1282. A Major Hurdle for HIV Elimination: How Do We Promote Pre-Exposure Prophylaxis Persistence among Men Who Have Sex with Men in the Deep South?

Abstract

BackgroundPre-Exposure Prophylaxis (PrEP) effectively prevents HIV acquisition in men who have sex with men (MSM), if taken appropriately. Effective PrEP requires persistence in PrEP care. We defined the PrEP care continuum in a Deep South PrEP clinic and examined factors related to persistence in care among MSM.MethodsWe reviewed data for MSM at a university-affiliated PrEP clinic in Birmingham, AL from 2014–2018 to define the PrEP continuum at five major steps: screening, initial visit, follow-up visit, current persistence, and self-reported adherence. We defined persistence as attending a PrEP clinic visit in the last 6 months and nonpersistence as prior attendance without a visit in the last 6 months. We compared demographics, insurance status, and patient-reported behaviors from initial and most recent visits between those who persisted (“persisters”) and did not (“non-persisters”) using Wilcoxon rank sum, chi-square, or Fisher’s exact test.Results226 (100%) MSM were screened, 141 (62%) MSM attended an initial visit, 116 (51%) MSM attended follow-up, 43 (19.0%) persisted in PrEP care, and 29 (13%) MSM self-reported good adherence (figure). Among 139 MSM (46 persisters, 93 nonpersisters), persisters were older than nonpersisters (33 vs. 32 yr, P = 0.03), and were less likely to report inconsistent condom use at their initial visit (48% vs. 73%; P = 0.01) as compared with their last visit (69% vs. 63%, P = 0.13). 23% of persisters and 29% of nonpersisters were black (P = 0.39), and 98% of persisters and 90% of nonpersisters were insured (P = 0.50). 60% of persisters and 74% of nonpersisters had multiple sex partners at initial visit (P = 0.19) as compared with 56% and 60% at their last visit, respectively (P = 0.83).ConclusionAt a Deep South PrEP clinic, persistence overall was poor for MSM. More nonpersisters had inconsistent condom use, indicating higher risk despite nonpersistence. Although not statistically significant, nonpersisters were more likely to be black, uninsured, and have multiple sexual partners when compared with persisters. Disparities seen nationally in new HIV diagnoses are reflected in nonpersisters. Nonpersisters may not realize the extent of their risk of HIV acquisition and warrant intensive engagement interventions. Disclosures All authors: No reported disclosures.

The relevance of pre-exposure prophylaxis in gay men’s lives and their motivations to use it: a qualitative study

“…The researchers hypothesized that when gay men consider using PrEP, they consider subjective and relational factors over and above their selfperceived risk. Previous studies about facilitators and barriers to PrEP uptake and adherence have identified social stigma, cost, health insurance, healthcare provider awareness, and concern about side effects as factors that allow or impede GMSM from starting PrEP [14,31,32]. As we discuss below, our research supports these findings.…”

“…PrEP uptake among some populations at greatest risk of HIV infection, such as young GMSM and GMSM of color, remains low [2]. Research has focused on describing how PrEP is utilized by GMSM, including what facilitates and hinders PrEP use, hoping to develop interventions that increase uptake [10] and persistence [11][12][13][14][15][16]. This research indicates PrEP uptake is significantly affected by awareness of it and its acceptability, cost and healthcare barriers, and PrEP-related stigma [17,18].…”