Acceptability and feasibility of HIV self-testing integration into publicly-funded HIV prevention services: Perspectives from HIV testing agency staff that provide HIV testing services to sexual and gender minority youth in Philadelphia County

PLoS ONE · 2025-03-25

BACKGROUND: Increasing HIV testing among priority populations is a primary strategy of the Ending the HIV Epidemic initiative. In October 2019, the Philadelphia Department of Public Health (PDPH) established a program to distribute publicly-funded HIV self-testing (HIVST) kits to Philadelphia County residents aged 16 years and older. METHODS: Through a community-academic partnership, we used a cross-sectional sequential transformative mixed-methods design to examine perceived organizational factors, opportunities, and challenges to HIVST integration among agency staff at PDPH-funded agencies early in the COVID-19 pandemic due to decreased access to traditional in-person HIV testing services with a focus on agencies whose client populations included sexual and gender minority clients assigned male sex birth aged 13 to 24 years (not the sole population served at each agency). We integrated data from online surveys conducted with HIV testers (test counselors and testing leads), agency leaders (agency leads and directors), and care navigators (n = 42), and semi-structured interviews with HIV testers and agency leaders (n = 11) employed at PDPH-funded agencies. RESULTS: Many staff were familiar with HIVST (79%), and approximately two-thirds (64%) were likely to encourage HIVST to clients. In interviews, perceived benefits of HIVST integration were increased access to HIV testing, accommodation for client privacy, decreased risk of stigmatizing encounters, and testing program adaptability. Perceived challenges were loss of connection with clients, suboptimal linkage to HIV treatment and prevention services after self-testing, concerns regarding clients' correct use or interpretation of test results, and client preference. CONCLUSIONS: Agency staff described HIVST as a useful tool for expanding low-barrier HIV testing services; however, staff foresaw potential implementation challenges. To optimize HIVST as a long-term strategy, resources are needed to increase familiarity and comfort with HIVST and enhance staff's capacity to establish meaningful client connections and link clients to post-test HIV treatment and pre-exposure prophylaxis services.

166. Engaging, Informative and Youth-Centric: Young People’s Perspectives on a Brief Animated Video Promoting Screening, Prevention and Treatment of Sexually Transmitted Infections (STIS) and Human Immunodeficiency Virus (HIV)

Journal of Adolescent Health · 2025-02-07

Micro- to arc-scale geochemical evaluation of plutonic-volcanic records across the Sunda-Banda Arc

2025-01-01

Magmatic arcs host large explosive eruptions and economic deposits of critical metals such as copper, which accumulates mainly in porphyry copper deposits. Assessing magmatic architecture and processes is important for the development of volcanism and ore deposits. However, variations in magma plumbing architecture across arc systems remain poorly constrained. In this contribution, we propose to evaluate the mineral, geochemical, and textural records of crystal cargoes from active volcanoes along the Sunda-Banda Arc in Indonesia. The Sunda-Banda region hosts several volcanic centres of varying degrees of alkalinity and source components, which could lead to distinct magmatic architectures, volcanic eruptions, and copper fertility. The interplay between geodynamics and active volcanism along the arc enables us to evaluate the magmatic connections between porphyry copper deposits and active volcanoes. Preliminary geochemical analyses of volcanic whole rock and groundmass samples show that geochemical signatures may be associated with differences in slab depth and transitions in subduction morphology. We propose to further this line of research by analyzing the volatile content and magmatic histories in zoned crystals and volatile-bearing phases to evaluate the copper accumulation potential of rocks from active volcanoes and porphyry copper deposits. Recent advances in micro-analytical geochemical techniques e.g. LA-ICP-MS trace element mapping of magmatic phases, and thermodynamic modelling of storage conditions and volatile systematics, means we can track micro-scale magmatic histories relevant to volcanism vs. copper enrichment. We will analyze a suite of rocks from several volcanic centres along the Sunda-Banda Arc. Results will be integrated into the macro-scale geodynamic context, requiring multidisciplinary collaboration between volcanology, geochemistry, and geodynamics. Implications of our research can advance not only current understanding on ore mineralization processes, but also volcanic hazard mitigation and crustal dynamics.

Take (Treat Act Know Engage) Steps: Outcomes of a Novel HIV and STI Prevention Intervention in Youth With Stis in Primary Care

Journal of Adolescent Health · 2025-02-07

Feasibility, Acceptability, and Fidelity of the Take Steps HIV Prevention Intervention

Journal of Adolescent Health · 2025-02-07

Intention, Self-Efficacy, and Interpersonal Reactivity on Partner Notification for Philadelphia-Area Adolescents With Sexually Transmitted Infections

Journal of Adolescent Health · 2025-02-07

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19

American Journal of Preventive Medicine · 2024-02-28 · 3 citations

Sources of Contraception Among Adolescents and Young Adults

JAMA Pediatrics · 2024-03-25 · 2 citations

This cross-sectional study describes the nationwide pattern of contraception access by sociodemographic characteristics and health care settings among US youth aged 15 to 24 years.

Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study

JMIR Pediatrics and Parenting · 2024-11-28 · 1 citations

BACKGROUND: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. OBJECTIVE: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. METHODS: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded "think aloud" interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. RESULTS: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during "think aloud" interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. CONCLUSIONS: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical.

The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care

JAMA Pediatrics · 2024-07-01 · 20 citations

Importance: Lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings. Objectives: To compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes. Design, Setting, and Participants: This cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey. Exposures: The primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates. Main Outcomes and Measures: PHQ-9-M-derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt. Results: The sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P < .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P < .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P < .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P < .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth. Conclusions and Relevance: Compared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support-focused interventions to mitigate mental health inequities for LGBTQ+ youth.