The Motivational PrEP Cascade Guides Interpretation of Early PrEP Linkage to Care for Young Black Men Who Have Sex With Men: The Case of Chicago's PrEPLine

Abstract

Pre-exposure prophylaxis (PrEP) uptake remains low among Black men who have sex with men (BMSM). PrEPLine, launched in August 2015, based in Chicago, was designed to support PrEP linkage among BMSM. PrEPLine moves clients through the Motivational PrEP Cascade, addresses barriers, and tracks outcomes. Study findings suggest that three variables (i.e., being gay/same gender loving, living more than 15 miles from a clinic location, rescheduling an appointment) demonstrated a significant positive association with initiating PrEP. A subanalysis of BMSM found that two variables (i.e., living on the West Side of Chicago relative to those living on the South Side, and among those living in communities with a higher rate of poverty [more than 30%], relative to those living in communities with a lower rate of poverty [less than 20%]) demonstrated a significant negative association with initiating PrEP.

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

“…57 The Health Department screened >3,000 people and linked >35% to PrEP. In Chicago, Dehlin et al 58 implemented PrEPLine, a phone support line to assist Black MSM, TGW, and heterosexual women with navigating the PrEP continuum. Over 32 months, Chicago’s PrEPLine generated 566 encounters, with 31% leading to PrEP initiation.…”

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

“…), limiting the number of visits required for PrEP initiation and maintenance could significantly reduce PrEP care continuum drop off [ 121 ]. Importantly, PrEP initiation is only one step in the care continuum and later steps such as persistence and retention will need support [ 86 ]. Finally, long-acting injectable PrEP may be of particular importance.…”

“…After reading the script participants were asked if they ever tried to get PrEP and if they would be interested in taking PrEP. We then asked a series of questions about potential barriers to, and facilitators of taking PrEP, such as taking a pill daily, follow-up appointments if taking PrEP, PrEP cost, social support to take PrEP, what they think about people who are taking PrEP, and any other worries or concerns they might have in relation to PrEP [ 86 ]. Participants were also asked about their willingness to use injectable PrEP and where they felt the best place to engage in PrEP care was for people who use drugs.…”

The Co-Evolution of Network Structure and PrEP Adoption among a Large Cohort of PrEP Peer Leaders: Implications for Intervention Evaluation and Community Capacity-Building

“…HIV status was measured using biomedical lab testing (i.e., blood tests) or self-reports if lab tests were not available. Third, to account for the theorized relationship between behavioral intentions and behavioral adoption [ 50 , 51 ], we account for PrEP intentions [ 52 ] measured as the perceived likelihood that a participant would take PrEP in the next six months (1 = probably/definitely would not take PrEP; 2 = might take PrEP; 3 = probably/definitely would take PrEP).…”