Results indicate that MH diagnoses or symptoms are a barrier to retention in HIV care and emphasize the importance of providing MH treatment to HIV patients in need. (PsycINFO Database Record
Background:
Pre-exposure prophylaxis (PrEP) use among populations most vulnerable to HIV as identified in the national HIV prevention goals is not fully known. This systematic review assessed trends of lifetime self-reported PrEP use and disparities among key populations.
Methods:
We used the CDC HIV/AIDS Prevention Research Synthesis cumulative database of electronic and manual searches in MEDLINE, CINAHL, EMBASE, and PsycINFO from 2000 to 2019 to identify English-language primary studies reporting PrEP use. Two reviewers independently screened citations, extracted data, and assessed the risk of bias with the modified Newcastle–Ottawa Scale. We estimated pooled proportions and crude/adjusted odds ratio.
Results:
We identified 95 eligible studies including 95,854 US-based survey respondents. A few studies (6.3%) focused on persons who inject drugs. In 2015–2017, men who have sex with men (MSM) had highest proportion of individuals who used PrEP over their lifetime [13.9% (95% confidence interval: 8.8 to 21.1), k (number of surveys) = 49] followed by Hispanic/Latinos [11.5 (7.1 to 18.1), 12], transgender women [11.2 (5.8 to 20.6), 5], and blacks [9.9 (8.3 to 11.8), 18]. Odds of PrEP use increased by 34%/year [odds ratio = 1.34/year (95% confidence interval: 1.09 to 1.64)] and significantly increased over time among MSM [1.53/year (1.21–1.93)] and blacks [1.44 (1.13–1.83)]. People in the Southern United States [9.9 (4.7–19.7), 8] and youth [7.3 (4.7–11.2), 8] had lower rates and did not demonstrate growth [0.94 (0.29–3.18); 0.82 (0.43–1.55)]. Odds of reporting lifetime PrEP use was twice [2.07 (1.27–3.38)] as great among MSM than non-MSM.
Conclusions:
Proportions of PrEP use in published surveys have been growing, but remain low for people in the Southern United States and youth, and understudied in persons who inject drugs. Limitations include few studies in certain years, whereas strengths include a large number of respondents. Culturally tailored approaches targeting vulnerable populations are essential in increasing PrEP use to reduce disparities in HIV acquisition.
: When combining results from all published surveys, about one in nine global study participants (10.7%) reported ever using preexposure prophylaxis (PrEP) by 2017, a significant increase since US FDA approval in 2012 [odds ratio (OR) = 1.6/year, P < 0.00001]. Moreover, nearly one in six US-based study participants (17.3%) and nearly one in four MSM who met the Centers for Disease Control and Prevention's PrEP indications (24.5%) reported ever using PrEP by 2016. The odds of reporting PrEP use are approximately doubling each year (OR = 1.8/year, P < 0.00001; OR = 2.0/year, P < 0.00001).
HIV (human immunodeficiency virus) preexposure prophylaxis (PrEP) is an effective biomedical HIV prevention tool. Increasing PrEP use among populations disproportionately affected by HIV is one of the key efforts in the United States’ Ending the HIV Epidemic (EHE) initiative and the HIV National Strategic Plan for the United States. Given that PrEP is available only through prescription, it is important to explore structural, organizational, or environmental factors that could facilitate or impede health care provider’s PrEP prescribing behavior. The purpose of this systematic review (PROSPERO [CRD: 42019138889]) is to identify qualitative studies that addressed this topic and conduct meta-synthesis using the thematic synthesis method to identify major themes on the characteristics of clinic infrastructure or clinic models that providers consider as facilitators of PrEP prescribing in the United States. Eighteen citations representing 15 studies were included in this review. Five overarching themes were identified: (1) routinized HIV risk assessment; (2) interdisciplinary/coordinated PrEP teams or services; (3) clinic capacity to provide essential PrEP-related services; (4) low out-of-pocket patient costs; and (5) access to the priority populations. Some of these themes are consistent with the recommendations of CDC’s PrEP clinical guidelines and the EHE initiative. More recent studies that include perspectives of diverse providers, timely analysis of these studies, and implementation research to assess strategies to address the current practice gaps are needed to further promote PrEP prescribing among providers in the United States.
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