Kenneth H. Mayer

Self-efficacy (SE) is central to sexual health behavior change and may be important for pre-exposure prophylaxis (PrEP) adherence among men who have sex with men (MSM). This study examines factors associated with three PrEP self-efficacy domains: routine adherence (RA), medication management (MM), and overcoming psychosocial challenges (OPC). Three hundred U.S. MSM, who either initiated daily oral PrEP or reported anticipated adherence difficulties, and who all experienced at least one psychosocial syndemic condition, were recruited as part of a randomized controlled trial. Baseline assessments included PrEP SE and psychosocial, structural, and sociodemographic variables. Bayesian variable selection and multiple linear regression identified several predictors. Younger age (RA: b = 0.048, 95% CI [0.025, 0.072]; MM: b = 0.033, 95% CI [0.012, 0.054]; OPC: b = 0.060, 95% CI [0.023, 0.087]) and greater structural barriers (RA: b = − 0.090, 95% CI [-0.151, − 0.029]; MM: b = − 0.192, 95% CI [-0.246, − 0.138]; OPC: b = − 0.145, 95% CI [-0.229, − 0.055]) were associated with decreased SE across all factors ( p < .01). Social anxiety was associated with lower routine adherence SE ( b = − 0.039, 95% CI [-0.063, -0.016], p < .01); lifetime polysubstance use was associated with lower medication management SE ( b = − 0.192, 95% CI [-0.325, -0.058], p < .01); and overseas-born status ( b = − 0.932, 95% CI [-1.759, -0.106], p < .05) and greater sexual compulsivity ( b = − 0.157, 95% CI [-0.269, -0.046], p < .01) were both associated with lower SE in overcoming psychosocial challenges. Findings underscore the need for multilevel, culturally responsive PrEP interventions that promote SE across all three domains.

Analysis of PCORnet electronic health record data from 1.26 million outpatient influenza patients (2022–2025) found antiviral treatment prescribing was 41% overall and 44% among those at higher risk for complications. Lower prescribing may reflect multiple factors, including delayed care-seeking, suggesting opportunities to support more timely treatment and potentially reduce influenza-related complications.

Background: Transgender women with HIV face higher rates of atherosclerotic cardiovascular disease (ASCVD) than the general population. However, ASCVD risk estimators use binary sex variables that may misclassify their risk. We examined the effects of sex variable inputs in the Predicting Risk of Cardiovascular Disease Events (PREVENT) and Pooled Cohort Equation (PCE) risk calculations and tested for associations of ASCVD risk scores with HIV and hormone use. Setting: Participants were recruited from health centers in Boston, New York, and Washington, DC. Methods: We performed a cross-sectional comparison of PCE and PREVENT scores by sex variable inputs using data from 108 Black and Latina transgender women with HIV. Logistic regression models tested whether hormone duration and time since HIV diagnosis were associated with hyperlipidemia, diabetes, hypertension, or cardiac events. Results: Using an illustrative ≥ 5% risk score as the threshold for statin initiation, 40.6% with PCE versus 9.5% with PREVENT met or exceeded 5% risk when male was entered for all, compared with 17.7% with PCE versus 9.5% with PREVENT when female was entered for all, and 24.0% with PCE versus 8.4% with PREVENT when female was entered for participants taking hormones. Neither years since HIV diagnosis nor hormone duration were associated with ASCVD risk factors or events Conclusion: Use of the PREVENT calculator generates lower ASCVD risk estimates than PCE in transgender women with HIV. Research is needed to determine how best to incorporate gender diversity and intersecting factors into ASCVD risk calculations.

Was not provided for this article.

Objectives: High-risk alcohol use is associated with depressive symptoms. It is unclear if changes in alcohol use are correspondingly associated with changes in depression severity among people with HIV (PWH). Methods: Data were from clinical assessments of patient-reported outcomes (PROs) completed by PWH receiving primary care at 7 sites of the Center for AIDS Research Network of Integrated Clinical Systems. Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores, range (lower to higher risk): 0–12, and Patient Health Questionnaire-9 (PHQ-9) scores, range for depressive symptom burden: 0–27 (≥10 indicative of clinically relevant depression), from PROs were identified as observation pairs (PHQ-9 and AUDIT-C on the same day) occurring 1–2 years apart. We used linear regression with clustered standard errors to estimate the association between changes in AUDIT-C and changes in PHQ-9 stratified by baseline alcohol consumption. Results: A total of 7806 PWH contributed 13,302 observation pairs with a baseline mean age of 45.4 (SD: ±11.4); 15% were female and 55% identified with a non-White race/ethnicity. Each 1-point increase in AUDIT-C was associated with a 0.30-point (95% CI: 0.15–0.44), 0.26-point (95% CI: 0.14–0.37), and 0.20-point (95% CI: 0.10–0.30) increase in PHQ-9 for PWH with no alcohol use, low-to-moderate risk alcohol use, and high-risk alcohol use at baseline, respectively. Estimates were essentially stable after adjusting for sex, age, and race/ethnicity. Conclusions: There is a modest, statistically significant association between change in AUDIT-C and change in PHQ-9. These findings highlight the importance of routinely monitoring alcohol use and depression in HIV primary care settings. Future studies exploring causal directions are warranted.

Substance use in general, and stimulant use in particular, among men who have sex with men (MSM) remains an important issue within the field of public health because of its rates of use, its relati...

Background: Long-acting cabotegravir (CAB-LA) was approved as HIV pre-exposure prophylaxis (PrEP) in the U.S. in December 2021, but data are limited on uptake, adherence, and persistence in clinical practice. Methods: We extracted electronic health records of adults receiving oral or injectable PrEP during December 2021-June 2024 at Kaiser Permanente (KP) Northern California and Mid-Atlantic States, two large integrated healthcare systems. We used chi-square tests to compare characteristics of CAB-LA users and oral-PrEP-only users. Among CAB-LA users, we assessed adherence to bimonthly injections after lead-in doses (weeks 0 and 4) and used Kaplan-Meier methods to estimate persistence. Results: Among 23,311 individuals accessing oral or injectable PrEP, 180 (0.8%) received CAB-LA, with 23.9% having no documentation of prior PrEP use at KP. Compared with oral-PrEP-only users, a lower proportion of CAB-LA users were commercially insured (82.2% vs 89.2%; P =0.014) and a higher proportion were Black (18.9% vs 10.2%) or Hispanic (34.4% vs 23.6%; P <0.001 across race/ethnicity categories). Of 688 non-lead-in CAB-LA injections, 90.4% were administered within 8 weeks +7 days after the prior injection. Persistence on CAB-LA was 87.9% and 74.9% at 6 and 12 months, respectively. There were no incident HIV infections during CAB-LA use. Conclusions: CAB-LA is engaging new users, including populations traditionally underrepresented in PrEP uptake, and adherence and persistence are high in clinical practice. However, uptake of CAB-LA is extremely low, suggesting population impact will be limited without efforts to expand implementation and use.