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      “How PrEPared are you?”: Knowledge of and attitudes toward PrEP among overseas-born and newly arrived gay, bisexual, and other men who have sex with men in Australia

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          Abstract

          Introduction

          Overseas-born and newly arrived gay and bisexual men and men who have sex with men (GBMSM) are at higher risk of acquiring HIV in comparison to Australian-born GBMSM. Pre-exposure prophylaxis (PrEP) is subsidized by the Australian government under Medicare, Australia's universal health insurance scheme, however many members of this population are Medicare-ineligible, which could prevent them from accessing PrEP. We wanted to explore participants' knowledge of and attitudes toward PrEP and their opinions of new PrEP modalities, namely injectable PrEP and PrEP implants.

          Methods

          We conducted in-depth qualitative interviews between February 2021 to September 2021 with 22 overseas-born, newly arrived (<5 years in Australia) GBMSM of varying PrEP use. We asked their opinions of PrEP and their preferences of new PrEP modalities. Interviews were audio recorded and transcribed verbatim. We conducted a reflexive thematic analysis to interpret the data.

          Results

          Participants' views reflect the intersections between systemic factors, such as Medicare ineligibility and the high cost of PrEP, with socio-cultural factors, such as lack of knowledge about PrEP, internalized stigma stemming from homo- and sex-negativity, and stigmatizing attitudes toward PrEP and PrEP users. For participants who were on PrEP, being community connected, having a positive relationship with doctors and nurses, and being informed of the option to purchase PrEP from overseas pharmacies at a low cost helped them to overcome some of these barriers. Additionally, there was a strong preference for injectable PrEP but not PrEP implants. Participants stressed the importance of providing a comprehensive information about PrEP specific to this population and to make PrEP free for all.

          Conclusions

          We concluded that resources about PrEP specific to this population that address both systemic and socio-cultural factors are needed, and for these resources to be available in languages other than English. This is to coincide with on-going advocacy to increase the capacity of publicly funded sexual health clinics to provide multilingual PrEP services for people without Medicare, and to make PrEP free for all. These combined strategies have the potential to increase PrEP knowledge and uptake among this population.

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          Most cited references38

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Purposive sampling: complex or simple? Research case examples

            Background Purposive sampling has a long developmental history and there are as many views that it is simple and straightforward as there are about its complexity. The reason for purposive sampling is the better matching of the sample to the aims and objectives of the research, thus improving the rigour of the study and trustworthiness of the data and results. Four aspects to this concept have previously been described: credibility, transferability, dependability and confirmability. Aims The aim of this paper is to outline the nature and intent of purposive sampling, presenting three different case studies as examples of its application in different contexts. Results Presenting individual case studies has highlighted how purposive sampling can be integrated into varying contexts dependent on study design. The sampling strategies clearly situate each study in terms of trustworthiness for data collection and analysis. The selected approach to purposive sampling used in each case aligns to the research methodology, aims and objectives, thus addressing each of the aspects of rigour. Conclusions Making explicit the approach used for participant sampling provides improved methodological rigour as judged by the four aspects of trustworthiness. The cases presented provide a guide for novice researchers of how rigour may be addressed in qualitative research.
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              The Distinctions Between Theory, Theoretical Framework, and Conceptual Framework

              Health professions education (HPE) researchers are regularly asked to articulate their use of theory, theoretical frameworks, and conceptual frameworks in their research. However, all too often, these words are used interchangeably or without a clear understanding of the differences between these concepts. Further problematizing this situation is the fact that theory, theoretical framework, and conceptual framework are terms that are used in different ways in different research approaches. In this article, the authors set out to clarify the meaning of these terms and to describe how they are used in 2 approaches to research commonly used in HPE: the objectivist deductive approach (from theory to data) and the subjectivist inductive approach (from data to theory). In addition to this, given that within subjectivist inductive research theory, theoretical framework, and conceptual framework can be used in different ways, they describe 3 uses that HPE researchers frequently rely on: fully inductive theory development, fully theory-informed inductive, and theory-informing inductive data analysis.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                19 August 2022
                2022
                : 10
                : 946771
                Affiliations
                [1] 1Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University , Melbourne, VIC, Australia
                [2] 2Melbourne Sexual Health Centre, Alfred Health , Melbourne, VIC, Australia
                [3] 3Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne , Melbourne, VIC, Australia
                [4] 4The Kirby Institute, University of New South Wales , Sydney, NSW, Australia
                [5] 5The Burnet Institute , Melbourne, VIC, Australia
                [6] 6The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital , Melbourne, VIC, Australia
                [7] 7Department of Infectious Diseases, Alfred Health and Monash University , Melbourne, VIC, Australia
                Author notes

                Edited by: Kingston Rajiah, Gandhi Institute of Technology and Management University, India

                Reviewed by: Barry Adam, University of Windsor, Canada; Maria Pyra, Howard Brown Health Center, United States

                *Correspondence: Budiadi Sudarto budiadi.sudarto@ 123456monash.edu

                This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health

                †These authors share senior authorship

                Article
                10.3389/fpubh.2022.946771
                9437584
                36062118
                69d51098-d265-433c-96a3-f631af3a748c
                Copyright © 2022 Sudarto, Chow, Medland, Fairley, Wright, Armishaw, Price, Phillips and Ong.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 May 2022
                : 22 July 2022
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 52, Pages: 16, Words: 12200
                Funding
                Funded by: National Health and Medical Research Council, doi 10.13039/501100000925;
                Award ID: GNT1158035
                Award ID: GNT1172873
                Award ID: GNT1172900
                Award ID: GNT1193955
                Categories
                Public Health
                Original Research

                prep,hiv,intersecting barriers,hiv prevention,overseas-born,newly arrived,gbmsm

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