Predictors of HIV Preexposure Prophylaxis Initiation Among Public Health Clients in Rural and Small Urban Areas in Iowa

Abstract

Objective Preexposure prophylaxis (PrEP) is a safe and effective method for HIV prevention, but little is known about PrEP uptake in rural and small urban areas. We described rates and predictors of HIV PrEP initiation among public health clients in rural and small urban areas in Iowa. Methods This was a prospective cohort study of clients with PrEP indications served by HIV testing and disease intervention specialist/partner services (DIS/PS) programs in public health departments in Iowa from February 1, 2018, through February 28, 2019. Eligible participants were aged 18-70 and referred for PrEP by public health personnel. Participants completed surveys at enrollment addressing demographic characteristics; sexual history; previous drug use; PrEP experiences; and knowledge, attitudes, and beliefs about PrEP. A follow-up survey assessed PrEP initiation at 30 days. We compared baseline characteristics of PrEP initiators and non-initiators. Results Two hundred thirty-four public health clients consented to participate in the study; 189 completed the baseline survey, and 117 (61.9%) completed the follow-up survey. The mean age of participants in the baseline survey was 30 (range, 18-68); 109 (57.7%) were male, 127 (67.2%) were White, and 169 (89.4%) lived in a rural or small urban area. Of 117 participants in the follow-up survey, those who initiated PrEP were significantly more likely than those who did not initiate PrEP to be referred by DIS/PS programs (46.7% vs 7.8%, P < .001) and to recognize that PrEP was ≥90% effective (86.7% vs 35.3%, P = .001). No PrEP initiators and 8 PrEP non-initiators agreed that PrEP is for promiscuous people (0% vs 7.8%, P = .04). Perceived PrEP stigma was low and not associated with PrEP initiation. Conclusions PrEP initiation rates were low among rural and small urban health department clients. Interventions are needed to improve linkage to PrEP among rural and small urban public health clients.

Priorities in the implementation of partner services for HIV/STIs in high-income nations: a narrative review of evidence and recommendations

“…17,63 Studies from Seattle, Chicago, and Iowa suggest that between one-quarter and one-third of HIV-negative men who have sex with men (MSM) who are not on PrEP can be successfully linked to PrEP through PS. [64][65][66] Data on the success of PS in relinking out-of-care HIV-positive persons to care are limited, but a study of syphilis and gonorrhoea PS in six US jurisdictions found that 29% of previously diagnosed HIV-positive persons receiving PS for syphilis or gonorrhoea in 2016-17 -17 574 peoplewere out of care or not virally suppressed, suggesting that PS could play a large role in increasing engagement in HIV care. 67 In general, the marginal cost of integrating these outcomes into the services provided to people who are already receiving PS is low.…”

Assisted Partner Notification Services in Namibia: Comparison of Case-Finding in Persons With New and Previously Diagnosed Human Immunodeficiency Virus, and Success as a Platform for PrEP Referral

“…Data from the US suggest that APS can be an effective platform for promoting preexposure prophylaxis (PrEP), but little data exists on this from contexts outside the United States. [12][13][14][15][16][17] Namibia is approaching the UNAIDS 95-95-95 targets with an estimated 92% of people living with HIV (PLHIV) diagnosed, 99% of diagnosed PLHIV on antiretroviral therapy (ART), and 94% of patients on ART virally suppressed. 18 Starting in October 2019, the Namibian MHSS, technically supported by the International Training and Education Center for Health (I-TECH) at the University of Washington, implemented facility-based APS in 22 MHSS clinical sites in a focused effort to increase HIV case finding.…”

“…Finally, there are few data on the effectiveness of efforts to integrate outcomes other than HIV testing into APS programs. Data from the US suggest that APS can be an effective platform for promoting preexposure prophylaxis (PrEP), but little data exists on this from contexts outside the United States 12–17 …”