HIV Pre-exposure Prophylaxis Services for Black and Hispanic or Latino Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in THRIVE, 2015-2020

Abstract

Background and setting: From 2015 to 2020, the THRIVE project supported 7 US health departments to improve HIV prevention services for Black or African American (Black) and Hispanic or Latino gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). Methods:We described services provided in the THRIVE PrEP continuum. Using Poisson regression models, we estimated associations between race or ethnicity and age and PrEP screening, linkage, and prescription. We examined associations between colocation of services and PrEP linkage and prescription for 2 sites.Results: THRIVE served 12,972 GBM without HIV; 37% of PrEPeligible GBM were prescribed PrEP. THRIVE served 1185 TGW without HIV; 45% of PrEP-eligible TGW were prescribed PrEP. Black and Hispanic or Latino GBM were 29% (RR = 0.71, 95% CI: 0.66-0.77) and 19% (RR = 0.81, 95% CI: 0.75-0.87) less likely, respectively, to be prescribed PrEP than White GBM. GBM aged 18-24 years and 55 years or older were 19% (RR = 0.81, 95% CI: 0.75-0.87) and 22% (RR = 0.78, 95% CI: 0.67-0.9) less likely, respectively, to be prescribed PrEP compared with those aged 35-44 years. Colocated services were associated with a 54% (RR = 1.54, 95% CI: 1.44-1.64) and a 31% (RR = 1.31, 95% CI: 1.19-1.43) greater likelihood of PrEP linkage and prescription, respectively, compared with services at different locations.Conclusions: THRIVE provided PrEP to higher proportions of PrEP-eligible persons than current national estimates; however, PrEP use disparities persist. Colocation of services may be a useful component of jurisdictional strategies to increase PrEP coverage.

Inequities Along the Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis Services Continuum for Black Women in the United States, 2015–2020

“…In THRIVE, the proportion of Black women who were eligible for PrEP and prescribed PrEP (7.0%) was much smaller compared with the proportion of Black and Hispanic men who have sex with men (37.0%) and transgender women (45.0%) who were eligible for PrEP and prescribed PrEP. 11 This may have been a result of the focus in THRIVE to support PrEP use by Black and Hispanic men who have sex with men and transgender women. Although THRIVE was very successful in reaching Black women to provide HIV and STI testing, our finding suggests that opportunities were missed to increase PrEP use by Black women.…”

“…We used the Fisher exact test to compare proportions of Black women and Hispanic or Latina, White, or women of additional races and ethnicities stratified by age group, STI testing and infections, HIV status during initial assessment, and the five steps of the PrEP service continuum (screening, eligibility, referral, linkage, and prescription). 11 We summarized the number of Black women who were screened and eligible for PrEP among those with a negative HIV test result or assumed negative HIV status at the time of THRIVE enrollment; among Black women who were eligible for PrEP, we summarized the number referred, linked, and prescribed PrEP. Missing continuum data were categorized as service not received, except when services received later in the continuum were imputed into earlier steps (eg, PrEP screening must have occurred if PrEP prescription occurred).…”