Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color

Wood, Sarah; Gross, Robert; Shea, Judy A.; Bauermeister, José A.; Franklin, Joshua; Petsis, Danielle; Swyryn, Meghan; Lalley‐Chareczko, Linden; Koenig, Helen; Dowshen, Nadia

doi:10.1007/s10461-019-02502-y

Cited by 99 publications

(107 citation statements)

References 42 publications

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“…Primary among them were challenges with medication adherence. Struggles with daily adherence to PrEP is something common in many populations, particularly racial/ ethnic, sexual, and gender minority populations [14,23,24]. Intervention trials are underway to test simple mobile technology products (e.g., text messaging services, mobile applications) to support PrEP adherence [25][26][27].…”

Section: Plos Onementioning

confidence: 99%

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PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

et al. 2020

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Purpose Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen. Methods In-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data. Results Four themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence. Conclusions PrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.

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Section: Plos Onementioning

confidence: 99%

“…After PrEP initiation, safe and effective use depends on adherence to the medication, retention in routine PrEP medical monitoring, and consistent use during periods of high-risk behaviors. Difficulty adhering to these behaviors contributes to reduced protection against HIV infection among BLMSM and BLTW PrEP users [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

et al. 2020

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“…Another barrier is that some persons with HIV risk factors do not feel sufficiently at-risk for HIV to warrant PrEP [5][6][7][8], which relates to perceptions of risk not health systems issues. Studies comparing perceptions of HIV risk against HIV risk scores showed differences in how personal risk-taking was viewed, with many believing their behaviours were "too low-risk" to warrant PrEP [9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining

2019

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While pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy, its uptake is limited. To address barriers, we piloted a nurse-led PrEP clinic in an STI clinic and had public health nurses refer patients during STI follow-up. We recorded the number of PrEP offers and declines and clinic uptake. We conducted a thematic analysis of patients' responses from nursing notes written at the time patients declined PrEP. From August 6, 2018 to August 5, 2019, nurses offered a PrEP referral to 261 patients who met our criteria; only 47.5% accepted. Qualitative analysis identified four themes: (1) perceptions of risk, (2) lack of interest, (3) inability to manage, and (4) concerns about PrEP. Our patients did not feel sufficiently at-risk for HIV to use PrEP and maintained that PrEP was for a reckless "other". This analysis sheds light on how assumptions about risk affect PrEP uptake, particularly among those at-risk for HIV.

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“…The in uence of these two factors on PrEP has been shown in previous studies. 18,27,28 In Golub's research, PrEP stigma was found to be highly associated with HIV stigma as PrEP is designed to prevent HIV infection. 28 People tend to relate HIV stigma to concerns about being seen taking medicine by family or friends, and such concerns substantially impact adherence.…”

Section: Discussionmentioning

confidence: 99%

Reliability and Validity of a Free Oral Pre-exposure Prophylaxis (PrEP) Adherence Questionnaire Among Patients with Sexually Transmitted Infection and Without HIV Infection in Shanghai

Chen

et al. 2020

Preprint

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Objective: In this study, we aimed to evaluate the validity and reliability of the free oral pre-exposure prophylaxis (PrEP) adherence questionnaire among patients with sexually transmitted infection who do not have HIV infection in Shanghai. Methods: We conducted a cross-sectional study among 816 patients from sexually transmitted infection (STI) clinics in Shanghai. The questionnaire included self-reported demographic characteristics, items on adherence to free oral pre-exposure prophylaxis (PrEP), and PrEP uptake behavior measurement. Item analysis was carried out by calculating the critical ratio and item-total correlations. Internal consistency and split-half reliability were measured to assess reliability. Content validity, construct validity, convergent validity and discriminant validity were measured to assess validity. We conducted logistic regression with receiver operating characteristic (ROC) curve analysis to assess the predictive value of the adherence questionnaire for PrEP uptake behavior. Results: All items were considered acceptable in the item analysis (P<0.05). The questionnaire had a Cronbach’s alpha of 0.757 and split-half reliability of 0.633. The scale-level content validity index (CVI) was 0.938 and the item-level CVI of each item ranged from 0.750 to 1. In exploratory factor analysis, we introduced a four-factor model accounting for 79.838% of the aggregate variance with all factors loading more than 0.4, which was validated in confirmatory factor analysis (c2=47.1, degrees of freedom=14, root mean square error of approximation=0.078). According to regression analysis, adding PrEP adherence questionnaire scores contributed to prediction of PrEP uptake behavior (P<0.001). The maximum area under the ROC curve was 0.778 (95% confidence interval: 0.739–0.817), corresponding to a cutoff score of 9.Conclusion: The PrEP adherence questionnaire generally has acceptable reliability and validity. This questionnaire can be used as a tool to evaluate PrEP adherence in patients with STI who do not have HIV infection.

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Barriers and Facilitators of PrEP Adherence for Young Men and Transgender Women of Color

Cited by 99 publications

References 42 publications

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

Active-Offer Nurse-Led PrEP (PrEP-RN) Referrals: Analysis of Uptake Rates and Reasons for Declining

Reliability and Validity of a Free Oral Pre-exposure Prophylaxis (PrEP) Adherence Questionnaire Among Patients with Sexually Transmitted Infection and Without HIV Infection in Shanghai

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