HIV pre-exposure prophylaxis practices in Florida, USA: Clinicians’ perceptions of initiation, risk identification, barriers, and facilitators

PLoS ONE · 2026-02-06

This qualitative exploratory study aimed to learn clinicians' perspectives on Pre-exposure Prophylaxis (PrEP) initiation, the HIV risk assessment process, perceived barriers to PrEP implementation, and how a potential electronic health record (EHR)-based PrEP clinical decision support tool can help improve their practices. Using purposive sampling, we recruited 15 clinicians with experience in PrEP practices for the three remote focus groups held between October 2021 and November 2021 using a semi-structured discussion guide. The focus groups were audio-recorded, transcribed, and analyzed in NVivo using thematic analysis. Five themes emerged from the qualitative analysis: (1) PrEP initiation is a joint effort between patients and clinicians; (2) Patient-clinician conversations are key for identifying PrEP candidates; (3) EHRs are helpful but insufficient for identifying PrEP candidates; (4) Patient, clinician, and system-level barriers deter PrEP implementation; and (5) Adopting technological innovations in health care can improve PrEP prescribing. Our analysis suggests that implementing effective communication strategies and behavioral interventions can improve PrEP awareness and reduce barriers in patient-clinician discussions of sexual history and substance use.

Sociodemographic differences in clinical phenotypes among patients with COPD: a latent class analysis

BMJ Open Respiratory Research · 2026-03-01

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition whose clinical severity may be influenced by social factors. We aimed to identify distinct COPD clinical phenotypes and assess variation by social determinants of health. METHODS: In this retrospective cohort study, we identified adults aged 50-80 years with a diagnosis of COPD (n=59 797) at a tertiary academic medical centre in North-Central Florida using codes from International Classification of Diseases. Latent class analysis defined COPD clinical phenotypes using indicators of clinical severity, including frequency of acute care encounters (urgent care, emergency department visits and hospitalisations), presence of COPD as the principal diagnosis, comorbidity burden and use of Global Initiative for Chronic Obstructive Lung Disease Group D medications. Kaplan-Meier survival curves and Cox proportional hazards models assessed mortality across phenotypes. Multinomial logistic regression models estimated associations between phenotype membership and race/ethnicity, income, rurality and smoking status, using the minimal phenotype as reference. RESULTS: Five clinical phenotypes were identified: minimal (20.9%), mild (35.2%), moderate (22.5%), severe (12.2%) and very severe (9.3%). The very severe phenotype had the highest mortality (adjusted HR 2.94; 95% CI 2.72 to 3.18). Odds of very severe COPD were higher among non-Hispanic Black (adjusted OR (aOR) 1.29; 95% CI 1.21 to 1.36) and Hispanic individuals (aOR 1.75; 95% CI 1.63 to 1.87), those in the lowest income communities (aOR 1.25; 95% CI 1.18 to 1.32), rural residents (aOR 1.80; 95% CI 1.68 to 1.92) and individuals who currently smoke (aOR 1.30; 95% CI 1.20 to 1.42). CONCLUSION: Most patients with COPD had mild disease; however, the very severe phenotype, which was associated with higher mortality, was more common among Black and Hispanic individuals, those residing in lower-income and rural areas and those who currently smoke. These clinical phenotypes highlight sociodemographic differences in COPD severity as reflected in healthcare utilisation and outcomes.

What to consider when developing a new molecular HIV surveillance tool: Perspectives of key stakeholders working in HIV prevention and treatment

2025-06-18

Developing and validating novel molecular HIV surveillance (MHS) tools capable of predicting the growth and trajectory of localized outbreaks driven by specific transmission clusters is key to the Ending the HIV Epidemic in the United States initiative. This study explored stakeholders' perspectives on HIV prevention and treatment regarding a developing deep-learning framework, DeepDynaForecast, and its ability to predict HIV transmission cluster trajectories and inform decision-making on HIV prevention and treatment scale-up approaches in Florida. We conducted five virtual focus group discussions with 16 clinical health professionals and state and local public health personnel. Focus group discussions were audio-recorded, transcribed using Zoom transcription, and manually coded using a reflexive thematic analysis approach. Overall, participants reported a high level of acceptability for using MHS tools. However, when exploring their perspectives on using the DeepDynaForecast tool, participants discussed their acceptance criteria, including key features that the DeepDynaForecast tool should have and the need to determine the data types the tool should generate to meet their needs and be deemed acceptable. Before implementation, participants felt the tool should undergo extensive software testing, followed by end-users receiving comprehensive training and the developers determining how the DeepDynaForecast tool could integrate with existing MHS tools. Likewise, participants discussed using the data generated by DeepDynaForecast to increase HIV prevention, education, outreach activities, and mobilization efforts in communities where the most HIV diagnoses occur, as well as increase behavioral change communication efforts. Participants also expressed concerns about HIV-related stigma, a potentially dangerous unintended consequence of using existing and new MHS tools. Current MHS tools have helped inform and evaluate HIV prevention and treatment efforts in the US. A novel MHS tool such as DeepDynaForecast may be critical to achieving the Ending the HIV Epidemic (EHE) goals and curbing the spread of HIV in Florida and in the US.

Prevalence and characteristics of people with HIV who had late, delayed and timely HIV diagnoses in Florida, 2015–2021

AIDS Care · 2025-04-01 · 1 citations

Different definitions of late HIV diagnosis are used to represent people diagnosed at an advanced stage of their illness. How well varying definitions represent those at risk for poor outcomes is unclear. Our aim was to examine proportions of late, delayed and timely HIV diagnoses in Florida and identify factors associated with diagnosis status. Using the first laboratory test in the Enhanced HIV/AIDS Reporting System, we determined annual proportions of late (CD4 < 200 cells/μL), delayed (200 ≤ CD4 < 350 cells/μL) and timely (CD4 ≥ 350 cells/μL) diagnoses in Florida between 2015 and 2021 and assessed characteristics associated with diagnosis status using multinomial logistic regression models. Among 30,411 individuals (20% female, 39% non-Hispanic Black, 34% Hispanic, mean age 37.1 years), 22% had a late and 17% had a delayed diagnosis. Non-Hispanic Black race, older age, and diagnosis at an inpatient facility were associated with greater odds of having a late or delayed diagnosis compared with having a timely diagnosis. There was no change in the prevalence of late, delayed, and timely diagnoses each year during the study period. Nearly 40% of HIV diagnoses in Florida were late or delayed. Given those with late and delayed diagnoses were similar, strategies to improve timeliness of diagnosis among these groups are needed.

The Onset, Progression, and Continuation of Hazardous Drinking Among Women With HIV Enrolled in a Clinical Trial to Reduce Drinking: A Qualitative Assessment of Lifetime Drinking History

Drug and Alcohol Dependence · 2025-02-01

Who could benefit the most from long-acting antiretroviral therapy? perspectives of HIV care providers and people with HIV in Florida

AIDS Care · 2025-05-28

Injectable cabotegravir/rilpivirine (CAB/RPV) is now available, and other long-acting antiretroviral therapy (ART) regimens are in development. The present study describes the factors that HIV care providers and people with HIV (PWH) in Florida (a high HIV incidence and prevalence setting) consider when assessing populations of PWH who could benefit from long-acting ART. We conducted semi-structured qualitative interviews with 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women) and 16 PWH (31% non-Hispanic Black, 19% Hispanic, 50% cis men, 69% aged 50+) from five sites in Florida. Participants were asked about the groups of PWH who they thought could benefit the most from long-acting ART. Responses were analyzed using a reflexive thematic approach. Seven populations of PWH who could benefit from long-acting ART were identified: 1) younger PWH, 2) PWH with co-occurring conditions, 3) PWH who use substances, 4) PWH experiencing housing instability, 5) PWH with frequent travel, 6) PWH experiencing stigma, and 7) PWH who reliably take medication and engage in care. Many groups who may be excluded from injectable CAB/RPV based on the current guidelines were seen as potentially benefiting from such an option.

HIV Pre-exposure Prophylaxis (PrEP) Practices in Florida, USA: Clinicians’ Perceptions of Initiation, Risk Identification, Barriers, and Facilitators

medRxiv · 2025-01-31

Abstract This study aimed to learn clinicians’ perspectives on PrEP initiation, the HIV risk assessment process, perceived barriers to PrEP implementation, and how a potential EHR-based PrEP clinical decision support (CDS) tool can help improve their practices. Data were collected between October 2021 and November 2021 via three remote focus groups with 15 clinicians with experience prescribing PrEP. The focus groups were audio recorded, transcribed, and analyzed using thematic analysis. Five themes emerged from the qualitative analysis: (1) PrEP initiation is a joint effort between patients and clinicians; (2) Electronic health records (EHRs) are helpful but insufficient for identifying PrEP candidates; (3) Patient-clinician conversations are key for identifying PrEP candidates; (4) Patient, clinician, and system-level barriers deter PrEP implementation; and (5) Adopting technological innovations in health care can improve PrEP prescribing. Our analysis suggests that implementing effective communication strategies and behavioral interventions can improve PrEP awareness and reduce barriers in patient-clinician discussions of sexual history and substance use.

Exploring how women with HIV develop hazardous drinking patterns: a qualitative assessment of drinking histories

BMC Public Health · 2025-08-09

INTRODUCTION: Hazardous alcohol use is prevalent among people with HIV, with women disproportionately experiencing adverse alcohol-related outcomes in HIV care. This study aimed to qualitatively explore factors contributing to the onset, escalation, and continuation of hazardous drinking among women with HIV. METHODS: Women with HIV and hazardous drinking patterns were recruited from the WHAT-IF? Study, a randomized trial evaluating the efficacy of naltrexone for alcohol reduction. Participants completed 60-minute semi-structured interviews. Interview transcripts were analyzed using thematic analysis methods. RESULTS: Twenty women (mean age 49.3 years; 85% Black) participated. Common themes identified by the participants as influencing their drinking onset and escalation were early exposure and normalization, and the impact of use among family and friends. Emotion and coping were identified as essential motivators in drinking escalation, as well as drug use (using alcohol and drugs together or using alcohol instead of drugs). These factors also contributed to the persistence of hazardous drinking, alongside participants' perceived health benefits of alcohol. While not common, some participants talked about a history of trying to reduce or stop drinking; they reported that their mental health and family and friends were instrumental in encouraging sobriety or continued alcohol use. CONCLUSION: Women with HIV identified emotional and social factors as primary drivers of hazardous drinking across their lifespan. Interventions that address coping strategies and enhance social support may be beneficial in reducing alcohol use in this population.

Examining Survival of People Diagnosed With HIV in Florida Between 2015 and 2021 After a Late, Delayed, or Timely Diagnosis

JAIDS Journal of Acquired Immune Deficiency Syndromes · 2025-12-10

INTRODUCTION: Late HIV diagnosis is a global concern linked to poor health outcomes and is a barrier to ending the HIV epidemic. However, differences in survival outcomes between late and delayed diagnoses remain unclear in the era of effective treatments. This study examined all-cause mortality among individuals with late (CD4 < 200 cells/μL), delayed (200 ≤ CD4 < 350 cells/μL), or timely (CD4 ≥ 350 cells/μL) HIV diagnoses in Florida from 2015 to 2021. SETTING: Using data from the Florida Enhanced HIV/AIDS Reporting System, we included 24,374 individuals with at least 3 CD4 tests. Mortality data were linked through the National Death Index and Social Security Death Index. METHODS: Cox proportional hazards models and Kaplan-Meier curves assessed mortality risk, adjusting for age, year of diagnosis, race/ethnicity, and sex. RESULTS: Among participants (mean age 37.1 years; 20% female; 39% non-Hispanic Black; 34% Hispanic; 25% non-Hispanic White), 895 deaths (4%) occurred. Late and delayed diagnoses accounted for 23% and 18% of cases, respectively. Compared with timely diagnosis, the hazard of death was significantly higher for late (hazard ratio = 2.18, 95% confidence interval: 1.89 to 2.52) and delayed (hazard ratio = 1.25, 95% confidence interval: 1.03 to 1.52) diagnoses. Female sex and older age were associated with increased mortality, whereas Hispanic and non-Hispanic Black individuals had lower mortality risks. CONCLUSIONS: Late and delayed HIV diagnoses were associated with elevated mortality risk, with late diagnosis posing the greatest risk. These findings underscore the need for earlier HIV detection and intervention to improve survival outcomes.

Sociodemographic Characteristics Associated with Lifetime and Recent Traumatic Experiences Among People Living with HIV in Florida

AIDS and Behavior · 2025-10-10

Trauma prevalence among people with HIV (PWH) exceeds that of the general population by 2 times in the United States. Conducted within the Florida Cohort (2019-2022; n = 509), this study aimed to (1) describe the prevalence of 12 types of traumatic experiences (TEs) over a lifetime and within the past 12 months, and (2) describe whether the prevalence of lifetime and past 12-month traumatic experiences varied by age, race/ethnicity, sex assigned at birth, and sexual orientation among PWH in Florida. Participants were predominantly non-heterosexual men (42%) aged 50 + years (59%), identified as Black (43%), White (39%), and Hispanic (18%). TEs were measured by participants' "Yes" responses to questions about having ever experienced verbal harm, emotional abuse, physical abuse, harmful punishment, physical attack, being stalked, discrimination, hate crime, sexual harassment, unwanted sexual touch, forced sex, and transactional sex in their lifetime and the past 12 months. Chi-square analyses compared traumatic experience prevalence rates by age, race/ethnicity, sex assigned at birth, and sexual orientation, with significant differences reported at a p-value of < 0.05. Overall, the most prevalent TEs were lifetime emotional abuse (56%), verbal harm (55%), physical abuse (53%), and discrimination (44%). Younger participants (< 35 years) reported the highest prevalence of lifetime discrimination, unwanted sexual touch, and hate crime compared to those aged 35-50 or 50+ (p < 0.05). Patterns for the past 12 months were mostly similar. Non-Hispanic Whites reported the highest lifetime prevalence of emotional abuse, verbal harm, physical abuse, being stalked, forced sex, sexual harassment, unwanted sexual touch, and harmful punishment compared to Hispanics or non-Hispanic Blacks (p < 0.05). For past 12-month experiences, Hispanics reported the highest prevalence of discrimination compared to non-Hispanic Blacks or non-Hispanic Whites (p < 0.05). Male non-heterosexuals reported the highest lifetime prevalence of discrimination, verbal harm, physical attack, and sexual harassment compared to females or male heterosexuals (p < 0.05). Similar patterns were reported for the past 12 months. Overall, among PWH in this sample, there was a significant prevalence of lifetime traumatic experiences, particularly verbal harm, emotional abuse, physical abuse, and discrimination. This study highlights demographic variations in trauma prevalence, especially among younger individuals, non-Hispanic Whites, and male non-heterosexuals. Clinicians may consider the significant importance of screening for traumatic experiences due to their intersecting impact on the HIV care continuum. Further research is needed to determine whether trauma-informed interventions could enhance health care in this population.