Development and feasibility of the peer and nurse-led HIV Self-Testing Education and Promotion (STEP) intervention among social networks of men in Dar es Salaam, Tanzania: application of the ADAPT-ITT model.
HIV
HIV self-testing
Men
Tanzania
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
02 Oct 2024
02 Oct 2024
Historique:
received:
21
08
2023
accepted:
12
09
2024
medline:
3
10
2024
pubmed:
3
10
2024
entrez:
2
10
2024
Statut:
epublish
Résumé
According to the 2016-2017 Tanzania HIV Impact Survey, only 45% of men living with HIV (MLWH) were aware of their HIV status. In an effort to increase HIV testing in Tanzania, including among men, the Government of Tanzania passed a law in December 2019 allowing HIV self-testing (HIVST) to be included in the national testing strategies. The objective of this paper is to describe the development and pilot feasibility assessment of the Self-Testing Education and Promotion (STEP) intervention, which includes male peer education and demand creation for HIVST, and nurse-led distribution of HIVST kits in a community setting. The development and piloting processes were guided by the ADAPT-ITT model and informed by a national PEPFAR/USAID-funded HIV implementation science project called Sauti. The adapted STEP intervention included the following two components: 1) peer-based HIVST promotion; and 2) nurse-led HIVST distribution. For the feasibility assessment, 25 men were selected and trained as peer educators in 2019 to promote HIVST among their peers before recruiting 253 men who received instructions and an HIVST kit from a nurse at a community-based study tent site. Of the 236 participants who completed the 1-month follow-up survey, 98.3% reported using the kit. The majority (92.4%) of participants reported a negative HIVST result while 4.2% (n = 10) received a positive result. Most (70%, n = 7) of the participants with a positive result sought follow-up services at a healthcare facility while 40.3% (n = 95) of the participants with a negative self-test result visited the community-based project site. Most of the men (53%, n = 129) did not visit a healthcare facility or the study site. The findings demonstrate that the combined peer-based promotion and nurse-led distribution of HIVST intervention was acceptable and feasible, though seeking follow-up services at healthcare facilities remained low. Future research should evaluate the effectiveness of offering nurse-led community-based clinical follow-up services in addition to HIVST rather than referral to facilities.
Sections du résumé
BACKGROUND
BACKGROUND
According to the 2016-2017 Tanzania HIV Impact Survey, only 45% of men living with HIV (MLWH) were aware of their HIV status. In an effort to increase HIV testing in Tanzania, including among men, the Government of Tanzania passed a law in December 2019 allowing HIV self-testing (HIVST) to be included in the national testing strategies. The objective of this paper is to describe the development and pilot feasibility assessment of the Self-Testing Education and Promotion (STEP) intervention, which includes male peer education and demand creation for HIVST, and nurse-led distribution of HIVST kits in a community setting.
METHODS
METHODS
The development and piloting processes were guided by the ADAPT-ITT model and informed by a national PEPFAR/USAID-funded HIV implementation science project called Sauti. The adapted STEP intervention included the following two components: 1) peer-based HIVST promotion; and 2) nurse-led HIVST distribution. For the feasibility assessment, 25 men were selected and trained as peer educators in 2019 to promote HIVST among their peers before recruiting 253 men who received instructions and an HIVST kit from a nurse at a community-based study tent site.
RESULTS
RESULTS
Of the 236 participants who completed the 1-month follow-up survey, 98.3% reported using the kit. The majority (92.4%) of participants reported a negative HIVST result while 4.2% (n = 10) received a positive result. Most (70%, n = 7) of the participants with a positive result sought follow-up services at a healthcare facility while 40.3% (n = 95) of the participants with a negative self-test result visited the community-based project site. Most of the men (53%, n = 129) did not visit a healthcare facility or the study site.
CONCLUSION
CONCLUSIONS
The findings demonstrate that the combined peer-based promotion and nurse-led distribution of HIVST intervention was acceptable and feasible, though seeking follow-up services at healthcare facilities remained low. Future research should evaluate the effectiveness of offering nurse-led community-based clinical follow-up services in addition to HIVST rather than referral to facilities.
Identifiants
pubmed: 39358728
doi: 10.1186/s12913-024-11586-9
pii: 10.1186/s12913-024-11586-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1166Informations de copyright
© 2024. The Author(s).
Références
Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC). Tanzania HIV Impact Survey (THIS) 2022-2023: Summary Sheet. Dar es Salaam: 2023.
Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC). Tanzania HIV Impact Survey (THIS) 2016-2017: Final Report. Dar es Salaam: 2018.
Conserve DF, Msofe J, Issango J, Tureski K, McCarthy P, Rwezahura P, et al. Development, implementation, and scale up of the national furaha yangu campaign to promote HIV test and treat services uptake among men in tanzania. Am J Mens Health. 2022;16(2):15579883221087838.
pubmed: 35333688
pmcid: 8958702
doi: 10.1177/15579883221087838
Gillum C, Tureski K, Msofe J. Strengthening Social and Behavior Change Programming Through Application of an Adaptive Management Framework: A Case Study in Tanzania. Global Health: Science and Practice. 2023.
Conserve DF, Issango J, Kilale AM, Njau B, Nhigula P, Memiah P, et al. Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan. BMC Health Serv Res. 2019;19:1–10.
doi: 10.1186/s12913-019-4120-3
Conserve DF, Muessig KE, Maboko LL, Shirima S, Kilonzo MN, Maman S, et al. Mate Yako Afya Yako: formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men. PLoS ONE. 2018;13(8): e0202521.
pubmed: 30148846
pmcid: 6110473
doi: 10.1371/journal.pone.0202521
Johnson CC, Kennedy C, Fonner V, Siegfried N, Figueroa C, Dalal S, et al. Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21594.
pubmed: 28530049
pmcid: 5515051
doi: 10.7448/IAS.20.1.21594
Zanolini A, Chipungu J, Vinikoor MJ, Bosomprah S, Mafwenko M, Holmes CB, et al. HIV self-testing in Lusaka Province, Zambia: acceptability, comprehension of testing instructions, and individual preferences for self-test kit distribution in a population-based sample of adolescents and adults. AIDS Res Hum Retroviruses. 2018;34(3):254–60.
pubmed: 28969432
pmcid: 5863088
doi: 10.1089/aid.2017.0156
Choko AT, Corbett EL, Stallard N, Maheswaran H, Lepine A, Johnson CC, et al. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. PLoS Med. 2019;16(1): e1002719.
pubmed: 30601823
pmcid: 6314606
doi: 10.1371/journal.pmed.1002719
Mbita G, Mwanamsangu A, Plotkin M, Casalini C, Shao A, Lija G, et al. Consistent condom use and dual protection among female sex workers: surveillance findings from a large-scale, community-based combination HIV prevention program in Tanzania. AIDS Behav. 2020;24(3):802–11.
pubmed: 31444713
doi: 10.1007/s10461-019-02642-1
Birdthistle I, Schaffnit SB, Kwaro D, Shahmanesh M, Ziraba A, Kabiru CW, et al. Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings: a study protocol. BMC Public Health. 2018;18(1):1–15.
doi: 10.1186/s12889-018-5789-7
Wingood GM, DiClemente RJ. The ADAPT-ITT model: a novel method of adapting evidence-based HIV Interventions. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2008;47:S40–6.
pubmed: 18301133
doi: 10.1097/QAI.0b013e3181605df1
Yamanis TJ, Maman S, Mbwambo JK, Earp JAE, Kajula LJ. Social venues that protect against and promote HIV risk for young men in Dar es Salaam. Tanzania Social science & medicine. 2010;71(9):1601–9.
doi: 10.1016/j.socscimed.2010.07.039
Conserve DF, Alemu D, Yamanis T, Maman S, Kajula L. “He told me to check my health”: a qualitative exploration of social network influence on men’s HIV testing behavior and HIV self-testing willingness in Tanzania. Am J Mens Health. 2018;12(5):1185–96.
pubmed: 29808781
pmcid: 6142152
doi: 10.1177/1557988318777674
Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, et al. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC Public Health. 2015;16:1–12.
doi: 10.1186/s12889-016-2774-x
Conserve DF, Bay C, Kilonzo MN, Makyao NE, Kajula L, Maman S. Sexual and social network correlates of willingness to self-test for HIV among ever-tested and never-tested men: implications for the Tanzania STEP project. AIDS Care. 2019;31(2):169–76.
pubmed: 30362377
doi: 10.1080/09540121.2018.1537466
EngenderHealthandPromundo. Engagging Men at the Community Level Manual. 2008.
Dyson YD, Mobley Y, Harris G, Randolph SD. Using the Social-Ecological Model of HIV Prevention to Explore HIV Testing Behaviors of Young Black College Women. J Assoc Nurses AIDS Care. 2018;29(1):53–9.
pubmed: 29274654
doi: 10.1016/j.jana.2017.11.003
Fisher WA, Fisher JD, Harman J. The Information-Motivation-Behavioral Skills Model: A General Social Psychological Approach to Understanding and Promoting Health Behavior. Malden, MA, USA: Blackwell Publishing Ltd; 2003. p. 82–106.
U Bronfenbrenner B. Ecology of Human Development: Experiments by Nature and Design. Cambridge: Harvard University Press; 1981.
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.
doi: 10.1016/0749-5978(91)90020-T
Billingham SAM, Whitehead AL, Julious SA. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database. BMC Med Res Methodol. 2013;13(1):104.
pubmed: 23961782
pmcid: 3765378
doi: 10.1186/1471-2288-13-104
Pearson N, Naylor P-J, Ashe MC, Fernandez M, Yoong SL, Wolfenden L. Guidance for conducting feasibility and pilot studies for implementation trials. Pilot Feasib Stud. 2020;6(1):167.
doi: 10.1186/s40814-020-00634-w
Ministry of Finance and Planning, Tanzania National Bureau of Statistics and President’s Office – Finance and Planning, Office of the Chief Government Statistician, Zanzibar. The 2022 Population and Housing Census: Age and Sex Distribution Report, Key Findings, Tanzania. 2022.
National Bureau of Statistics (NBS) [Tanzania]. Tanzania Integrated Labour Force Survey 2020/21. Dodoma: NBS; 2022.
Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC). Tanzania HIV Impact Survey (THIS) 2022-2023: Summary Sheet. Dar es Salaam: 2023.
Hamilton A, Thompson N, Choko AT, Hlongwa M, Jolly P, Korte JE, et al. HIV self-testing uptake and intervention strategies among men in sub-Saharan Africa: a systematic review. Front Public Health. 2021;9: 594298.
pubmed: 33681120
pmcid: 7933016
doi: 10.3389/fpubh.2021.594298
Hlongwa M, Mashamba-Thompson T, Makhunga S, Muraraneza C, Hlongwana K. Men’s perspectives on HIV self-testing in sub-Saharan Africa: a systematic review and meta-synthesis. BMC Public Health. 2020;20(1):1–13.
doi: 10.1186/s12889-020-8184-0
Adepoju VA, Umebido C, Adelekan A, Onoja AJ. Acceptability and strategies for enhancing uptake of human immunodeficiency virus self-testing in Nigeria. World Journal of Methodology. 2023;13(3):127–41.
pubmed: 37456976
pmcid: 10348083
doi: 10.5662/wjm.v13.i3.127
Tan Y-R, Kaur N, Ye AJ, Zhang Y, Lim JXZ, Tan RKJ, et al. Perceptions of an HIV self-testing intervention and its potential role in addressing the barriers to HIV testing among at-risk heterosexual men: a qualitative analysis. Sexually transmitted infections. 2021;97(7):514–20.
pubmed: 33452131
doi: 10.1136/sextrans-2020-054773
Wirtz AL, Naing S, Mon SHH, Paing AZ, Mon EK, Thu KH, et al. High acceptability of HIV self-testing in a randomized trial among transgender women and men who have sex with men. Myanmar AIDS care. 2022;34(4):421–9.
pubmed: 34802339
doi: 10.1080/09540121.2021.2005763
Kgotlaetsile K, Bogart LM, Phaladze N, Klein DJ, Mosepele M. Feasibility and Acceptability of Human Immunodeficiency Virus Self-Testing for Men of Middle-to-Upper Socioeconomic Status in Botswana: A Pilot Study at 4 Worksites in the Financial Sector. Open Forum Infect Dis. 2024;11(1):ofad661-ofad.
pubmed: 38264095
doi: 10.1093/ofid/ofad661
Conserve DF, Saini S, Issango J, Kilale AM, Kamwela J, Maboko L, et al. Perceived benefits, challenges, and recommendations for HIV research dissemination and implementation science efforts in Tanzania: Findings from the HIV/AIDS Research Forum brainstorming session. PLOS Global Public Health. 2022;2(10): e0000952.
pubmed: 36962600
pmcid: 10022396
doi: 10.1371/journal.pgph.0000952
Kajula LJ, Kilonzo MN, Conserve DF, Mwikoko G, Kajuna D, Balvanz P, et al. Engaging young men as community health leaders in an STI and intimate partner violence prevention trial in Dar es Salaam. Tanzania Global social welfare. 2019;6:259–66.
pubmed: 31857942
doi: 10.1007/s40609-018-00134-z
Choko AT, Nanfuka M, Birungi J, Taasi G, Kisembo P, Helleringer S. A pilot trial of the peer-based distribution of HIV self-test kits among fishermen in Bulisa, Uganda. PLoS ONE. 2018;13(11): e0208191.
pubmed: 30496260
pmcid: 6264512
doi: 10.1371/journal.pone.0208191
Matovu JK, Bogart LM, Nakabugo J, Kagaayi J, Serwadda D, Wanyenze RK, et al. Feasibility and acceptability of a pilot, peer-led HIV self-testing intervention in a hyperendemic fishing community in rural Uganda. PLoS ONE. 2020;15(8): e0236141.
pubmed: 32764751
pmcid: 7413506
doi: 10.1371/journal.pone.0236141
Njau B. A theory-based behaviour change intervention to increase HIV self-testing uptake and linkage to HIV prevention, care and treatment for hard to reach populations in Northern Tanzania. Tanzan J Health Res. 2023;24(2):121–37.
Adeagbo OA, Seeley J, Gumede D, Xulu S, Dlamini N, Luthuli M, et al. Process evaluation of peer-to-peer delivery of HIV self-testing and sexual health information to support HIV prevention among youth in rural KwaZulu-Natal, South Africa: qualitative analysis. BMJ Open. 2022;12(2): e048780.
pubmed: 35165105
pmcid: 8845207
doi: 10.1136/bmjopen-2021-048780
Matovu JK, Mbita G, Hamilton A, Mhando F, Sims WM, Thompson N, et al. Men’s Comfort to Distribute or Receive HIV Self-Test Kits from Close Male Social Network Members in Tanzania: Baseline Results from the STEP Project. 2021.
Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, et al. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC public health. 2016;16(113):113.
pubmed: 26842360
pmcid: 4738785
Gandhi M, Greenblatt RM. Hair it is: the long and short of monitoring antiretroviral treatment. Ann Intern Med. 2002;137(8):696–7.
pubmed: 12379072
doi: 10.7326/0003-4819-137-8-200210150-00016
Baxi SM, Liu A, Bacchetti P, Mutua G, Sanders EJ, Kibengo FM, et al. Comparing the Novel Method of Assessing PrEP Adherence/Exposure Using Hair Samples to Other Pharmacologic and Traditional Measures (1999). J Acq Immune Def Synd. 2015;68(1):13–20.
doi: 10.1097/QAI.0000000000000386
Olds PK, Kiwanuka JP, Nansera D, Huang Y, Bacchetti P, Jin C, et al. Assessment of HIV antiretroviral therapy adherence by measuring drug concentrations in hair among children in rural Uganda. AIDS Care. 2015;27(3):327–32.
pubmed: 25483955
doi: 10.1080/09540121.2014.983452
Tabb ZJ, Mmbaga BT, Gandhi M, Louie A, Kuncze K, Okochi H, et al. Antiretroviral drug concentrations in hair are associated with virologic outcomes among young people living with HIV in Tanzania. AIDS (London). 2018;32(9):1115–23.
doi: 10.1097/QAD.0000000000001788
Georgeu D, Colvin CJ, Lewin S, Fairall L, Bachmann MO, Uebel K, et al. Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial. Implement Sci. 2012;7:1–13.
doi: 10.1186/1748-5908-7-66
Mabelane T, Marincowitz GJ, Ogunbanjo GA, Govender I. Factors affecting the implementation of nurse-initiated antiretroviral treatment in primary health care clinics of Limpopo Province. South Africa South African Family Practice. 2016;58(1):9–12.
doi: 10.1080/20786190.2015.1114704
Crowley T, Mokoka E, Geyer N. Ten years of nurse-initiated antiretroviral treatment in South Africa: A narrative review of enablers and barriers. Southern African Journal of HIV Medicine. 2021;22(1):1–13.
Tun W, Apicella L, Casalini C, Bikaru D, Mbita G, Jeremiah K, et al. Community-based antiretroviral therapy (ART) delivery for female sex workers in Tanzania: 6-month ART initiation and adherence. AIDS Behav. 2019;23:142–52.
pubmed: 31197700
pmcid: 6773663
doi: 10.1007/s10461-019-02549-x
Tun W, Conserve DF, Bunga C, Jeremiah K, Apicella L, Vu L. Quality of Care is Perceived to be High with Community-based Antiretroviral Therapy (ART) Services for Female Sex Workers in Tanzania: Qualitative Findings from a Pilot Implementation Science Study. AIDS Behav. 2023;28:1–11.
Programme NAC. National Guidelines for the Management of HIV and AIDS. Dodoma: The United Republic of Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children. 2019.
Tun W, Conserve DF, Bunga C, Jeremiah K, Apicella L, Vu L. Quality of Care is Perceived to be High with Community-based Antiretroviral Therapy (ART) Services for Female Sex Workers in Tanzania: Qualitative Findings from a Pilot Implementation Science Study. AIDS Behav. 2024;28(1):1–11.
pubmed: 37632605
doi: 10.1007/s10461-023-04155-4
Hunter LA, Rao A, Napierala S, Kalinjila A, Mnyippembe A, Hassan K, et al. Reaching Adolescent Girls and Young Women With HIV Self-Testing and Contraception at Girl-Friendly Drug Shops: A Randomized Trial in Tanzania. J Adolesc Health. 2023;72(1):64–72.
pubmed: 36241492
doi: 10.1016/j.jadohealth.2022.08.013
Eckenrode J, Campa M, Luckey DW, Henderson CR, Cole R, Kitzman H, et al. Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial. Arch Pediatr Adolesc Med. 2010;164(1):9–15.
pubmed: 20048236
doi: 10.1001/archpediatrics.2009.240
Miller TR. Projected outcomes of nurse-family partnership home visitation during 1996–2013, USA. Prev Sci. 2015;16(6):765–77.
pubmed: 26076883
pmcid: 4512284
doi: 10.1007/s11121-015-0572-9
MacPherson P, Lalloo DG, Webb EL, Maheswaran H, Choko AT, Makombe SD, et al. Effect of optional home initiation of HIV care following HIV self-testing on antiretroviral therapy initiation among adults in Malawi: a randomized clinical trial. JAMA. 2014;312(4):372–9.
pubmed: 25038356
pmcid: 4118051
doi: 10.1001/jama.2014.6493
Sanga ES, Mukumbang FC, Mushi AK, Lerebo W, Zarowsky C. Understanding factors influencing linkage to HIV care in a rural setting, Mbeya, Tanzania: qualitative findings of a mixed methods study. BMC public health. 2019;19(1):383.
pubmed: 30953503
pmcid: 6451278
doi: 10.1186/s12889-019-6691-7
Conserve DF, Issango J, Kilale AM, Njau B, Nhigula P, Memiah P. Developing national strategies for reaching men with HIV testing services in Tanzania: Results from the male catch-up plan. BMC Health Serv Res. 2019;19(1):1–10.
Nelson LE, Wilton L, Agyarko-Poku T, Zhang N, Aluoch M, Thach CT, et al. The Association of HIV Stigma and HIV/STD Knowledge With Sexual Risk Behaviors Among Adolescent and Adult Men Who Have Sex With Men in Ghana, West Africa. Res Nurs Health. 2015;38(3):194–206.
pubmed: 25809638
doi: 10.1002/nur.21650
Mbeda C, Ogendo A, Lando R, Schnabel D, Gust DA, Guo X, et al. Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study. AIDS Care. 2020;32(8):1052–60.
pubmed: 32500722
pmcid: 7368806
doi: 10.1080/09540121.2020.1776824
Levi-Minzi MA, Surratt HL. HIV stigma among substance abusing people living with HIV/AIDS: implications for HIV treatment. AIDS Patient Care STDS. 2014;28(8):442–51.
pubmed: 24983302
pmcid: 4117265
doi: 10.1089/apc.2014.0076
Cloete A, Simbayi LC, Kalichman SC, Strebel A, Henda N. Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town. South Africa AIDS care. 2008;20(9):1105–10.
pubmed: 18608067
doi: 10.1080/09540120701842720
Regenauer KS, Myers B, Batchelder AW, Magidson JF. “That person stopped being human”: Intersecting HIV and substance use stigma among patients and providers in South Africa. Drug and alcohol dependence. 2020;216:108322.
pubmed: 33010712
pmcid: 7673102
doi: 10.1016/j.drugalcdep.2020.108322
Magidson JF, Rose AL, Regenauer KS, Brooke-Sumner C, Anvari MS, Jack HE, et al. “It’s all about asking from those who have walked the path”: Patient and stakeholder perspectives on how peers may shift substance use stigma in HIV care in South Africa. Addict Sci Clin Pract. 2022;17(1):52–12.
pubmed: 36131304
pmcid: 9490994
doi: 10.1186/s13722-022-00330-5
Korfmacher J, O’Brien R, Hiatt S, Olds D. Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial. Am J Public Health. 1999;89(12):1847–51.
pubmed: 10589314
pmcid: 1509014
doi: 10.2105/AJPH.89.12.1847
Olds DL, Hill PL, O’Brien R, Racine D, Moritz P. Taking preventive intervention to scale: The nurse-family partnership. Cogn Behav Pract. 2003;10(4):278–90.
doi: 10.1016/S1077-7229(03)80046-9
Mbita G, Komba AN, Casalini C, Bazant E, Curran K, Christensen A, et al. Predictors of HIV Among 1 Million Clients in High-Risk Male Populations in Tanzania. AIDS Behav. 2022;26(10):3185–98.
pubmed: 35362905
pmcid: 9474353
doi: 10.1007/s10461-022-03667-9