Publications
19 results found
Coukan F, Murray K-K, Papageorgiou V, et al., 2023, Barriers and facilitators to HIV Pre-Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum., HIV Med
OBJECTIVES: HIV pre-exposure prophylaxis (PrEP) delivery in the UK is inequitable; over 95% of PrEP users were men who have sex with men (MSM) despite making up less than 50% of new HIV diagnoses. We conducted a systematic review to identify modifiable barriers and facilitators to PrEP delivery in the UK among underserved populations. METHODS: We searched bibliographic/conference databases using the terms HIV, PrEP, barriers, facilitators, underserved populations, and UK. Modifiable factors were mapped along the PrEP Care Continuum (PCC) to identify targets for interventions. RESULTS: In total, 44 studies were eligible: 29 quantitative, 12 qualitative and three mixed-methods studies. Over half (n = 24 [54.5%]) exclusively recruited MSM, whereas 11 were in mixed populations (all included MSM as a sub-population) and the other nine were in other underserved populations (gender and ethnicity minorities, women, and people who inject drugs). Of the 15 modifiable factors identified, two-thirds were at the PrEP contemplation and PrEParation steps of the PCC. The most reported barriers were lack of PrEP awareness (n = 16), knowledge (n = 19), willingness (n = 16), and access to a PrEP provider (n = 16), whereas the more reported facilitators were prior HIV testing (n = 8), agency and self-care (n = 8). All but three identified factors were at the patient rather than provider or structural level. CONCLUSIONS: This review highlights that the bulk of the scientific literature focuses on MSM and on patient-level factors. Future research needs to ensure underserved populations are included and prioritized (e.g. ethnicity and gender minorities, people who inject drugs) and provider and structural factors are investigated.
Papageorgiou V, Anderson J, Bruton P, et al., 2023, Co-production in HIV research: reflections from a study on building relationships, conducting qualitative research and developing skills remotely, AIDS Impact
Appleby G, Papageorgiou V, Horter S, et al., 2022, Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: a mixed-methods study, PLoS One, Vol: 17, ISSN: 1932-6203
BACKGROUND: During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. MATERIALS AND METHODS: We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. RESULTS: Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers' journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived "overwhelmed" NHS by speaking to trusted sources, predominantly general practitioners (GPs). CONCLUSION: Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child's health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the h
Papageorgiou V, Bruton P, Johnson H, et al., 2022, Supporting material for co-researchers
This pack has been designed to be used alongside the Peer Research Training Resource (https://doi.org/10.25561/94819) and includes:• Skills, experience, and training reviews for Advisory Group Members and Peer Researchers• Zoom Interviews: Guide for Peer Researchers• Useful COVID-19 resources for people living with HIVThe pack is suitable for academics and public involvement practitioners who are involving people with lived experience as co-researchers in research. The material presented here was developed for a participatory research study on COVID-19 experiences among people living with HIV where interviews were conducted online.
Papageorgiou V, Crittendon E, Coukan F, et al., 2022, Impact of daily, oral pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: a systematic review and narrative synthesis [version 2; peer review: 2 approved], Wellcome Open Research, Vol: 7, Pages: 1-21, ISSN: 2398-502X
Background: There are concerns that the use of pre-exposure prophylaxis (PrEP) may result in an increased incidence of sexually transmitted infections (STIs). Evidence for this is mixed and has mostly been based on reviews focussed on gay and bisexual men and transgender women, while none have summarised evidence in cisgender women.Methods: We conducted a systematic review to explore whether daily, oral PrEP use is associated with changes in bacterial STI occurrence (diagnoses or self-reported) and/or risk among HIV seronegative cisgender women (ciswomen). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.Results: We included 11 full text articles in a narrative synthesis, with the studies published between 2012 and 2021. The studies were mostly based in Africa (n=7, 63.6%) and reported on 3168 ciswomen using PrEP aged 16–56 years. Studies had marked differences in variables, including measurements and definitions (e.g., STI type) and limited data available looking specifically at ciswomen, principally in studies with both male and female participants. The limited evidence suggests that PrEP use is not associated with increased STI rates in ciswomen generally; however, adolescent girls and young women in Sub Saharan Africa have a higher prevalence of bacterial STIs prior to PrEP initiation, compared to adult ciswomen and female sex workers.Conclusions: We suggest future PrEP research make efforts to include ciswomen as study participants and report stratified results by gender identity to provide adequate data to inform guidelines for PrEP implementation.PROSPERO registration: CRD42019130438
Papageorgiou V, Bruton P, Dsouza K, et al., 2022, Experiences of the COVID-19 epidemic: a participatory qualitative study with people living and/or working with HIV in the UK, 24th International AIDS Conference
Papageorgiou V, Davies B, Cooper E, et al., 2022, Influence of material deprivation on clinical outcomes among people living with HIV in high-income countries: a systematic review and meta-analysis, AIDS and Behavior, Vol: 26, Pages: 2026-2054, ISSN: 1090-7165
Despite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.
Papageorgiou V, Crittendon E, Coukan F, et al., 2022, Impact of daily, oral pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: a systematic review and narrative synthesis, Publisher: Wellcome Open Research
Background: There are concerns that the use of pre-exposure prophylaxis (PrEP) may result in an increased incidence of sexually transmitted infections (STIs). Evidence for this is mixed and has mostly been based on reviews focussed on gay and bisexual men and transgender women, while none have summarised evidence in cisgender women.Methods: We conducted a systematic review to explore whether daily, oral PrEP use is associated with changes in bacterial STI occurrence (diagnoses or self-reported) and/or risk among HIV seronegative cisgender women (ciswomen). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.Results: We included 11 full text articles in a narrative synthesis, with the studies published between 2012 and 2021. The studies were mostly based in Africa (n=7, 63.6%) and reported on 3168 ciswomen using PrEP aged 16–56 years. Studies had marked differences in variables, including measurements and definitions (e.g., STI type) and limited data available looking specifically at ciswomen, principally in studies with both male and female participants. The limited evidence suggests that PrEP use is not associated with increased STI rates in ciswomen generally; however, adolescent girls and young women in Sub Saharan Africa have a higher prevalence of bacterial STIs prior to PrEP initiation, compared to adult ciswomen and female sex workers.Conclusions: We suggest future PrEP research make efforts to include ciswomen as study participants and report stratified results by gender identity to provide adequate data to inform guidelines for PrEP implementation.PROSPERO registration: CRD42019130438
Papageorgiou V, Bruton P, Johnson H, et al., 2022, Peer Research Training Resource
This training slide deck, developed by the Patient Experience Research Centre at Imperial College, London, aims to support and provide a starting point for academics and public involvement practitioners who want to train people with lived experience to become co-researchers in qualitative/interview-based research studies. The resource was developed from a series of online training sessions which were originally used to induct and train peer researchers for a participatory research study on COVID-19 experiences among people living with HIV and covers training on:• Research Integrity: Ethics and Research Data Management• Qualitative Research and Public Involvement• Interviewing Skills and Emotional Wellbeing• Analysing Interview Transcripts
Papageorgiou V, Jones K, Halliday B, et al., 2021, A qualitative exploration of participant and investigator perspectives from the TRED-HF trial, ESC Heart Failure, Vol: 8, Pages: 3760-3768, ISSN: 2055-5822
Aim We explored the experiences and motivations of participants and staff who took part in the TRED-HF trial (Therapy withdrawal in REcovered Dilated cardiomyopathy). MethodsWe conducted a qualitative study, using semi-structured interviews, with participants (n=12) and the research team (n=4) from the TRED-HF trial. Interviews were carried out in 2019 and were audio-recorded and transcribed. Data were managed using NVivo and analysed using framework analysis. A patient representative provided guidance on the interpretation of findings and presentation of themes to ensure these remained meaningful, and an accurate representation, to those living with dilated cardiomyopathy.ResultsThree key themes emerged from the data: (1) perception of health; (2) experiences and relationships with healthcare services and researchers; and (3) perception of risk. Study participants held differing perceptions of their health; some did not consider themselves to have a heart condition or disagreed with the medical term ‘heart failure’. Relationships between participants, research staff and clinical management teams influenced participants’ experiences and decision-making during the trial, including following clinical advice. There were differences in participants’ perceptions of risk and their decisions to take heart failure medication after the trial was completed. Although the original TRED-HF trial did not provide the results many had hoped for, a strong motivator for taking part was the opportunity to withdraw medication in a safely monitored environment which had been previously considered by some participants before. Investigators acknowledged that the insights gained from the study can now be used to support evidence-based conversations with patients.Conclusion For people whose dilated cardiomyopathy is in remission, decisions to continue, reduce or stop their medication are influenced by perceptions of personal health, perceive risk and the important o
Papageorgiou V, Bruton J, Petretti S, et al., 2021, Impact of COVID-19 on the HIV care continuum in the United Kingdom, 11th IAS Conference on HIV Science, Publisher: IAS
Atchison C, Pristerà P, Cooper E, et al., 2020, Usability and acceptability of home-based self-testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibodies for population surveillance, Clinical Infectious Diseases, Vol: 2020, Pages: 1-10, ISSN: 1058-4838
BACKGROUND: This study assesses acceptability and usability of home-based self-testing for SARS-CoV-2 antibodies using lateral flow immunoassays (LFIA). METHODS: We carried out public involvement and pilot testing in 315 volunteers to improve usability. Feedback was obtained through online discussions, questionnaires, observations and interviews of people who tried the test at home. This informed the design of a nationally representative survey of adults in England using two LFIAs (LFIA1 and LFIA2) which were sent to 10,600 and 3,800 participants, respectively, who provided further feedback. RESULTS: Public involvement and pilot testing showed high levels of acceptability, but limitations with the usability of kits. Most people reported completing the test; however, they identified difficulties with practical aspects of the kit, particularly the lancet and pipette, a need for clearer instructions and more guidance on interpretation of results. In the national study, 99.3% (8,693/8,754) of LFIA1 and 98.4% (2,911/2,957) of LFIA2 respondents attempted the test and 97.5% and 97.8% of respondents completed it, respectively. Most found the instructions easy to understand, but some reported difficulties using the pipette (LFIA1: 17.7%) and applying the blood drop to the cassette (LFIA2: 31.3%). Most respondents obtained a valid result (LFIA1: 91.5%; LFIA2: 94.4%). Overall there was substantial concordance between participant and clinician interpreted results (kappa: LFIA1 0.72; LFIA2 0.89). CONCLUSION: Impactful public involvement is feasible in a rapid response setting. Home self-testing with LFIAs can be used with a high degree of acceptability and usability by adults, making them a good option for use in seroprevalence surveys.
Papageorgiou V, Cooper E, Bruton J, et al., 2020, Insight Report: COVID-19 Community Involvement - “Let’s Talk About…HIV Care”
This informal session led by the Patient Experience Research Centre (PERC), in collaboration with Positively UK, invited people living with, affected by, or working in HIV to share their experience, views, questions and concerns on accessing HIV care during COVID-19. The aim of the call was to gather feedback on specific areas to help guide a proposed qualitative (interview-based study) looking to explore experiences, specifically on:1. Challenges and concerns in managing HIV care during COVID-192. Challenges in the provision of HIV care during COVID-193. Opportunities presented for HIV care during COVID-19We also wished to inspire new ways to rapidly engage and involve communities remotely during a public health emergency, through strengthening partnerships with existing groups (in this case, Positively UK).
Papageorgiou V, Singer A, Cooper E, et al., 2020, PROSPERO Registration: A systematic review of social determinants and HIV treatment outcomes among people living with HIV in high-income countries, PROSPERO International prospective register of systematic reviews
Pristera P, Papageorgiou V, Kaur M, et al., 2020, Report 14: Online community involvement in COVID-19 research & outbreak response: early insights from a UK perspective
The Patient Experience Research Centre (PERC) at Imperial College London is developing research to explore and understand people’s views about, experiences of and behavioural responses to the outbreak in the UK and elsewhere. To guide that effort and to help inform COVID-19 research and responses more broadly - for example in mathematical modelling and policy - PERC launched an online community involvement initiative that sought rapid, early insight from members of the public and aimed to establish a network for ongoing community engagement.Priority areas for COVID-19 research Vaccine development was considered the most urgent research priority for many respondents. Social studies exploring the public’s experiences, risk perceptions and behaviours during this outbreak were necessary and important according to 95% of the respondents. Such research could:Improve the way the current outbreak response is planned and implemented;Improve the way information and guidance is provided to and understood by the public;Optimise the support provided to communities and vulnerable groups; andImprove future outbreak preparedness.Other recommended areas of research included:Understanding the role of the media in influencing how people react and respond;Furthering our basic understanding of the virus – how it spreads, who it affects the most and why, and whether people achieve and maintain immunity after being infected;Critiquing the UK’s response to the pandemic against that of other countries; andEnsuring lessons can be learnt from this outbreak to better equip us for future outbreaks, and public health emergencies in general.Key unmet needs amongst communities The main challenges described by respondents were ineffective communication, including access to information and information overload; and conflicting guidance and misinformation. Respondents’ described feelings of concern, confusion and, in some cases, panic as a result of these communication a
Papageorgiou V, Wharton-Smith A, Campos-Matos I, et al., 2020, Patient data-sharing for immigration enforcement: a qualitative study of healthcare providers in England, BMJ Open, Vol: 10, ISSN: 2044-6055
Aim: To explore healthcare providers’ perceptions and experiences of the implications of a patient data-sharing agreement between National Health Service (NHS) Digital and the Home Office on access to NHS services and quality of care received by migrant patients in England.Design: A qualitative study using semi-structured interviews, thematic analysis and constant-comparison approach.Participants: Eleven healthcare providers and one non-clinical volunteer working in community or hospital-based settings who had experience of migrants accessing NHS England services. Interviews were carried out in 2018.Setting: England.Results: Awareness and understanding of the patient data-sharing agreement varied among participants, who associated this with a perceived lack of transparency by the government. Participants provided insight into how they thought the data-sharing agreement was negatively influencing migrants’ health-seeking behaviour, their relationship with clinicians and the safety and quality of their care. They referred to the policy as a challenge to their core ethical principles, explicitly patient confidentiality and trust, which varied depending on their clinical specialty.Conclusions: A perceived lack of transparency during the policy development process can result in suspicion or mistrust towards government among the health workforce, patients and public, which is underpinned by a notion of power or control. The patient data-sharing agreement was considered a threat to some of the core principles of the NHS and its implementation as adversely affecting healthcare access and patient safety. Future policy development should involve a range of stakeholders including civil society, healthcare professionals and ethicists, and include more meaningful assessments of the impact on healthcare and public health.
Papageorgiou V, Jones K, Mindham R, et al., 2019, ‘Do I really want to do this for the rest of my life?’: a qualitative exploration of participant and study staff perspectives from the Therapy withdrawal in Recovered Dilated cardiomyopathy - Heart Failure (TRED-HF) study, Chronic Living Conference 2020
Papageorgiou V, Crittendon E, Davies B, et al., 2019, Impact of pre-exposure prophylaxis on the risk of bacterial sexually transmitted infections among cisgender women: systematic review, AIDS Impact 2019
Papageorgiou V, Crittendon E, Davies B, et al., 2019, PROSPERO registration: Impact of pre-exposure prophylaxis (PrEP) on the risk of bacterial sexually transmitted infections (STIs) among cisgender women: a systematic review, PROSPERO International prospective register of systematic reviews
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