An Information–Motivation–Behavioral Skills Model of PrEP Uptake

Dubov, Alex; Altice, Frederick L.; Fraenkel, Liana

doi:10.1007/s10461-018-2095-4

Cited by 80 publications

(63 citation statements)

References 92 publications

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“…15,57 This model emphasized the need for at-risk individuals to have information (accurate, factual knowledge of HIV transmission and PrEP efficacy, safety, and dosage), motivation (perceived HIV risk and positive healthcare attitudes and personal intentions), and behavioral skills (self-efficacy for obtaining and using PrEP, action planning for PrEP consultations, screening appointments, and adherence). 58 However, the appropriateness of this model for out-of-treatment individuals with current injection drug use should be assessed in future studies.…”

Section: Discussionmentioning

confidence: 99%

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

Bazzi

Biancarelli

Childs

et al. 2018

AIDS Patient Care and STDs

101

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People who inject drugs (PWID) experience sexual and injection-related HIV risks, but uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among PWID has been low. Improving PrEP uptake in this population will require understanding of PrEP knowledge and interest. In 2017, we conducted in-depth, semistructured interviews with HIV-uninfected PWID and key informants (PrEP and harm reduction providers) in the US Northeast. Thematic analysis of coded data explored PrEP knowledge and the factors that influence PrEP interest. Among PWID (n = 33), median age was 36 years, 55% were male, 67% were white, and 24% identified as Hispanic/Latino. Accurate PrEP knowledge among PWID was low, which key informants (n = 12) attributed to PrEP marketing focused on other risk populations, as well as healthcare providers' lack of time and unwillingness to discuss PrEP with PWID. There was a discrepancy between self-reported HIV risk behaviors, which were common, and HIV risk perceptions, which varied and strongly influenced PrEP interest. Most PWID and key informants thought that PrEP would be most beneficial for those who shared syringes, used discarded syringes, engaged in transactional sex, or were homeless. Improving uptake of PrEP for HIV prevention among high-risk PWID will require education to increase PrEP knowledge and addressing factors that negatively influence PrEP interest such as perceptions regarding low HIV risk and the process for obtaining PrEP. This may require specialized PrEP marketing and outreach efforts and improved capacity of healthcare providers to effectively assess HIV risk (and perceptions) and communicate the benefits of PrEP to at-risk PWID.

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Section: Discussionmentioning

confidence: 99%

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

Bazzi

Biancarelli

Childs

et al. 2018

AIDS Patient Care and STDs

101

View full text Add to dashboard Cite

show abstract

“…Interviews were performed by one of two medical anthropologists or an infectious diseases physician, audio‐recorded and transcribed. A code book was first developed using the Motivational PrEP Cascade and the situated Information‐Motivation‐Behavioural Skills theoretical models [18‐20] and was subsequently iteratively revised based on emergent themes [21]. One‐tenth of transcripts were double‐coded, and the research team discussed discrepancies and revision of the code book accordingly.…”

Section: Methodsmentioning

confidence: 99%

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in‐depth interviews with people who HIV seroconverted after using PrEP. Methods We identified individuals who initiated PrEP in an integrated safety‐net public health system and performed in‐depth chart review to determine person‐time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention’s Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in‐depth interviews with those who seroconverted. Results Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person‐years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5‐fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on‐demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP’s benefit versus self‐perceived risk; and entering a primary partnership. The individual who developed HIV using on‐demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. Conclusions HIV incidence during gaps in PrEP use was nearly eight‐fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non‐daily PrEP may require additional education and support in the United States.

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“…We developed a semi‐structured interview guide (Table 2) informed from our literature review to elicit feedback and experiences from patients relevant to the IMB core concepts 19‐22 . Information includes objective and subjective knowledge of medication, treatment expectations and risks, cost, and self‐care 11 .…”

Section: Methodsmentioning

confidence: 99%

Describing barriers and facilitators for medication adherence and self‐management among kidney transplant recipients using the information‐motivation‐behavioral skills model

Ranahan

Visger

Kayler

2020

Clinical Transplantation

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Background We aimed to develop an adapted information‐motivation‐behavioral skills (IMB) model to describe barriers and facilitators for adherence and self‐management among kidney transplant recipients. Methods We conducted a review of literature about kidney transplant recipients' knowledge, perceptions, and experiences and organized our results using the IMB framework. We then conducted interviews with transplant recipients and transplant providers to supplement our literature search. Results Our proposed adaption of the IMB model describes informational, motivational, and behavioral skills barriers and facilitators for medication adherence and self‐management among kidney transplant recipients. Moderating factors influence not only behavioral skills, but also recipients' understanding of information and motivation to adhere and practice self‐management. Conclusion By using the IMB model to organize current research and interviews with recipients and providers, we developed an adapted model for medication adherence and self‐management. Results are promising to impact future educational and behavioral interventions for kidney transplant recipients.

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An Information–Motivation–Behavioral Skills Model of PrEP Uptake

Cited by 80 publications

References 92 publications

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

Describing barriers and facilitators for medication adherence and self‐management among kidney transplant recipients using the information‐motivation‐behavioral skills model

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