Individual and Social Network Influences on Potential Use of Pre-exposure Prophylaxis for HIV Prevention Among Adult Black Women PDF Download

Author: Whitney Chivonne Sewell
Publisher:
ISBN:
Category : Electronic dissertations
Languages : en
Pages : 195

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Book Description
Oral daily pre-exposure prophylaxis (PrEP) is a single tablet that is >90% effective in reducing HIV transmission among women. Despite evidence of PrEP's efficacy and safety, levels of awareness, prescription, and uptake of PrEP among Black women are disproportionately low. There is evidence suggesting that the influence of peers and sexual partners in the social networks of Black women are potential facilitators and barriers to the intent to use PrEP. However, there has been limited study examining how these individual and social network level factors influence the intent to use PrEP in this population. This dissertation collected used survey data from Black women, aged 18-44, to conduct advanced statistical analysis, including social network analysis, to identify critical individual and network level factors that influence PrEP uptake. This study found strong associations between PrEP support from sexual partners and healthcare providers and intent to use PrEP in this sample. This study builds upon existing research on PrEP and women by contributing to discussions about the importance of social connections in making the decision to engage in PrEP care and services.

Author: King K. Holmes
Publisher: World Bank Publications
ISBN: 1464805253
Category : Medical
Languages : en
Pages : 1027

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Book Description
Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Author: Jennifer Velloza
Publisher:
ISBN:
Category :
Languages : en
Pages : 140

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Book Description
Daily, oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a highly efficacious HIV prevention strategy for key populations at high risk of HIV, including women, in sub-Saharan Africa. However, open-label studies and demonstration projects have reported that young women have difficulty adhering to PrEP over time, which limits its effectiveness as a prevention option. PrEP projects are now exploring modifiable barriers to adherence among women to maximize its public health benefit as it is being rapidly rolled out worldwide. Mental health factors, including depression, traumatic stress symptoms, and stigma, are highly prevalent among women at high risk of HIV acquisition and are barriers to medication use and health promotion behaviors. However, there has been little consideration until now of how such factors might also influence PrEP adherence among women in sub-Saharan Africa. The aims in this dissertation attempt to fill this research gap by: 1) exploring the impact of depressive symptoms on PrEP adherence among women; 2) examining the mechanisms by which depressive symptoms influence PrEP adherence; 3) describing the broader context of HIV-related stigma and empowerment on PrEP use; and 4) integrating depression screening into HIV care delivery to improve mental health and HIV outcomes. Two studies have examined the influence of depression on PrEP adherence and found that depressive symptoms have a negative effect on daily PrEP use for transgender women and men who have sex with men. Ours is the first study to examine links between depression and PrEP adherence among cisgender women in sub-Saharan Africa. We used marginal structural models to estimate the association between depressive symptoms and PrEP adherence while adjusting for time-varying confounding by sexual behavior, stigma, and social support. We found that probable depression was significantly associated with poor PrEP adherence among women, but not men, suggesting that mental health and depression experiences have differential impact on HIV prevention behaviors by gender. This work also led to questions about the mechanism of this association and whether there were important mediators of the relationship between depression and PrEP adherence that could explain at least some of this total effect. We conducted a mediation analysis using marginal structural models to estimate the controlled direct effect of depression on PrEP adherence, after accounting for the potentially mediating influence of HIV-related stigma, social support, and optimism about PrEP effectiveness. We found a significant negative direct influence of depression on PrEP adherence but this relationship was not strongly mediated by other psychosocial factors. Future research is needed to explore additional potential mediators of this relationship and identify areas for intervention. Qualitative research methods allow us to explore narratives around PrEP use, experiences of stigma, and concerns about mental health that are not captured by quantitative data. We analyzed serial in-depth interview data from a cohort of young women using PrEP to understand the broader context around their pill-taking, mental health, and relationships. In this study, we found that women described experiences of HIV-related stigma when they began taking PrEP which influenced their ability to take PrEP and their feelings about themselves. However, over time, women became more empowered to use PrEP and combat HIV-related stigma by becoming "ambassadors" of PrEP in their communities. This work highlights the potential for empowerment-based interventions to improve PrEP adherence and reduce community stigma and the richness of serially collected qualitative data. In Aims 1-3, we found evidence of a strong negative impact of depression on PrEP adherence and high rates of depression among women at risk of HIV. This work suggests that integrated depression screening and treatment with HIV prevention service delivery could improve mental health outcomes and PrEP effectiveness for women. To support the design of future integrated interventions, we conducted cognitive interviews assessing comprehensibility and acceptability of a widely used depression screening tool in the context of a PrEP delivery intervention among pregnant and postpartum women in Thika, Kenya. We found that the tool was largely acceptable and well-understood, but several minor changes to item wording and instructions would improve symptom screening and linkage to mental health care. These changes are part of our recommendations for the future use of this tool. The collective results presented in this dissertation illustrate the negative influence of depression and related psychosocial factors on consistent PrEP use for women, opportunities for stigma-reduction and empowerment-based intervention approaches to improve mental health symptoms and PrEP use in this population, and the potential to administer depression screening within the context of HIV prevention service delivery. This work contributes to a better understanding of the links between mental health and HIV risk for women and highlights the importance of integrating mental health and empowerment-based interventions with PrEP delivery to improve mental health screening and treatment and PrEP effectiveness for women in sub-Saharan Africa.

Author: Geoffrey Arthur Rose
Publisher:
ISBN: 0192630970
Category : Medical
Languages : en
Pages : 190

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Book Description
The Strategy of Preventive Medicine by Geoffrey Rose, first published in 1993, remains a key text for anyone involved in preventive medicine. Rose's insights into the inextricable relationship between ill health, or deviance, in individuals and populations they come from, have transformed our whole approach to strategies for improving health. His personal and unique book, based on many years research, sets out the case that the essential determinants of the health of society are to be found in its mass characteristics. The deviant minority can only be understood when seen in its societal context, and effective prevention requires changes which involve the population as a whole. He explores the options for prevention, considering them from various viewpoints - theoretical and scientific, sociological and political, practical and ethical. The applications of his ideas are illustrated by a variety of examples ranging from heart disease to alcoholism to road accidents. His pioneering work focused on a population wide approach to the prevention of common medical and behavioral disorders has become the classic text on the subject. This reissue brings the original text to a new generation involved in preventive medicine. Kay-Tee Khaw and Michael Marmot retain the original text intact, but have added their own perspective on the work. They examine what relevance Rose's ideas might have in the era of the human genome project and other major scientific advances, they consider examples of how the theory might be applied and generalised in medicine and beyond, and discuss what implications it holds for the future. There is also an explanation of the population perspective, clarifying the often confused thinking and arguments about determinants of individual cases and determinants of population incidence. Rose's Strategy of Preventive Medicine will ensure that this seminal work continues to be read by future generations.

Author: Mary M. McKay
Publisher: Routledge
ISBN: 113580351X
Category : Health & Fitness
Languages : en
Pages : 394

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Book Description
Find out how best to develop HIV prevention programs that work Community Collaborative Partnerships: The Foundation for HIV Prevention Research Efforts is a must read for anyone interested in developing prevention programs within high-risk urban environments. Illustrative case studies, quality research, revealing personal stories, and helpful tables and figures provide valuable insights on innovative ways to partner in the prevention of the spread of HIV in youths. Leading experts in the field offer practical strategies to dissolve the distrust individuals in a community hold for researchers not a part of that community, fostering an effective collaboration to deal with problems. The book also describes ways to go beyond the United States’ model to reveal how to replicate the same dynamic relationships in international communities. Active participation with the community and families has been found to be vital for the success of HIV/AIDS prevention efforts. Community Collaborative Partnerships: The Foundation for HIV Prevention Research Efforts solves the common problem of forcing ineffective program models onto an unreceptive community. Program developers get the necessary tools to develop relationships and cultivate substantive input from those in the community to help ensure better program results. The research here is up-to-date, and the suggestions invaluable. Topics in Community Collaborative Partnerships: The Foundation for HIV Prevention Research Efforts include: the role of parenting in mental health and HIV risk research findings about frequency of sexual intercourse among adolescents racial socialization and family role in HIV knowledge family influences on exposure to situations of sexual possibility preadolescent risk behavior influence on parental monitoring strategies for collaboration between community and academic HIV prevention researchers involving urban parents as collaborators in HIV prevention research motivatorsand barriersto participation of minority families in a prevention program transferring a university-led HIV prevention program to the community Trinidad and Tobago HIV/AIDS prevention using a family-based program and much more! Community Collaborative Partnerships: The Foundation for HIV Prevention Research Efforts is valuable reading for researchers, program developers, community-based organizations, public policy/advocacy organizations, community organizers, educators, and students in the fields of social work, public health, public administration, and community medicine.

Author: David Allen Roberts
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

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Book Description
Daily oral tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as HIV pre-exposure prophylaxis (PrEP) is a safe and effective method for HIV prevention and offers potential to substantially reduce HIV incidence in sub-Saharan Africa. Mathematical models are commonly used to project the cost-effectiveness of investments in PrEP in comparison to alternative resource allocation strategies. Predictive modeling can also identify individuals at elevated risk who may benefit most from PrEP. The studies contained in this dissertation address fundamental issues in estimating the cost and potential impact of PrEP implementation in sub-Saharan Africa. First, we estimated the cost of routine PrEP delivery through maternal and child health (MCH) and family planning (FP) clinics in western Kenya (Chapter 1). PrEP delivery through MCH and FP leverages existing service delivery platforms that reach a large fraction of women at elevated HIV risk. Using data from over 20,000 PrEP encounters through 16 clinics, we estimated that the cost per client-month of PrEP dispensed to be $26.52 (2017 USD), with personnel (43%), drugs (25%), and laboratory testing (14%) accounting for the majority of costs. Postponing creatinine testing from PrEP initiation to the first follow-up visit could save 8% of total program costs. Under Ministry of Health implementation, we projected costs would decrease by 38%, but estimates were sensitive to changes in PrEP uptake and retention. Second, we used an individual-based transmission model calibrated to Eswatini to evaluate the sensitivity of model projections of PrEP impact and efficiency to specification HIV exposure heterogeneity (Chapter 2). A common method for introducing HIV exposure heterogeneity into a model is to stratify the population into “risk group” categories with different average sexual behavior parameters, allowing PrEP coverage to vary by risk group without having to explicitly represent individual partnerships. We found that this specification leads to a sharp tradeoff between total impact and efficiency depending on PrEP coverage levels in each risk group. In comparison, PrEP use among the general population is projected to be two times more efficient if PrEP use is prioritized during partnerships and over six times more efficient if use is further prioritized among individuals with HIV-positive partners. In addition, large incidence reductions can be achieved at low levels of PrEP coverage if PrEP use in the general population is concentrated when HIV exposure is more likely, but high levels of PrEP coverage are needed if time-varying individual risk is ignored. Third, we developed and validated HIV risk prediction models incorporating individual-level and geospatial covariates using data from nearly 20,000 individuals in a population-based cohort in rural KwaZulu-Natal, South Africa (Chapter 3). Individual-level predictors included demographic, socioeconomic, and sexual behavior measures, while geospatial covariates included local estimates of community HIV prevalence and viral load. We compared full models to simpler models restricted to only individual-level covariates or only age and geospatial covariates. Models using only age group and geospatial covariates had similar performance (women: area under the receiver operating characteristic curve (AUROC) = 0.65, men: AUROC = 0.71) to the full models (women: AUROC = 0.68, men: AUROC = 0.72). In addition, geospatial models more accurately identified high incidence regions than individual-level models; the 20% of the study area with the highest predicted risk accounted for 60% of the high incidence areas when using geospatial models but only 13% using models with only individual-level covariates. These findings have implications for PrEP policies. Our primary costing study identified service delivery bottlenecks and cost drivers that can inform efforts to streamline PrEP delivery. By ignoring the alignment of PrEP use with time-varying individual HIV exposure, models using a risk group specification may overestimate the cost and underestimate the impact of widespread PrEP availability. Finally, local estimates of HIV prevalence can help identify individuals and areas to prioritize for PrEP services to maximize impact.

Author: Stephanie Brown
Publisher: Oxford University Press, USA
ISBN:
Category : Family & Relationships
Languages : en
Pages : 316

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Book Description
Motherhood is often portrayed as one of the most fulfilling experiences in a woman's life. Books on pregnancy, birth and motherhood not only tell women what they should do, they also encourage them to have high expectations of what is inevitably a 'journey into the unknown'. Missing Voices isdifferent: its authors offer no prescriptions. Instead they tell the stories of 800 recent mothers. We hear about what happened to them during pregnancy and childbirth, what contributed to good and bad experiences of birth, and what women thought of the care they received. Ninety of the women went on to participate in interviews two years later. The result is a moving and powerful account of what it is like to be a mother in Australia in the 1990s. How do mothers' daily lives compare with accepted wisdom about 'good mothers'? How is the work of caring for children,running the household and providing financial support divided within the family? How do women feel about the care of children and work - both paid and unpaid? One in seven women was depressed in the year after birth. In Missing Voices they talk candidly about the origins of this depression and howthey coped with it. This is a book for all mothers (and fathers), for anyone contemplating having children, and for all those concerned about the health and well-being of mothers, children and families.

Author: Brea L. Perry
Publisher: Structural Analysis in the Soc
ISBN: 110713143X
Category : Political Science
Languages : en
Pages : 371

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Book Description
An in-depth, comprehensive and practical guide to egocentric network analysis, focusing on fundamental theoretical, research design, and analytic issues.

Author: Todd G. Pierce
Publisher:
ISBN:
Category : African American women
Languages : en
Pages : 374

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Book Description
African American women are amongst the fastest growing population of new HIV cases in the United States. Washington, D.C. represents the highest rates of HIV in the United States. There are many contributing factors as to why African American women are at such risk. Poverty, violence, illegal drug use and histories of childhood sexual abuse are some of these factors. This dissertation examines the interplay between violence, social networks, drug abuse, sexual behaviors and HIV risk among African American women in Washington, D.C. who have had lifelong histories as victims of violence and sexual abuse. Thirty-two months of ethnographic research was conducted with five selected women who have histories of drug abuse, sexual abuse and other forms of abuse and violence in their lives. Research was also conducted with harm reduction organizations, such as HIV risk reduction outreach and education organizations to assist in contextualizing the participating women's lives. Neighborhood community data collected on issues of violence and social beliefs provided further social contexts in which to frame the lives of the participating women. A multi-methodological approach using participant observation, life history interviews, social network plotting and event recall interviews was utilized to illustrate and examine the effects of psychological and physical trauma brought on by experiences of violence and abuse, and how said trauma impact individual social and sexual practices. This research also examined ways in which cyclical violence and abuse within the participating women's family and social network histories have influenced the women's decision-making abilities with regards to HIV risk behaviors. This research illustrates the interplay between the self and social networks in relation to drug addiction and violence, and demonstrates how violence affects the self and limits human agency, especially in regard to HIV risk behaviors, and identifies the need to include childhood sexual abuse as a key indicator for risk of HIV and other diseases and social ailments.

Author: Valentine Adhiambo Wanga
Publisher:
ISBN:
Category :
Languages : en
Pages : 82

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Book Description
The rollout of pre-exposure prophylaxis (PrEP) for HIV prevention to priority populations, including young women, is expanding in sub-Saharan Africa. However, existing barriers to PrEP rollout at the individual, community and policy levels could slow progress and impede the success of PrEP implementation programs. In order to achieve success in HIV prevention, it is crucial to address these barriers, particularly among young women, a population especially vulnerable to HIV. In this dissertation, we evaluated the links among risk perception, sexual behavior and PrEP adherence in serodiscordant couples, evaluated the impact of incorporating HIVST in PrEP delivery for young women and assessed the cost of delivering PrEP to young women. In Aim 1, we used data from HIV-negative adults enrolled in a study of PrEP and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda to examine associations between: 1) condom use and risk perception and 2) risk perception and PrEP adherence. In Aim 2, we offered HIV self-testing (HIVST) to young women enrolled in a PrEP implementation study in two family planning clinics and assessed satisfaction with HIV testing and clinic experience, and the impact of HIVST on PrEP delivery procedures. In Aim 3, using the same population as that in Aim 2, we used micro-costing methods to estimate the incremental cost of delivering PrEP to young women. We found that sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual's decisions about PrEP use. Additionally, we found HIVST to be feasible and acceptable for young women using PrEP, highlighting the need to evaluate its utility to streamline PrEP delivery and provide more testing options for young women on PrEP. Lastly, using practical data from PrEP implementation, we estimated the cost of delivering PrEP to young women, providing valuable data to inform budget impact and cost-effectiveness analyses as well as local resource allocation for scale-up of PrEP delivery to young women. Collectively, these studies addressed some of the barriers to PrEP delivery, proposed solutions to these barriers and drew attention to priority research needs for PrEP delivery to young women.