Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019

Abstract

Objective: Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. Methods: We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. Results: PrIDE jurisdictions implemented multiple health equity–focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP ( z = −33.57; P < .001). Conclusions: PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity–focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.

PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs

“…From the provider perspective, the bridge clinic structure, where several providers might see the same patient while they await connection to longer-term care, also presented some barriers to PrEP delivery adherence support. Patient navigation, through peer or professional supports, has been shown to increase engagement in HIV and substance use treatment in other clinical settings and populations, including PrEP-specific navigation [47][48][49][50][51][52]. This is consistent with our participants' experiences regarding the value of outreach services supporting PrEP adherence and follow-up in community settings [53].…”

Trends in preexposure prophylaxis use among sex partners as reported by persons with HIV – United States, May 2015–June 2020

“…PrEP navigation models designed by clinics and community-based organizations that combine professional and peer navigation have been found to be highly effective in linking MSM of color to PrEP [32]. However, even among programs implementing intensive multilevel activities to increase PrEP use, racial and ethnic disparities persisted [33]. Although we found that reported PrEP use among Black partners rose an estimated annual 29.9% from the 2015 to 2019 MMP cycle, the percentage point difference in PrEP use was higher in 2019 compared to 2015 (À11.9 percentage points vs. À7.8 percentage points).…”

HIV Pre-exposure Prophylaxis Services for Black and Hispanic or Latino Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women in THRIVE, 2015-2020

“…4,5,9 Six of the 7 THRIVE sites are EHE-funded phase 1 jurisdictions. 8 THRIVE laid important groundwork for the ongoing work in the EHE initiative to reduce HIV incidence at least 90% by 2030 through diagnosis, prevention, treatment, and outbreak response. 10 Most THRIVE clients were screened for PrEP, and there were no notable disparities in screening by age or race or ethnicity.…”

“…6 THRIVE activities took place in Birmingham, AL; Baltimore, MD; Washington District of Columbia; New Orleans, LA; Brooklyn, New York City, NY; Philadelphia, PA; and Hampton Roads, VA. New York City, Baltimore, LA, and Virginia departments of health were also recipients of funding through the "Pre-exposure Prophylaxis* Intervention*Data-to-Care-*Evaluation" (PrIDE) project. 8 Project activities to increase the use of PrEP among GBM and TGW, especially among Black and Hispanic or Latino persons, were complementary and intertwined to varying degrees in these jurisdictions. Data on service usage reported here reflect those combined PrIDE and THRIVE activities at cofunded sites but are referred to throughout as THRIVE.…”