Dawn K. Smith's research while affiliated with Centers for Disease Control and Prevention and other places

Publications (17)

Article
Full-text available
Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operatin...
Article
HIV (human immunodeficiency virus) preexposure prophylaxis (PrEP) is an effective biomedical HIV prevention tool. Increasing PrEP use among populations disproportionately affected by HIV is one of the key efforts in the United States’ Ending the HIV Epidemic (EHE) initiative and the HIV National Strategic Plan for the United States. Given that PrEP...
Chapter
New HIV infections are disproportionately concentrated among black Americans. Yet the most powerful new tool to reduce HIV acquisition, daily oral antiretroviral preexposure prophylaxis (PrEP), is inequitably accessed. While black men and women comprised 43% of new diagnoses in 2017, and 44% of persons estimated to have risk behaviors that indicate...
Article
When used appropriately, pre-exposure prophylaxis (PrEP) substantially reduces the risk of HIV acquisition. Early implementation outcomes often suggest poor PrEP adherence and persistence; however, this intervention is time-limited and the need for PrEP fluctuates as risk behaviours change. In this Viewpoint we examine the current guidelines and ea...
Article
Cases of seroconversion on PrEP should be carefully investigated given their public health implications and rarity. We report a case of transmitted drug resistance causing seroconversion on PrEP in spite of high adherence, confirmed with dried blood spot and segmental hair drug-level testing and single-genome sequencing.
Article
Full-text available
Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy to reduce HIV infections, however, racial/ethnic HIV disparities continue among black MSM. The purpose of this review was to assess available data to inform interventions to increase PrEP awareness, uptake, and adherence among black MSM. Of the 3024 studies retrieved, 36 met final inclu...
Article
Full-text available
Prompt determination of HIV infection status is critical during follow-up visits for patients taking preexposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of am...
Article
Introduction: Expanding use of preexposure prophylaxis (PrEP) in ways that address current racial/ethnic disparities is an important HIV prevention goal. We investigated missed opportunities to provide PrEP during healthcare visits occurring prior to HIV infection. Methods: This retrospective cohort study linked South Carolina HIV case surveilla...
Article
Purpose: Effectively measuring progress in delivering HIV pre-exposure prophylaxis (PrEP) requires subnational estimates of the number of adults with indications for its use that account for differences in HIV infection rates by transmission risk (risk) group and race/ethnicity. Methods: We applied a multiplier method with 2015 Centers for Disea...
Article
Full-text available
Preexposure prophylaxis (PrEP) is a highly effective HIV prevention method; however, it is underutilized among women who are at risk for acquisition of HIV. Women comprise one in five HIV diagnoses in the United States, and significant racial disparities in new HIV diagnoses persist. The rate of new HIV diagnoses among black and African American wo...
Article
Full-text available
Existing U.S. guidelines recommend that men with human immunodeficiency virus (HIV) infection should achieve virologic suppression* with effective antiretroviral therapy (ART) before attempting conception (1). Clinical studies have demonstrated that effective ART profoundly reduces the risk for HIV transmission (2-4). This information might be usef...
Article
Full-text available
What is already known about this topic? For HIV-discordant couples (in which the man is HIV-infected and the woman is not HIV-infected) who wish to conceive a biological child, strategies to minimize the risk for sexual transmission are needed. In 1990, CDC recommended against insemination with semen from HIV-infected men. What is added by this rep...
Article
Community-based organizations (CBOs) are critical to delivery of effective HIV prevention because of their reach to key populations. This online survey of a national sample of CBOs assessed their awareness of, interest in, and resources needed to provide nonoccupational postexposure prophylaxis (nPEP), preexposure prophylaxis (PrEP), and HIV treatm...
Article
Full-text available
Background Preexposure prophylaxis (PrEP) is effective for preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) within trial settings. Population impact will depend on clinical indications for PrEP initiation, coverage levels, and drug adherence. No modeling studies have estimated the impact of clinical prac...
Article
Full-text available
Best practices for integrating human immunodeficiency virus (HIV) testing and antiretroviral interventions for prevention and treatment are suggested based on research evidence and existing normative guidance. The goal is to provide high-impact prevention services during periods of substantial risk. Antiretroviral medications are recommended for po...

Citations

... PrEP is thus a valuable tool for addressing HIV and reducing national rates of new infections. Although PrEP usage is becoming more common in the United States, clear disparities remain with regards to atrisk demographic subgroups (6,7) and geographical location outside of urban areas (8,9). In the current study, we investigated familiarity, prior usage, and current interest in PrEP in a sample of Black and Hispanic adults in the state of Indiana. ...
... It involves taking pills for a particular sex event (two pills 2-24 h before sex and two pills for 2 days after sex). Event-driven PrEP is recommended by the World Health Organization (World Health Organization, 2019) and is included in PrEP prescribing guidelines in several countries (Rutstein et al., 2020). These recommendations include guidance on how a person should commence daily PrEP, which involves taking two pills 2-24 h before sex and continuing it daily thereafter (ASHM, 2019; Rutstein et al., 2020). ...
... However, lowest prevalence of PrEP uptake was observed primarily in states in the South: Georgia, Kentucky, North Carolina, South Carolina, Virginia, and West Virginia [7]. Noticeable gaps exist between the willingness to use PrEP and its uptake across the U.S. [3,5,7,8]. Between 2014 and 2015, 68.8% of 333 BMSM surveyed in the American Men's Internet Survey were willing to use PrEP, but only 7.5% used PrEP in the previous year [20]. Similarly in 2017, a national behavioral survey conducted in 23 U.S. cities revealed that 78.3% of BMSM were aware of PrEP, but only 18.8% had used it [21]. ...
... 8,[10][11][12][13][14][15] Several cases of seroconversion on PrEP despite high adherence have been reported in men who have sex with men whose partner(s) may have transmitted multidrug-resistant virus to them. [16][17][18][19][20][21][22][23] While these data provide insight on the risk of HIVDR with PrEP use during clinical trials, the risk may differ in larger-scale PrEP rollout programs. During PrEP use outside of the controlled environment of a clinical trial, there may be diagnostic challenges including delayed detection of seroconversion and longer intervals between HIV tests, both of which could lengthen the time an individual may remain on PrEP after becoming HIV positive. ...
... [16]. Numerous observational studies with MSM in the US have revealed important barriers across multiple socioecological levels that may affect the uptake/adherence of PrEP, including individual-(e.g., perception of low HIV risk, insufficient PrEP knowledge and concerns over side effects) [19][20][21], interpersonal-(e.g., lack of parent/peer support) [20][21][22], healthcare system-(e.g., high cost and low PrEP care quality) [5,19,20] and social-cultural-(e.g., stigma, discrimination and medical mistrust) levels [5,[19][20][21]23]. ...
... Clinical reasons for holds included side effects, pregnancy due to South African guidelines which restricted PrEP use to non-pregnant women at the time of the study, and temporary holds due to reactive HIV tests which were subsequently demonstrated to be false-positive results. Providers need to be prepared for false-positive screening tests with the dual antigen/antibody test and lower positive predictive value in PrEP users [34,35]. Most women who stopped PrEP in this study discontinued due to missed visits or based on personal preference, including perceived lower risk, pill fatigue and loss of interest. ...
... Ambulatory clinics across the US have been forced to significantly decrease in-person visits in the setting of the covid-19 pandemic, creating a chain reaction of limited access to medical providers and disengagement in routine timely care. Patients seeking sexual health services, including screening for STIs and HIV, may access EDs 16 . The need for robust STI screening, and linkage back to primary care for sexual healthcare services after an ED visit is critical to preventing new HIV infections. ...
... According to a recent estimate of the "PrEP gap" in Europe, around 500,000 MSM cannot access PrEP. In France, where PrEP is available and fully reimbursed, the number of people initiating PrEP has consistently been inferior to the projected number of eligible MSM (Epi-phare, 2020; Velter et al., 2013) and the same is true in the US (Smith et al., 2018;Sullivan et al., 2018).Moreover, a recent European survey showed that individual and structural barriers might hinder PrEP access in France (Annequin et al., 2020). Therefore, current European data suggest that PrEP is not always accessible and it may not meet the needs of all populations with high-risk exposure to HIV who may prefer other prevention methods. ...
... Barriers to PrEP use among women include a lack of awareness of PrEP, low perceived risk of HIV, cost, stigma, and lack of access (Aaron et al., 2018;Auerbach, 2015;Collier et al., 2017;Flash et al., 2017;Goparaju et al., 2017;Hill et al., 2021;Hull, 2012;Koren et al., 2018;Kwakwa et al., 2016;Ojikutu et al., 2018;Patel et al., 2019;Wingood et al., 2013). The literature indicates that Black women anticipated that side effects, medical mistrust, cost, partners and providers would be important, but surmountable barriers to uptake (Aaron et al., 2018;Flash et al., 2017;Goparaju et al., 2015Goparaju et al., , 2017Kwakwa et al., 2018;Ojikutu et al., 2018;Tekeste et al., 2018;Wingood et al., 2013). ...
... A few months ago, however, an MMWR was circulated by the CDC that suggested condomless sex might be safe if the HIV-infected partner's HAART achieved an undetectable viral load in his blood [16]. This new opinion was based on reports by three teams of investigators cited in the MMWR: BAll three studies observed no HIV transmission to the uninfected partner while the partner with HIV was virologically suppressed with ART [16].^Unfortunately, ...