Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015

Smith, Dawn K.; Handel, Michelle Van; Grey, Jeremy A.

doi:10.1016/j.annepidem.2018.05.003

Cited by 244 publications

(169 citation statements)

References 13 publications

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“…We did not collect data on PrEP persistence, which is a critical threat to the population‐level impact of PrEP on averting new HIV infections . The proportion of our respondents who were PrEP‐eligible was 51%, whereas CDC estimates that about 25% of MSM overall are PrEP‐eligible . This suggests that some selection bias occurred in our sampling of MSM, resulting in an over‐representation of men at high risk for HIV infection.…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is a key HIV prevention technology, and is a pillar of a comprehensive HIV prevention approach for men who have sex with men (MSM). Because there have been no national data to characterize trends in the PrEP continuum in the United States, overall and for key demographic groups of MSM, we aimed to describe the extent to which PrEP awareness, willingness and use changed over time, overall and for specific groups of MSM critical for HIV prevention (e.g. Black and Hispanic MSM, younger MSM, MSM in rural areas and MSM without health coverage). Methods The American Men's Internet Survey (AMIS) is an annual survey of US MSM conducted in the United States among MSM aged ≥15 years since 2013. We analysed data on trends in elements of the PrEP continuum (awareness, willingness and use of PrEP) in a sample of 37,476 HIV‐negative/unknown status MSM from December 2013 through November 2017. We evaluated trends in continuum steps overall and among demographic subgroups using Poisson models with Generalized Estimating Equations. For 2017 data, we used logistic regression to compare the prevalence of PrEP use among demographic groups. Results Overall, 51.4% (n = 19,244) of AMIS respondents were PrEP‐eligible across study years. Between 2013 and 2017, PrEP awareness increased from 47.4% to 80.6% willingness to use PrEP increased from 43.9% to 59.5% and PrEP use in the past 12 months increased from 1.7% to 19.9%. In 2017, use of PrEP was lower for men who were younger, lived outside of urban areas, and lacked health insurance; PrEP use was not different among Black, Hispanic and white MSM. Conclusions Our data show progress in use of PrEP among US MSM, but also reveal mismatches between PrEP use and epidemic need. We call for additional support of PrEP initiation, especially among young, non‐urban and uninsured MSM. Black and Hispanic MSM report levels of PrEP use no different from white MSM, but given higher HIV incidence for Black and Hispanic MSM, parity in use is not sufficient for epidemic control or health equity.

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Section: Discussionmentioning

confidence: 96%

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

et al. 2020

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“…This target uses a fairly straightforward denominator – all persons living with HIV. In contrast, the PrEP denominator is not as easily defined, as HIV risk is hard to assess outside of clinical trials or may not even been known by the participant; for instance, even the CDC's multiplier approach is limited by missing data for risk groups other than MSM . PrEP use is not lifelong and depends on risk for HIV, which fluctuates over time.…”

Section: Discussionmentioning

confidence: 99%

Global implementation of PrEP for HIV prevention: setting expectations for impact

Pyra

Haberer

Hasen³

et al. 2019

J Intern AIDS Soc

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Introduction Questions remain whether HIV pre‐exposure prophylaxis (PrEP) can be translated into a successful public health intervention, leading to a decrease in population‐level HIV incidence. We use examples from HIV treatment and contraceptives to discuss expectations for PrEP uptake, adherence, and persistence and their combined impact on the epidemic. Discussion Targets for PrEP uptake must be based on the local HIV epidemic and will depend on appropriate estimates of the key populations at risk for HIV. However, there is evidence that targets, once established, can successfully be met and that uptake may increase with awareness. Messaging around adherence should include that daily adherence is the goal (except for those MSM for whom event‐driven dosing is a good fit), but perfect adherence should not be a barrier. Ideally, clients persist on PrEP for as long as they are at risk for HIV. While PrEP will be most effective when coverage is focused on high‐risk populations, normalizing rather than stigmatizing PrEP will be highly beneficial. Conclusions While many challenges to PrEP implementation exist, we focused on the three key steps of uptake, adherence and persistence as measurable processes that can lead to improved coverage and decreased HIV incidence.

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“…In the United States, estimates range from 12,000-200,000 individuals taking PrEP in 2017 [5,6]. Recent gains in increasing PrEP prescriptions may be leveling off, [5] far short of the 1.1 Mio.…”

Section: Introductionmentioning

confidence: 99%

“…Recent gains in increasing PrEP prescriptions may be leveling off, [5] far short of the 1.1 Mio. persons the Centers for Disease Control and Prevention (CDC) estimates are indicated for PrEP [6]. Progress in scaling up PrEP has not been uniform.…”

Section: Introductionmentioning

confidence: 99%

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

et al. 2020

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Stigma regarding HIV pre-exposure prophylaxis (PrEP) is commonly implicated as a factor limiting the scale-up of this highly effective HIV prevention modality. To quantify and characterize PrEP stigma, we developed and validated a brief HIV PrEP Stigma Scale (HPSS) among a group of 279 men who have sex with men (MSM). Scale development was informed by a theoretical model to enhance content validity. We assessed two scale versions, Semantic Differential and Likert, randomizing the order in which scales were presented to participants. Both scales demonstrated high internal consistency. The Likert scale had substantially better construct validity and was selected as the preferred option. Scale scores demonstrated construct validity through association with constructs of interest: healthcare distrust, HIV knowledge, perceived proportion of friends/partners on PrEP, perceived community evaluation of PrEP, and perceived effectiveness of PrEP. The scale accounted for 25% of the total variance in reported willingness to be on PrEP, indicating the substantial role PrEP stigma may have on decisions to initiate PrEP. Given increased efforts to roll-out PrEP, having a valid tool to determine the level and types of PrEP stigma in individuals, groups, and communities can help direct implementation plans, identify goals for stigma reduction, and monitor progress over time.

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Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015

Cited by 244 publications

References 13 publications

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

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

Global implementation of PrEP for HIV prevention: setting expectations for impact

Validation of the HIV Pre-exposure Prophylaxis Stigma Scale: Performance of Likert and Semantic Differential Scale Versions

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