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      “A dream come true”: Perspectives on long-acting injectable antiretroviral therapy among female sex workers living with HIV from the Dominican Republic and Tanzania

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          Abstract

          Background

          Long-acting injectable antiretroviral therapy (LA ART) was found to be non-inferior to daily oral ART in Phase 3 clinical trials. LA ART may offer an important alternative for people living with HIV with challenges adhering to daily oral ART or preferences for non-pill-based regimens.

          Methods

          Using a mixed methods approach integrating survey, in-depth interview and biological data from female sex workers (FSW) living with HIV in Tanzania (N = 208) and the Dominican Republic (DR) (N = 201), we assessed factors associated with the potential likelihood of LA ART use if it were available. We conducted multivariate logistic regression and thematic content analysis.

          Results

          Likelihood of LA ART use was high with 84.92% of FSW from the DR and 92.27% of FSW from Tanzania reporting they would be “likely” or “very likely” to use LA ART if available (p = 0.02). In Tanzania better HIV-related patient-provider communication (AOR 4.58; 95% CI 1.90–11.05) and quality of HIV clinical care (AOR 3.68; 95% CI 1.05–12.86) were positively associated with the high likelihood of LA ART use. In the DR, easier clinic access was associated with a higher likelihood of LA ART use (AOR 3.04; 95% CI 1.41–6.56), as was greater monthly income from sex work (AOR 2.37; 95% CI 1.27–4.41). In both settings, years on ART was significantly associated with a strong likelihood of LA ART use (TZ: AOR 1.16 per year; 95% CI 1.00–1.34/DR: AOR 1.07 per year; 95% CI 1.00–1.14). Qualitative findings underscored enthusiasm for LA ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use.

          Conclusions

          We found a high likelihood of LA ART use if available among FSW in two diverse settings and documented barriers to future uptake. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA ART use among FSW.

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          Most cited references38

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          Structural stigma: Research evidence and implications for psychological science.

          Psychological research has provided essential insights into how stigma operates to disadvantage those who are targeted by it. At the same time, stigma research has been criticized for being too focused on the perceptions of stigmatized individuals and on microlevel interactions, rather than attending to structural forms of stigma. This article describes the relatively new field of research on structural stigma, which is defined as societal-level conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of the stigmatized. I review emerging evidence that structural stigma related to mental illness and sexual orientation (a) exerts direct and synergistic effects on stigma processes that have long been the focus of psychological inquiry (e.g., concealment, rejection sensitivity), (b) serves as a contextual moderator of the efficacy of psychological interventions, and (c) contributes to numerous adverse health outcomes for members of stigmatized groups-ranging from dysregulated physiological stress responses to premature mortality-indicating that structural stigma represents an underrecognized mechanism producing health inequalities. Each of these pieces of evidence suggests that structural stigma is relevant to psychology and therefore deserves the attention of psychological scientists interested in understanding and ultimately reducing the negative effects of stigma. (PsycINFO Database Record
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            Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial

            Cabotegravir and rilpivirine are antiretroviral drugs in development as long-acting injectable formulations. The LATTE-2 study evaluated long-acting cabotegravir plus rilpivirine for maintenance of HIV-1 viral suppression through 96 weeks.
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              • Article: not found

              Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities.

              Food insecurity and HIV/AIDS are intertwined in a vicious cycle that heightens vulnerability to, and worsens the severity of, each condition. We review current knowledge and research priorities regarding the impact of food insecurity on HIV transmission risk and clinical outcomes. Observational studies suggest that food insecurity is associated with increased HIV transmission risk behaviors and decreased access to HIV treatment and care. Among individuals receiving antiretroviral therapy (ART), food insecurity is associated with decreased ART adherence, reduced baseline CD4 cell count, incomplete virologic suppression, and decreased survival. Integration of food security interventions into HIV/AIDS treatment programs is essential to curtail the HIV/AIDS epidemic and improve health and quality of life among those infected. Longitudinal research applying validated measurement tools is needed to better understand the mechanisms through which food insecurity adversely impacts HIV transmission, treatment, and care. Research should compare the effectiveness of various food assistance and livelihood strategies.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysis
                Role: Formal analysis
                Role: Formal analysis
                Role: Conceptualization
                Role: Conceptualization
                Role: Conceptualization
                Role: Conceptualization
                Role: Investigation
                Role: Formal analysis
                Role: Conceptualization
                Role: Investigation
                Role: Investigation
                Role: Formal analysisRole: Investigation
                Role: Investigation
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 June 2020
                2020
                : 15
                : 6
                : e0234666
                Affiliations
                [1 ] Department of Sociology, American University, Washington, DC, United States of America
                [2 ] Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
                [3 ] Department of Health Policy, Yale University, New Haven, Connecticut, United States of America
                [4 ] Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
                [5 ] Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
                [6 ] HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
                [7 ] Public Health Innovation and Action, New York, New York, United States of America
                [8 ] Health Analytics and Outcomes, London, United Kingdom
                [9 ] Department of Statistics, University of Haifa, Mt Carmel, Israel
                University of Ghana College of Health Sciences, GHANA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0001-7401-9159
                http://orcid.org/0000-0002-4482-1383
                http://orcid.org/0000-0002-9694-3091
                Article
                PONE-D-20-07582
                10.1371/journal.pone.0234666
                7292359
                32530939
                2023ccb9-4308-472f-b963-67711eab9a18
                © 2020 Kerrigan et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 March 2020
                : 30 May 2020
                Page count
                Figures: 0, Tables: 3, Pages: 16
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R01MH110158
                Award Recipient : Deanna L Kerrigan
                Funded by: ViiV Healthcare (GB)
                Award Recipient : Deanna L Kerrigan
                The funders of this work include the National Institute of Mental Health (R01MH110158) and ViiV Healthcare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Biology and Life Sciences
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                Medical Microbiology
                Microbial Pathogens
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                Immunodeficiency Viruses
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                Data cannot be shared publicly because of potentially sensitive information from a vulnerable population. Data are available by contacting the IRB of the Johns Hopkins Bloomberg School of Public Health for researchers who meet the criteria for access to confidential data at irb@ 123456jhsph.edu .

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