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Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) for HIV prevention may improve adherence for those with concerns with daily pills. Limited data exist on LAI-PrEP acceptability among Black women in the U.S., a population vulnerable to HIV. We assessed willingness to use LAI-PrEP among Black women eligible for PrEP in the Southern U.S. We conducted a cross-sectional online survey of HIV-negative Black women from March to June 2022 in the U.S. South. Participants provided information on sociodemographic characteristics, HIV knowledge, PrEP awareness, and use, stigma, risk perception, medical mistrust, and healthcare access. Multivariate logistic regression models determined factors associated with willingness to use LAI-PrEP. Of 491 women, the mean (SD) age was 40.1 (17.5), 53% of participants had a college degree or lower, 79% were single, and 80% resided in urban/suburban settings. Thirty-nine percent were aware of PrEP before the study and 36.7% of women were willing to use LAI-PrEP. In multivariate analyses, PrEP awareness [adjusted odds ratio (aOR=2.37, 95% CI 1.40, 3.73, p < 0.001), having a personal clinician (aOR=2.01, 95% CI 1.10, 3.68, p = 0.02), HIV worried (aOR=1.78, 95% CI 1.09, 2.89, p = 0.02), and medical trust (aOR=1.41, 95% CI 1.03, 1.93, p = 0.04) were statistically associated with willingness to use LAI-PrEP. However, the healthcare stereotype (beliefs that healthcare is biased) had lower odds of using LAI-PrEP (aOR=0.94, 95% CI 0.89, 0.99, p = 0.04). Black women at risk for HIV are more likely to consider injectable PrEP when they understand HIV risk factors, are aware of PrEP, have a clinician, and trust the medical care. Implementing client-centered care interventions could effectively address medical mistrust and enhance engagement in HIV prevention services among Black women.

Background Disparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals’ lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access–affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South. Method Between January 2019 to February 2020, we conducted twenty-five life-history interviews with low-income individuals who may become pregnant living in suburban counties in Georgia, USA. Interviews covered the ways individual and health system access factors influenced care-seeking for family planning over the life course. Interview transcripts were analyzed using a thematic analysis approach to identify experiences associated with individual and health system access. Results Affordability was identified as a major determinant of access, one tied to unique combinations of individual factors (e.g., financial status) and health system characteristics (e.g., cost of methods) that fluctuated over time. Navigating the process to attain affordable care was unpredictable and had important implications for care-seeking. A “poor fit” between individual and health system factors could lead to inequities in access and gaps in, or non-use of contraception. Participants also reported high levels of shame and stigma associated with being uninsured or on publicly funded insurance. Conclusions Affordability is one domain of contraceptive access that is shaped by the interplay between individual factors and health system characteristics as well as by larger structural factors such as health and economic policies that influence both. Assessments of the affordability of contraceptive care must account for the dynamic interplay among multilevel influences. Despite the expansion of contraceptive coverage through the Affordable Care Act, low-income individuals still struggle with affordability and disparities persist.

Background Psychological trauma is a highly prevalent driver of poor health among people with HIV in the Southern United States. Trauma-informed care (TIC) has potential to advance national Ending the HIV Epidemic goals, but formative research is needed to tailor TIC implementation to complex and interdependent HIV networks. Methods We applied a community-based participatory research approach to iteratively engage personnel from high-volume HIV care institutions in Nashville, Tennessee. Current practices and potential implementation determinants were identified through participatory process mapping and key informant interviews. The Consolidated Framework for Implementation Research was applied to deductively code interview data. Personnel attending a dissemination summit developed a network-wide implementation plan. Results Data were collected with personnel from five institutions (e.g., community-based organizations, primary care clinics, public health department), via process mapping ( n  = 48), interviews ( n  = 35) and a summit ( n  = 17). Results suggest there are limited trauma screenings, assessments, and services across the network. Relevant Characteristics of Individuals included a trauma-sensitive workforce committed to continuous learning and TIC adoption. Relevant Inner Setting Factors were networks and communications, with strong tension for change, high compatibility with TIC, and need for advancing cultural responsiveness. Relevant Outer Setting Factors included patient needs and resources and cosmopolitanism, with need for better leveraged mental health services. Relevant Process domains were champions and leadership, with need to diversify championship among leaders. Relevant Intervention Characteristics included relative advantage and complexity, with need for personnel wellness initiatives and increased engagement with the community as service designers. Four recommendations included development of shared communication systems, personnel wellness campaigns, routine evaluations to inform practices, and culturally responsive care initiatives. Conclusion Modifiable TIC determinants were identified, and a community-created implementation plan was developed to guide adoption. Future research should focus on city-wide implementation and strengthening pre-implementation research in other settings.

Postpartum family planning (PPFP) reduces adverse maternal-child outcomes related to short interpregnancy intervals and unintended pregnancies. This mixed-method study assessed PPFP needs in rural government health facilities as well as clients' knowledge and barriers to PPFP uptake in Rwanda. From May-July 2023, we conducted cross-sectional PPFP needs assessments in rural government health facilities and focus group discussions (FGDs) among couples attending antenatal clinics to understand women's and men's perceptions and barriers to PPFP uptake. Quantitative data were collected from twelve rural government health facilities (two hospitals, four health centers, six health posts). Qualitative data were collected during six FGD with 6-12 participants per session. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically with a deductive approach. Seventeen (65%) hospital nurses and 11 (23%) health center nurses were trained in implant insertion, and six (23%) hospital nurses and four (9%) health center nurses were trained in postpartum intrauterine device (PPIUD) insertion. Hospitals provided an average of 204 postpartum implants (29% of deliveries) and seven PPIUDs per month (1% of deliveries), while health centers provided 25 postpartum implants and no PPIUDs per month. At health posts, there was no equipment for implant or intrauterine device (IUD) provision. FGD findings revealed that couples have access to family planning counseling at the health center, but they were concerned about limited information on contraceptive method mechanisms of action and side effects; knowledge about and access to IUD/PPIUD was especially limited. Enhanced PPFP training and provision is needed in rural areas, especially for PPIUD. Knowledge gaps and concerns about side effects were emphasized in FGDs. PPFP demand creation strategies tailored for the rural populace as well as rural provider training could improve PPFP access and uptake in rural government clinics of Rwanda.

Approximately half of people living with HIV (PLWH) in the United States are not retained in HIV care. Although numerous studies have identified individual-level barriers to care (i.e., substance abuse, mental health, housing, transportation challenges), less is known about institutional-level barriers. We aimed to identify clinic-level barriers to HIV care and strategies to address them to better engage PLWH who have been out of care (PLWH-OOC). As part of a larger qualitative study in a Ryan White-funded HIV Clinic in Atlanta, which aimed to understand the acceptance and feasibility of community-based HIV care models to better reach PLWH-OOC, we explored barriers and facilitators of HIV care engagement. From October 2022-March 2023, 18 in-depth-interviews were conducted with HIV-care providers, administrators, social workers, and members of a Community Advisory Board (CAB) comprised of PLWH-OOC. Transcripts were coded by trained team members using a consensus approach. Several clinic-level barriers emerged: 1) the large burden placed on patients to provide proof of eligibility to receive Ryan White Program services, 2) inflexibility of provider clinic schedules, 3) inadequate processes to identify patients at risk of disengaging from care, 4) poorly-resourced hospital-to-clinic transitions, 5) inadequate systems to address primary care needs outside of HIV care, and 6) HIV stigma among medical professionals. Strategies to address these barriers included: 1) colocation of HIV and non-HIV services, 2) community-based care options that do not require patients to navigate complex transportation systems, 3) hospital and community-based peer navigation services, 4) dedicated staffing to identify and support PLWH-OOC, and 5) enhanced systems support to help patients collect the high burden of documentation required to receive subsidized HIV care. Several systems-level HIV care barriers exist and intersect with individual and community-level barriers to disproportionately affect HIV care engagement among PLWH-OOC. Findings suggest several strategies that should be considered to reach the remaining 50% of PLWH who remain out-of-care.

Background Sexual violence—any sexual act committed against a person without freely given consent—disproportionately affects women. Women’s first experiences of sexual violence often occur in adolescence. In Asia and the Pacific, 14% of sexually experienced adolescent girls report forced sexual debut. Early prevention with men that integrates a bystander framework is one way to address attitudes and behavior while reducing potential resistance to participation. Methods This paper describes a study protocol to adapt RealConsent for use in Vietnam and to test the impact of the adapted program—GlobalConsent—on cognitive/attitudinal/affective mediators, and in turn, on sexual violence perpetration and prosocial bystander behavior. RealConsent is a six-session, web-based educational entertainment program designed to prevent sexual violence perpetration and to enhance prosocial bystander behavior in young men. The program has reduced the incidence of sexual violence among men attending an urban, public university in the Southeastern United States. We used formative qualitative research and the Centers for Disease Control and Prevention’s Map of the Adaptation Process to adapt RealConsent. We conducted semi-structured interviews with college men ( n  = 12) and women ( n  = 9) to understand the social context of sexual violence. We conducted focus group discussions with university men and stakeholders ( n  = 14) to elicit feedback on the original program. From these data, we created scripts in storyboard format of the adapted program. We worked closely with a small group of university men to elicit feedback on the storyboards and to refine them for acceptability and production. We are testing the final program—GlobalConsent—in a randomized controlled trial in heterosexual or bisexual freshmen men 18–24 years attending two universities in Hanoi. We are testing the impact of GlobalConsent ( n  = 400 planned), relative to a health-education attention control condition we developed (n = 400 planned), on cognitive/attitudinal/affective mediators, prosocial bystander behavior, and sexual violence perpetration. Discussion This project is the first to test the impact of an adapted, theoretically grounded, web-based educational entertainment program to prevent sexual violence perpetration and to promote prosocial bystander behavior among young men in a middle-income country. If effective, GlobalConsent will have exceptional potential to prevent men’s sexual violence against women globally. Trial registration U.S. National Library of Medicine Clinicaltrials.gov NCT04147455 on November 1, 2019 (Version 1). Retrospectively registered. Protocol amendments will be submitted to clinicaltrials.gov .

There remain unmet HIV prevention needs in China, particularly among gay, bisexual, and other men who have sex with men. Technology-based interventions are increasingly used in HIV prevention worldwide. We aimed to conduct a systematic review and meta-analysis of studies to assess the effectiveness of technology-based HIV prevention interventions to improve HIV testing and consistent condom use in China. We searched English-language (PubMed and MEDLINE, Embase, and Web of Science) and Chinese-language (Wanfang, WEIPU, and China National Knowledge Infrastructure) databases for technology-based HIV prevention intervention studies published between January 1, 2004, and September 30, 2021. Eligible studies were technology-based HIV prevention intervention studies with outcomes of HIV testing or condom use among men who have sex with men or transgender women using randomized controlled or nonrandomized pretest-posttest designs in China. The intervention technologies identified were apps, web pages, and other types of electronic communications (eg, email, SMS text messages, and video messages). A Bayesian meta-analysis was conducted to estimate the pooled effect size and 95% credible interval (CrI). We added study and intervention features as covariates to explore their associations with the study effects. Study quality was assessed using the integrated quality criteria for review of multiple study designs. Publication bias was assessed using funnel plots and robust Bayesian meta-analyses. We identified 1214 and 1691 records from English-language and Chinese-language databases, respectively. A total of 141 records entered full-text screening, and 24 (17%) studies were eligible for the review. Approximately half (14/24, 58%) of the interventions were delivered through social media platforms, predominantly using message-based communication. The remaining studies used email and web-based platforms. The pooled effect sizes estimated were an absolute increase of 20% (95% CrI 10%-30%) in HIV testing uptake and an absolute increase of 15% (95% CrI 5%-26%) in consistent condom use. The pooled point estimate of the effect of randomized controlled trials was smaller than that of nonrandomized studies for HIV testing uptake (16% vs 23%) and consistent condom use (10% vs 19%), but their CrIs largely overlapped. Interventions lasting >6 months were associated with a 35% greater uptake of HIV testing (95% CrI 19%-51%) compared to those lasting 6 months. Technology-based HIV prevention interventions are promising strategies to improve HIV testing uptake and consistent condom use among men who have sex with men in China, with significant effects found across a broad array of studies and study designs. However, many studies in this review did not include randomized designs or a control group. More rigorous study designs, such as randomized controlled trials, are needed, with outcome measurements that address the limitation of self-report outcomes to inform the development and implementation of future intervention programs. PROSPERO CRD42021270856; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021270856.

Background Experiences of discrimination in healthcare settings contribute to inequities in healthcare access and outcomes. Black, Latina, and Indigenous communities have lower levels of trust in reproductive healthcare due to a longstanding history of abuses. In this context, discriminatory behaviors by providers may be particularly problematic. This study aimed to test the psychometric properties of a nine-item measure of lifetime experiences of discrimination in family planning settings developed by Thorburn Bird and Bogart (2003). Methods Data came from the nationally representative Person-Centered Contraceptive Access Metrics Survey (unweighted N  = 3,059). We performed exploratory factor analysis using principal axis extraction and Promax rotation, assessed reliability using coefficient omega, and employed weighted linear regression to test known-groups validity. Results We identified two factors and retained seven scale items. The two factors, general healthcare discrimination and stereotype-based discrimination, were consistent with the scale’s original 2005 validation with African American women. The measure demonstrated strong reliability (coefficient omega 0.97) and goodness-of-fit (TLI = 0.988, RMSEA = 0.066). Known-groups validity testing indicated that people of color experienced higher levels of discrimination in family planning settings compared to white respondents. Conclusions This updated validation with a nationally representative sample confirms the scale’s utility for assessing discrimination in family planning settings and identifying the relationship with healthcare outcomes. The measure provides a tool to support research on the prevalence of discrimination and its impact on reproductive autonomy, including preferred method use and access to care. The scale may aid the assessment of clinic procedures and interventions promoting equitable access to high-quality reproductive healthcare. Plain English summary Many people of color get treated badly when they visit doctors for birth control. Doctors might be rude to them or make wrong guesses about their personal lives. We tested a survey about how people were treated during birth control visits. The survey was first made in 2003 for Black women, but we wanted to see if it works for more types of people across the United States. We studied answers from people who had talked to doctors about birth control. The questions ask about two things: being treated badly (like being rude or not listening) and unfair assumptions (like wrongly guessing how many kids or sexual partners someone has). People of color faced more unfair treatment than white people. Black people faced the most, especially unfair assumptions about their lives. This survey can help researchers and hospitals spot discrimination in family planning care. It can be used to find problems, test if efforts to improve care are working, and make sure hospitals treat all patients fairly. While this tool cannot stop all unfair treatment by itself, it gives us a way to measure problems and see if things get better over time. The goal is fairer birth control care for everyone.

OBJECTIVES/GOALS: This study examines health provider andcaregiver influences on adolescent dual prevention strategies, or the use of condoms and another form of contraception, to informa clinically focused triadic intervention, involving caregivers, adolescents aged 15-17, and health providers. METHODS/STUDY POPULATION: Data for the 2021 Teen and Parent Surveywere two online, cross-sectional surveys, a national sample of adolescents aged 15-19, and a survey of caregivers of 15–17-year-old adolescents. Data were matched to create a dyadic dataset (n=273). Drawing from the Actor-Partner-Dependance Model we will conduct a secondary retrospective analysis, specifically cross-sectional univariate, bivariate, and multivariate logistic regression analyses on sets of influences around contraception and sexual health: communication with parents and health providers, information delivery of sexual health, condom attitudes and self-efficacy around preventative behaviors. RESULTS/ANTICIPATED RESULTS: In preliminary unadjusted analyses, 91% of the sample were cis-gender females (n=249), of which 32% (n=87) had sexual contact with someone who could get them pregnant. In the past, 35% (n=86) discussed birth control pills and 9% (n=24) discussed long-acting contraception with a health provider. In the last health visit, 29% (n=72) discussed STI prevention. Caregivers discussed sexual decision-making (49%, n=144), how to prevent pregnancy (62%, n=169), and how to prevent STIs (55%, 151) at least once in the past year. At last sex (n=49) most used condoms (47%, n=23), followed by birth control pills (33%, n=16), and withdrawal (14%, n=7). Additional predictors and adjusted analyses will be further examined. DISCUSSION/SIGNIFICANCE: Dual prevention strategies can be influenced by caregivers and health providers, but they are contingent on communication. Triadic interventions may consider involving both caregiver and health provider communication around sexual health prevention.

Background Research is a cornerstone of medical progress and a vital component to promote a country’s sustainable development by optimizing healthcare practices, policies, and delivery. Ethiopia has low research productivity and contributions to the international literature. Despite research importance in promoting evidence-based medicine and improving the quality of patient care, medical doctors in Ethiopia face significant challenges engaging in research activities. This study explored the barriers and facilitators to conducting research among medical doctors in public health facilities in Addis Ababa, Ethiopia. Methods A qualitative descriptive study was conducted in Alert Comprehensive Specialized Hospital and General Jagama Kello Memorial Health Center in Addis Ababa, Ethiopia. Fourteen in-depth interviews were conducted with doctors at different career stages, including general practitioners, specialists, and sub-specialists, with a comparable gender balance and different levels of research experience. Three key informant interviews with doctors in leadership roles at the institutes, including a physician-researcher, provided additional insights. Data collection adhered to a semi-structured interview guide. Interviews were transcribed, translated, and thematically analyzed using MAXQDA Version 24 and Microsoft Excel 2010 using Braun and Clarke’s reflexive thematic analysis approach. Results Key barriers identified include high clinical workloads, staff shortages, financial constraints, insufficient research training, poor institutional support, low motivation/research interest, and bureaucratic obstacles within health facilities. Facilitators included effective mentorship programs, institutional recognition and incentives, visible impact of research on clinical care, and tailored practical research training mentorship. Participants emphasized the need for comprehensive research training, protected research time, and access to funding to alleviate barriers and enhance research productivity. Conclusions Research participation among medical doctors in Ethiopia is influenced by interrelated factors at individual, interpersonal, institutional, and systemic levels, highlighting the need for a comprehensive, multi-level approach to strengthen research culture and productivity. Addressing the barriers to research requires a multifaceted approach involving capacity building and institutional support. Developing mentorship programs, providing financial incentives, and integrating comprehensive research training into medical curriculum may strengthen medical doctors’ research culture and productivity in Ethiopia.