteratively developed coding scheme and entered into NVivo to facilitate thematic analysis. Our analysis identified the following three main themes: (1) the role of setting, context, and stigma in health care, (2) targeted PrEP messaging is further stigmatizing, and (3) recommendations for PrEP messaging and care. YBMSM in our sample felt highly stigmatized in their current environment and felt that PrEP messaging targeting YBMSM only enhanced their sense of marginalization. They concluded that broad and inclusive messaging would be just as relevant and cause less stigma. Our findings were somewhat surprising, as several prior studies benefited from using targeted materials to engage YBMSM in HIV prevention and PrEP uptake. The study's location may explain this difference in findings, which suggests the importance of considering local conditions and opinions when developing interventions for HIV prevention among minority populations.
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http://dx.doi.org/10.1089/apc.2019.0139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839422PMC
November 2019
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