Healthcare Access and PrEP Continuation in San Francisco and Miami After the US PrEP Demo Project

Abstract

Pre-exposure prophylaxis (PrEP) for prevention of HIV infection has demonstrated efficacy in randomized controlled trials as well as in demonstration projects. For PrEP implementation to result in significant reductions in HIV incidence for men who have sex with men (MSM) in the United States, sufficient access to PrEP care and continued engagement outside of demonstration projects is required. We report the results of a follow-up survey of 173 former participants from the Miami and San Francisco sites of the U.S. PrEP Demo Project, administered 4–6 months after study completion. Survey respondents continued to frequently access medical care and had a high incidence of sexually transmitted infections after completion of the Demo Project, indicating ongoing sexual risk behavior. Interest in continuing PrEP was high, with 70.8% indicating they were “very interested” in continuing PrEP. Among respondents, 39.9% reported continuation of PrEP following completion of the Demo Project, largely through their primary care providers and frequently at low or no cost. Variability in access and engagement was seen, with participants from the San Francisco site, those with medical insurance, and those with a primary care provider at the end of the Demo Project more likely to successfully obtain PrEP medication. Two respondents reported HIV seroconversion in the period between study completion and the follow-up survey. Additional effort to increase equitable access to PrEP outside of demonstration projects is needed to realize the potential impact of this evidence-based prevention intervention.

Time to Make the Jump: Translating HIV Pre-exposure Prophylaxis Research Into Real-World Public Health Impact

“…Most MSM who continued PrEP in Miami and San Francisco were White, non-Latino MSM (68.3%). 1 These racial disparities echo preliminary findings of a three-site study finding that race was an important factor in predicting lower likelihood of being retained in PrEP care. 3 Taken together, these findings suggest that African American and Hispanic/Latino MSM may need culturally tailored case management services to promote optimal rates of retention in care.…”

“…1 Their open-label demonstration study evaluated 173 patients in San Francisco and Miami following completion of a National Institutes of Health sponsored PrEP demonstration project. 2 PrEP was originally provided free of charge at these sites during a three-year study.…”

Interest in linkage to PrEP among people who inject drugs accessing syringe services; Miami, Florida

“…As in our survey where 39.5% reported cost as a barrier, economic concerns are prominent barriers to care and patients are more likely to initially accept PrEP when it is offered directly and for free [11,30]. Real and perceived barriers to PrEP care including cost, transportation, language issues, stigma, and immigration status can create disparities in PrEP engagement [31,32] that particularly impact the drug-using community. Furthermore, PrEP is an understudied and underutilized HIV prevention strategy for PWID.…”

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…Perhaps the most pervasive finding in the PrEP implementation literature to date is the importance of financial and health care access barriers in limiting PrEP uptake. 70 Insurance status remains a critical determinant of PrEP access; 71 in one study of GBMSM in three US states, uninsured patients were over four times less likely to be taking PrEP compared with those who were insured. 1 Financial concerns impact not only access to PrEP but also shape perceptions of its merits as a prevention strategy.…”