Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California

Abstract

Barriers to HIV preexposure prophylaxis (PrEP) use have not been well-characterized in people who became HIV-infected, all of whom could have benefited from PrEP. We invited members of Kaiser Permanente Northern California with an HIV diagnosis during 2014-2016, following a negative HIV test in the year prior to diagnosis, to complete a survey assessing barriers to PrEP use prior to HIV diagnosis. We used chi-square tests to identify factors associated with specific barriers, and Cochran-Armitage tests to assess trends in barriers by year of HIV diagnosis. Of 268 patients surveyed, 122 (46%) responded. Median age of respondents was 36, most (84%) were men who have sex with men, and 64% were of minority racial/ethnic background. Thirty-six (30%) had discussed PrEP with a provider, of whom 10 were diagnosed with HIV at PrEP intake. Overall, only 5 (4.1%) had used PrEP, and all 5 discontinued before diagnosis. Among all respondents, the most common barrier to PrEP use was lack of PrEP awareness (51%). Among those aware of PrEP, the most common barriers were cost/insurance concerns (36%) and perceived low risk for HIV (24%). Lack of PrEP awareness ranged from 39% among those aged 25-34 to 88% among those aged <25 (P=0.011), and from 33% among Hispanics to 69% among Blacks (P=0.055). Lack of PrEP awareness decreased from 61% of those diagnosed in 2014 to 37% in 2016 (P=0.032). Increasing awareness and affordability of PrEP, and facilitating accurate assessment of HIV risk, are critical to reducing missed opportunities for PrEP.

Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review

“…84.1% of participants had heard of PrEP [160] Race/ ethnicity c,d Survey of a Northern California consortium of individuals with recently acquired HIV (N = 122), the majority of whom were MSM (84%) and of minority racial/ethnic background (64%) A lack of PrEP awareness was noted in 69% of Black participants [161] Survey of Black individuals in the USA (N = 855)…”

“…Greater medical mistrust was associated with lower willingness to take PrEP [181] cis cisgender, HIV human immunodeficiency virus, MSM men who have sex with men, PrEP pre-exposure prophylaxis, PWID people who inject drugs, TGW transgender women a Please see study of Black MSM in the ' 'Sexual orientation'' category, also applicable here [188] b Please see study of Black MSM aged 16-25 years in the ' 'Sexual orientation' ' category, also applicable here [189] c Please see study of Black MSM in the ' 'Sexual orientation' ' category, also applicable here [174] Cost/insurance concerns were reported as barriers in 36% of patients [161] Interviews with MSM at Rhode Island Department of Corrections (N = 26)…”

HIV Preexposure Prophylaxis and Treatment as Prevention — Beliefs and Access Barriers in Men Who Have Sex with Men (MSM) and Transgender Women: A Systematic Review

“…Overall, the literature suggests that a key barrier to PrEP uptake is a lack of awareness or insufficient knowledge about PrEP, especially with younger people, black and Latino MSM, transgender people, and individuals with lower education and income levels. [10][11][12][13][14][15][16] Information about PrEP is not reaching all at-risk groups, and there is significant variability in the source and quality of the information. Perez-Figueroa et al found that only half of their study participants (N=100) who were young MSM living in New York City had "some knowledge" about PrEP as a form of HIV prevention.…”

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

“…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].…”