Implementation Strategies to Increase PrEP Uptake in the South

Sullivan, Patrick S.; Mena, Leandro; Elopre, Latesha; Siegler, Aaron J

doi:10.1007/s11904-019-00447-4

Cited by 152 publications

(133 citation statements)

References 57 publications

Supporting

Mentioning

115

Contrasting

Order By: Relevance

“…Even when co‐pay assistance is available, the time, transportation needs and costs of care required for ongoing PrEP prescriptions is burdensome for many PrEP users. Pharmacy‐/ telehealth‐delivered PrEP, and express visit systems, in which an initial triage is performed on computer tablets to allow stable PrEP users to defer in‐person medical provider visits, are potential solutions that deserve additional study [35‐37]. The recently‐passed California bill‐159, which allows pharmacists to dispense 60 days of PrEP without prescription, is likely to support uptake [37].…”

Section: Discussionmentioning

confidence: 99%

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

View full text Add to dashboard Cite

Introduction Pre‐exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in‐depth interviews with people who HIV seroconverted after using PrEP. Methods We identified individuals who initiated PrEP in an integrated safety‐net public health system and performed in‐depth chart review to determine person‐time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention’s Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in‐depth interviews with those who seroconverted. Results Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person‐years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5‐fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on‐demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP’s benefit versus self‐perceived risk; and entering a primary partnership. The individual who developed HIV using on‐demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. Conclusions HIV incidence during gaps in PrEP use was nearly eight‐fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non‐daily PrEP may require additional education and support in the United States.

show abstract

Section: Discussionmentioning

confidence: 99%

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Demedicalization of PrEP services may be an important intervention to improve persistence among high-risk Southern youth as this group may have more challenges accessing and navigating PrEP services given their inexperience with the healthcare system and fear of PrEP costs [21]. Low or no-cost mobile PrEP delivery is a promising implementation strategy that has been piloted among high-risk youth in the Southern US and resulted in many initiating PrEP with high acceptability ratings [31,32]. These and other remote care interventions for PrEP delivery should be considered for utilization by Southern public health organizations given the known geographical sparsity of PrEP clinics in this region [12], and increased ease and convenience of accessing services, which is especially relevant for youth and other groups who may be disproportionately impacted by factors such as lack of transportation and financial barriers.…”

Section: Discussionmentioning

confidence: 99%

PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA

Rolle

Onwubiko

et al. 2019

AIDS Behav

View full text Add to dashboard Cite

For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. Therefore, we implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA to promote PrEP uptake among high-risk clients. The Fulton County Board of Health PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as "persistent", whereas clients with a lapse in follow-up of > 6 months were defined as "not persistent." Factors associated with PrEP persistence were assessed with unadjusted odds ratios. Between October 2015 and June 2017, 399 clients were screened for PrEP, almost all were eligible [392/399 (98%)]; however, 158/392 (40%) did not return to start PrEP after screening. Of 234 patients, 216 (92%) received a prescription for PrEP. As of June 2017, only 69/216 (32%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was age ≥ 30 years (OR 1.86, 95% CI 1.02, 3.42). Implementation of PrEP in the county health department setting is feasible; however, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.

show abstract

“…A recent review of PrEP implementation strategies in the South highlighted a number of individual and structural factors, including a greater rural population, lesser access to PrEP care, fewer insured individuals, lower health literacy and HIV risk perception, and greater anti-HIV, anti-gay, and PrEP stigma, that likely influence PrEP uptake in the South. 41 Novel implementation strategies, such as telemedicine-based PrEP to better reach people in rural areas 42,43 or consideration of networks and social capital, 44,45 may be necessary to try to offset the barriers observed for PrEP uptake in the South. 48,49 highlight potential barriers to and gaps in implementing PrEP nationally which will need to be addressed to meet PrEP's full potential to reduce new infections across the US.…”

Section: Resultsmentioning

confidence: 99%

Association Between HIV PrEP Indications and Use in a National Sexual Network Study of Men Who Have Sex with Men

Weiss

Prasad

Sanchez

et al. 2021

Preprint

View full text Add to dashboard Cite

BACKGROUND: HIV preexposure prophylaxis (PrEP) is effective in preventing HIV transmission. US Public Health Service (USPHS) clinical practice guidelines define biobehavioral indications for initiation. To assess guideline implementation, it is critical to quantify PrEP non-users who are indicated and PrEP users who are not indicated. METHODS: Using data from a national web-based study of men who have sex with men (MSM) between 2017 and 2019, we estimated the association between PrEP use and PrEP indications. Log-binomial regression was used to estimate the relationship between PrEP indications and PrEP use, adjusted for geography and demographics. RESULTS: Of 3508 sexually active, HIV-negative MSM, 34% met indications for PrEP. The proportion with current PrEP use was 32% among those meeting indications and 11% among those without indications. Nearly 40% of those currently using PrEP did not meet indications for PrEP, and 68% of MSM with indications for PrEP were not currently using PrEP. After adjusting for geography and demographics, MSM with PrEP indications were about 3 times as likely to be currently using PrEP. This association varied slightly by geography and demography. CONCLUSIONS: Indications for PrEP strongly predicted current PrEP use among MSM. However, we identified substantial misalignment between indications and use in both directions (indicated MSM who were not benefitting from PrEP, and MSM taking PrEP while not presently being indicated). This calls for further implementation efforts to improve PrEP delivery to those most in need during periods of elevated sexual risk.

show abstract

Implementation Strategies to Increase PrEP Uptake in the South

Cited by 152 publications

References 57 publications

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA

Association Between HIV PrEP Indications and Use in a National Sexual Network Study of Men Who Have Sex with Men

Contact Info

Product

Resources

About