Challenges in Translating PrEP Interest Into Uptake in an Observational Study of Young Black MSM

Abstract

Background HIV incidence among US young, black MSM (YBMSM) is high, and structural barriers (e.g. lack of health insurance) may limit access to Pre-Exposure Prophylaxis (PrEP). Research studies conducted with YBMSM must ensure access to the best available HIV prevention methods, including PrEP. Methods We implemented an optional, non-incentivized PrEP program in addition to standard HIV prevention services in a prospective, observational cohort of HIV-negative YBMSM in Atlanta, GA. Provider visits and lab costs were covered; participant insurance plans and/or the manufacturer assistance program were used to obtain drug. Factors associated with PrEP initiation were assessed with prevalence ratios and time to PrEP initiation with Kaplan-Meier methods. Results Of 192 enrolled YBMSM, 4% were taking PrEP at study entry. Of 184 eligible men, 63% indicated interest in initiating PrEP, 10% reported no PrEP interest, and 27% wanted to discuss PrEP again at a future study visit. Of 116 interested men, 46% have not attended a PrEP initiation appointment. Sixty-three men (63/184; 34%) initiated PrEP; 11/63 (17%) subsequently discontinued PrEP. The only factor associated with PrEP initiation was reported STI in the prior year (PR 1.50, 95%CI 1.002-2.25). Among interested men, median time to PrEP initiation was 16 weeks (95% CI 7–36). Conclusions Despite high levels of interest, PrEP uptake may be suboptimal among YBMSM in our cohort even with amelioration of structural barriers that can limit use. PrEP implementation as standard of HIV prevention care in observational studies is feasible; however, further research is needed to optimize uptake for YBMSM.

Long‐term retention in pre‐exposure prophylaxis care among men who have sex with men and transgender women in the United States

“…We found that African American individuals in Mississippi had a significantly lower prevalence of retention in care compared to white individuals at initial and long‐term follow‐up visits. Previous research has found significant racial disparities in PrEP uptake and other PrEP care continuum endpoints , as well as across the HIV care continuum . Racial differences in retention in care were observed in our previous study among a similar population, where the follow‐up period was attenuated at the six‐month endpoint .…”

National trends in HIV pre‐exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017

“…Willingness to use PrEP grew in the sample overall, and in all demographic groups except MSM of multiple races, men recruited through geospatial social networking apps, and men with certain types of health insurance. The reasons that men who are aware of PrEP are not willing to take it are varied, and have been reported to include concerns about side effects, concerns about drug resistance, low perception of risk for HIV, aversion to daily pill taking, and low perceived efficacy of PrEP . Taken together, these data suggest that additional educational efforts could address some of the reasons for unwillingness to take PrEP that are less subjective.…”

Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries

“…As the rates of new infections continue at alarming rates among specific key populations, e.g. transgender persons in Europe and the U.S. and Black MSM in the U.S., and these populations face numerous social, structural, and economic barriers to accessing PrEP and being retained in PrEP care [125], any efforts at implementing PrEP must be culturally-tailored to engage and support these individuals and must address persistent inequities (table 2). …”