Implementation of Preexposure Prophylaxis for Human Immunodeficiency Virus Prevention Among Men Who Have Sex With Men at a New England Sexually Transmitted Diseases Clinic

Abstract

Background Pre-exposure prophylaxis (PrEP) is efficacious in preventing HIV among men who have sex with men (MSM). We assessed PrEP uptake among MSM presenting for services at a sexually transmitted diseases (STD) clinic. Methods MSM presenting to the Rhode Island STD Clinic between October 2013 and November 2014 were educated about, and offered, PrEP. We categorized PrEP engagement using an implementation cascade to describe gaps in uptake which described MSM who: 1) were educated about PrEP, 2) indicated interest, 3) successfully received follow-up contact, 4) scheduled an appointment, 5) attended an appointment, and 6) initiated PrEP (i.e., received a prescription). Bivariate and multivariable logistic regression models were used to examine predictors of PrEP initiation. Results A total of 234 MSM were educated about PrEP; of these, 56% expressed interest. Common reasons for lack of interest were low HIV risk perception (37%), wanting more time to consider (10%), concern about side effects (7%), and financial barriers (3%). Among those interested, 53% followed up. Of those, 51% scheduled an appointment. The most common reason patients did not schedule an appointment was low HIV risk perception (38%). Seventy-seven percent of those with an appointment attended the appointment; of those, 93% initiated PrEP. Patients with higher HIV risk perception (aOR=2.17, 95% CI 1.29-3.64) and a history of sex with an HIV-positive partner (aOR=7.08, 95% CI 2.35-21.34) had significantly higher odds of initiating PrEP. Conclusions Low HIV risk perception was the most significant barrier to PrEP uptake among MSM attending a public STD clinic.

Behavioral Changes Following Uptake of HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in a Clinical Setting

“…The PrEP program was established at an STI and HIV prevention clinic, and received referrals from the HIV care and treatment clinic (e.g., individuals in serodiscordant relationships), the STI clinic, and other providers in the state. All MSM presenting to the STI clinic are educated about PrEP by the clinic staff as previously described [11]. Individuals who are interested in PrEP are referred to the on-site PrEP program.…”

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…PrEP implementation research consistently cites inadequate risk perception as a barrier to PrEP interest and uptake, and many studies call for strategies to increase risk perception among PrEP-eligible individuals. [27][28][29][30] However, there are significant concerns about whether this approach is effective or sustainable as a strategy for increasing PrEP demand. Data demonstrate a pervasive disconnect between individuals' objective risk of HIV infection and their subjective risk perception.…”

Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis

“…Barriers are based on prior research and covered topics, including finding information, finding and talking to a PrEP provider, attending appointments, taking PrEP every day, coping with side effects, and paying for PrEP care. [28][29][30] We assessed barriers using a 5-point scale (1 = ''Very Easy'' to 5 = ''Very Difficult''). Likert responses were dichotomized for ease of descriptive presentation, and participants who identified a barrier as ''medium,'' ''difficult,'' or ''very difficult'' were classified as endorsing that barrier.…”