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"Edeza Alberto"
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“Health Is on the Back Burner:” Multilevel Barriers and Facilitators to Primary Care Among People Who Inject Drugs
BackgroundThe estimated 2.2 million people who inject drugs (PWID) in the USA experience significant gaps in preventive healthcare and a high burden of infectious, psychiatric, and other chronic diseases. Many PWID rely on emergency medical services, which are costly and not designed to deliver preventive services, manage chronic conditions, or address social needs.ObjectiveThe objective of this study was to explore barriers and facilitators to primary care utilization from the perspectives of PWID in New England, a region highly affected by the overdose crisis.DesignParticipants completed semi-structured qualitative interviews exploring substance use and healthcare utilization patterns.ParticipantsWe recruited 78 PWID through community-based organizations (e.g., syringe service programs) in 16 urban and non-urban communities throughout Massachusetts and Rhode Island.ApproachThematic analysis identified barriers and facilitators to primary care utilization at the individual, interpersonal, and systemic levels.Key ResultsAmong 78 PWID, 48 described recent primary care experiences; 33 had positive experiences and 15 described negative experiences involving discrimination or mistrust. Individual-level barriers to primary care utilization included perceived lack of need and competing priorities (e.g., avoiding opioid withdrawal, securing shelter beds). Interpersonal-level barriers included stigma and perceived low quality of care for PWID. Systemic-level barriers included difficulty navigating healthcare systems, inadequate transportation, long wait times, and frequent provider turnover. Participants with positive primary care experiences explained how appointment reminders, flexible hours, addiction medicine–trained providers, case management services, and transportation support facilitated primary care utilization and satisfaction.ConclusionsFindings regarding the multilevel barriers and facilitators to accessing primary care among PWID identify potential targets for programmatic interventions to improve primary care utilization in this population. Based on these findings, we make recommendations for improving the engagement of PWID in primary care as a means to advance individual and public health outcomes.
Journal Article
“I Do Try To Use Condoms, But…”: Knowledge and Interest in PrEP Among Male Sex Workers in Mexico City
In Mexico City, male sex workers (MSWs) are up to 126 times more likely to be living with HIV than the general public. We conducted interviews with 23 MSWs in Mexico City to examine their subjective understandings about their sexual risk behaviors and explore opportunities about HIV pre-exposure prophylaxis (PrEP) as a prevention approach in this group. Despite knowledge about sexual HIV risks, most participants reported condomless anal sex with clients. There was very little prior knowledge about PrEP, but very high interest in using a daily pill for prevention. Several participants expected an increase in condomless anal sex if taking PrEP, because of monetary incentives from clients or a perceived increase in pleasure. Additionally, seasonal sex workers expressed interest in using PrEP only during months when they were performing sex work. PrEP implementation efforts through Mexico’s healthcare system should recognize the varying needs and sexual risk behaviors of MSWs.
Journal Article
Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men
The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative.
This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM.
We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness.
Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus
Journal Article
“We don't get much of a voice about anything”: perspectives on photovoice among people who inject drugs
Background
In the context of the current US opioid crisis, people who inject drugs (PWID) are increasingly researched, but their ability to tell their own stories may be limited. Photovoice is a participatory action research method that allows participants to use photography to directly depict their experiences.
Methods
We conducted interviews with PWID (
n
= 33) as part of a qualitative study on the health needs of PWID in the USA to explore interest and acceptability of photovoice as a potential research method and way to share their voices.
Results
Participants identified facilitators and barriers to participating in a future photovoice project. Facilitators included a chance to depict one’s unique experience, help others in need by sharing one’s own story, and photography being a more “comfortable” way to tell their stories than traditional research methods. Barriers included safety concerns, embarrassment, and ability to retain cameras. Participants also identified areas of sensitivity related to documenting drug use.
Conclusions
While we found broad acceptability of photovoice, barriers would need to be addressed and additional training and support for research staff and potential participants related to the ethics of public photography and engaging PWID in photovoice research would be required.
Journal Article
Evidence-based and guideline-concurrent responses to narratives deferring HCV treatment among people who inject drugs
Background
Hepatitis C virus (HCV) infection is increasingly prevalent among people who inject drugs (PWID) in the context of the current US opioid crisis. Although curative therapy is available and recommended as a public health strategy, few PWID have been treated. We explore PWID narratives that explain why they have not sought HCV treatment or decided against starting it. We then compare these narratives to evidence-based and guideline-concordant information to better enable health, social service, harm reduction providers, PWID, and other stakeholders to dispel misconceptions and improve HCV treatment uptake in this vulnerable population.
Methods
We recruited HIV-uninfected PWID (
n
= 33) through community-based organizations (CBOs) to participate in semi-structured, in-depth qualitative interviews on topics related to overall health, access to care, and knowledge and interest in specific HIV prevention methods.
Results
In interviews, HCV transmission and delaying or forgoing HCV treatment emerged as important themes. We identified three predominant narratives relating to delaying or deferring HCV treatment among PWID: (1) lacking concern about HCV being serious or urgent enough to require treatment, (2) recognizing the importance of treatment but nevertheless deciding to delay treatment, and (3) perceiving that clinicians and insurance companies recommend that patients who currently use or inject drugs should delay treatment.
Conclusions
Our findings highlight persistent beliefs among PWID that hinder HCV treatment utilization. Given the strong evidence that treatment improves individual health regardless of substance use status while also decreasing HCV transmission in the population, efforts are urgently needed to counter the predominant narratives identified in our study. We provide evidence-based, guideline-adherent information that counters the identified narratives in order to help individuals working with PWID to motivate and facilitate treatment access and uptake. An important strategy to improve HCV treatment initiation among PWID could involve disseminating guideline-concordant counternarratives to PWID and the providers who work with and are trusted by this population.
Journal Article
Integrating Pre- and Post-exposure Prophylaxes Programs for HIV Prevention Guidelines in Manila, Philippines
IntroductionSuccessful implementation and promotion of biomedical HIV prevention strategies like pre- and post-exposure prophylaxes (PrEP/PEP) necessitate healthcare workers possessing sufficient knowledge of and positive attitudes toward PrEP/PEP.MethodsUsing semi-structured qualitative interviews conducted between July and August 2017, we examined PrEP/PEP awareness and attitudes among 15 healthcare workers as key informants in Manila, Philippines, where HIV is a rapidly expanding national public health crisis.ResultsMost key informants had heard about PrEP (n = 11) and PEP (n = 14). High medication cost and low PrEP/PEP awareness were identified as major barriers for PrEP/PEP implementation. Others expressed concerns for viral resistance and greater risk compensation. Concerns about infrastructural issues such as problems with logistics and funding inequities were identified as potential barriers.ConclusionHealthcare workers demonstrated awareness of PrEP/PEP and endorsed supportive attitudes toward PrEP/PEP but raised logistic and infrastructural concerns about implementation.Policy ImplicationsIn order for PrEP/PEP to be feasible in the Philippines, public funding, provider education, and standardized national prescription protocols, guidelines, and policies are needed. Such recommendations and support should take into account concerns of and address prescribing barriers among future PrEP/PEP providers.
Journal Article
Risk Perception and Interest in HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men with Rectal Gonorrhea and Chlamydia Infection
Rectal gonorrhea and chlamydia infections are associated with significantly increased risk of HIV transmission among gay, bisexual, and other men who have sex with men (MSM). MSM diagnosed with rectal gonorrhea or chlamydia may benefit from pre-exposure prophylaxis (PrEP) for HIV prevention. We analyzed HIV risk perception, PrEP interest, and sexually transmitted infection (STI) test results among MSM presenting to a publicly funded STI clinic from 2014 to 2016. A total of 401 MSM were tested for rectal STIs during the study period: 18% were diagnosed with rectal gonorrhea or chlamydia infection. Patients who perceived themselves to be at medium or high risk for HIV were significantly more likely to express interest in PrEP compared to those who reported low or no perceived risk (OR 1.88, 95% CI 1.13–3.11;
p
= .014). However, there was no significant difference in perceived HIV risk between those who were diagnosed with a rectal STI and those who were not. Although rectal STIs are a significant risk factor for HIV infection, MSM diagnosed with a rectal STI did not perceive themselves to be at increased risk for HIV infection, indicating a potential barrier to successful PrEP implementation in this population.
Journal Article
Expanding Gender-Based Health Equity Framework for Transgender Populations
The gender-transformative approach to health promotion in the United States and globally has been central to defining gender as a determinant of health and advancing health programs, services, and policies that respond to gender-based inequities. However, current gender frameworks are built on historical perspectives that center cisgender people's experiences and reinforce the gender binary. This restricted focus does not respond to health inequities experienced by transgender people—to the detriment of health programs, services, and policies. As transgender people's health and rights continue to garner attention in movements across health services and policy spaces, it is crucial for frameworks to be expansively redefined to achieve truly transformative gender equality and equity for all gender identities and expressions.
Journal Article
Catch of the Potato Psyllid Bactericera Cockerelli (Hemiptera: Triozidae) with Yellow Sticky Traps Covered with Mesh of Different Color and Size
Bactericera cockerelli
is a key pest in potato fields throughout the Americas. Yellow sticky traps are widely used for monitoring
B. cockerelli
within fields and regions. However, these traps lack specificity, which reduces their effectiveness and longevity. Using a mesh to cover their surface is a simple and efficient alternative to improve this limitation. Nevertheless, mesh traits may influence their effectiveness and there are currently no studies examining this for
B. cockerelli
. Two outdoor experiments were performed to evaluate the capture of
B. cockerelli
using twelve mesh colors and three sizes. Unmeshed traps were used as control. Additionally, the cleanliness of the traps (nontarget organisms and debris) was also evaluated. The experiments showed that yellow and medium (2.6 mm
2
hexagon-shape grooves)/large (4.5 mm
2
diamond-shape grooves) meshes did not significantly reduce the number of
B. cockerelli
caught and increased the trap cleanliness. Two additional experiments validated these traits. This study provides new useful insights for monitoring
B. cockerelli
with yellow traps.
Journal Article
Comparison of yellow sticky trap traits and placement for monitoring Anthonomus eugenii (Coleoptera: Curculionidae) adults in outdoor peppers (Capsicum spp.)
Opportune detection of Anthonomus eugenii is a fundamental aspect of any management program to this pest. Yellow traps are the most common monitoring strategy, and its efficacy is related with the trap design and placement within crops. However, there’s limited information on this. Two outdoor experiments were performed to determine the efficiency of traps with six different shapes (circle, square, diamond, ellipse, rectangle, and triangle) and seven frame colors (yellow, dark green, black, red, white, purple, and blue); seven to the traps placement at four orientations (North, South, East and West), five aside distances from the bed center (0, 20, 40, 60 and 80 cm aside to the inter-bed space) and six heights (0, 20, 40, 60, 80 and100 cm) on A. eugenii adults. There wasn’t significant difference among shapes and orientations. Traps with yellow, dark green and black frames had the highest number of insects. For the aside distance, the plots were categorized according to their width as narrow (54–65 cm) and wide (71–81 cm), the highest insects caught was exhibited on traps at 0–20 and 0–40 cm, respectively. Regarding the traps height, they were classified according to their height as short (62–64 cm), medium (78–82 cm) and tall (90–92 cm), the highest insects caught was exhibited on traps at 20–40, 40–60, and 40–80 cm, respectively. Regression analyzes indicate that catches decrease as the traps are installed into the inter-bed space and above the canopy. This study provides novel information to improve outdoor programs to monitor A. eugenii.
Journal Article