Freedom as Prevention: Mechanisms of Autonomy Support for Promoting HIV Pre-Exposure Prophylaxis Use and Condom Use among Black MSM in 3 US Cities—HPTN 073

Abstract

It is associated with long-term maintenance of health behaviors. We used structural equation modeling to investigate whether autonomy support was associated with increased odds of therapeutic serum levels of pre-exposure prophylaxis, through a pathway that satisfies basic psychological needs for autonomous self-regulation and Abstract Healthcare providers who use controlling or coercive strategies may compel short-term enactment of HIV and sexually transmitted infection prevention behaviors but may inadvertently undermine their client's motivation to maintain those behaviors in the absence of external pressure. Autonomous motivation refers to the self-emanating and self-determined drive

Overcoming structural barriers to diffusion of HIV pre-exposure prophylaxis

“…In many healthcare settings, there may be a lack of time focused on patients and ancillary services to support patients to adopt or adhere to PrEP. Challenges in provider availability, adequate ancillary staff, and lack of support such as adherence counseling or patient education 7,16,20,40 –43,47 –51 may limit the provider’s ability to ensure that patients stay on PrEP to achieve its greatest impact. Most healthcare settings lack sufficient staff to manage the multidisciplinary needs of the PrEP patient, which may include testing for other STIs, psychosocial support, or education.…”

“…This is the case even for currently available oral PrEP. For example, client-centered care coordination (C4) 42,43,47 –49 was explored as a vanguard intervention to support Black MSM in the uptake and adherence of F/TDF and demonstrated positive signals of effectiveness. 42,43,47,48 However, this intervention has not been fully examined in a randomized trial despite the ongoing urgency of developing new methods to support PrEP use among Black MSM.…”

“…For example, client-centered care coordination (C4) 42,43,47 –49 was explored as a vanguard intervention to support Black MSM in the uptake and adherence of F/TDF and demonstrated positive signals of effectiveness. 42,43,47,48 However, this intervention has not been fully examined in a randomized trial despite the ongoing urgency of developing new methods to support PrEP use among Black MSM. Similarly, adherence counselors who would be useful in helping to increase PrEP adherence and persistence 18 are seldom paid for in current insurance paradigms.…”

“…For recently approved long-acting injectable cabotegravir for PrEP, this is a clear challenge. By way of example, the nearly decade-long delay in the development of adequate evidence-based support strategies for F/TDF could have been overcome by requiring that methods for scale-up and implementation, such as C4, 42,43,47 –49 were included in the drug-development process. This would require pharmaceutical company investment and not primarily the efforts of federal and grassroots organizations to solve these implementation issues.…”

The importance of developmental assets in HIV prevention behaviors among young black men who have sex with men (MSM)

“…Young Black men who have sex with men (YBMSM) continue to face the highest HIV infection rates in the United States 1 , 2 , with a 50% chance of HIV acquisition in their lifetime, which possibly reaches 60% by age 40 3 . Thus, the Centers for Disease Control and Prevention (CDC) recommends annual or more frequent screening for those demonstrating a higher risk of HIV infection for this population 4 , 5 .…”