Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi

Arnold, Trisha; Brinkley‐Rubinstein, Lauren; Chan, Philip A.; Perez-Brumer, Amaya; Bologna, Estefany S.; Beauchamps, Laura; Johnson, Kendra; Mena, Leandro; Nunn, Amy

doi:10.1371/journal.pone.0172354

Cited by 174 publications

(188 citation statements)

References 36 publications

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“…Our findings about stigma are consistent with previous research identifying stigma as an important factor influencing PrEP use (Arnold et al, 2017;Collins, McMahan, & Stekler, 2017;Franks et al, 2018;García & Harris, 2017;Grace et al, 2018;Haire, 2015;Liu et al, 2014;Taylor et al, 2014;Thomann et al, 2018;. In our and other studies, PrEP stigma is closely tied to stigma around HIV, "risky" sexual behavior, and sexual and gender identity (Franks et al, 2018;Grace et al, 2018;Haire, 2015).…”

Section: Discussionsupporting

confidence: 91%

“Little Tablets of Gold”: An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities

Sun

Anderson

Toevs

et al. 2019

AIDS Education and Prevention

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There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members.Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.

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Section: Discussionsupporting

confidence: 91%

“Little Tablets of Gold”: An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities

Sun

Anderson

Toevs

et al. 2019

AIDS Education and Prevention

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“…Otherwise healthy patients may not always prioritize preventive health visits or experience other structural challenges that may delay their presentation to care. We have previously described the study settings and evaluated structural barriers to care that exist at our clinics that specifically highlight insurance‐related and financial challenges . Importantly, providers may also fill prescriptions without a patient presenting for care at three‐month intervals, particularly if they believe the short‐term benefits of refilling PrEP prescriptions outweigh HIV acquisition risks.…”

Section: Discussionmentioning

confidence: 99%

“…Structural, social, behavioural and clinical factors may undermine retention in PrEP care. Barriers may include medication and monitoring costs , access to care , medical mistrust , stigma related to sexual orientation , low self‐perceived HIV risk , lack of motivation and limited provider knowledge and willingness to prescribe PrEP , as well as personal and community stigma and promiscuity stereotypes regarding PrEP users.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Introduction Retention in HIV pre‐exposure prophylaxis (PrEP) care in real‐world settings, outside of controlled trials or demonstration projects, remains poorly understood. Methods We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients’ actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. Results From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow‐up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow‐up visit, having attended a visit three months after initiation. However, 76% had a follow‐up visit within eight months. Thirty‐percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16‐month endpoint. Self‐reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow‐up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. Conclusions Measuring retention in PrEP care using three‐month follow‐up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real‐world settings and should be the focus of future interventions.

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“…Several studies have found that the anticipation of high cost is a barrier to the acceptability of PrEP use as an HIV prevention method. 3,4 However in one study of 30 financially disadvantage PrEP users in Mississippi 5 , all had successfully accessed PrEP despite initial perceived concerns about costs. “While many participants noted that they had initially perceived the high cost of PrEP as a potential barrier to use, those barriers were overcome with the industry sponsored medication assistance program, which pays for PrEP for uninsured patients and provides assistance with medication copayments for insured individuals”.…”

Section: Introductionmentioning

confidence: 99%

Estimated Coverage to Address Financial Barriers to HIV Preexposure Prophylaxis Among Persons With Indications for Its Use, United States, 2015

Smith

Handel

Huggins³

2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background An estimated 1.2 million American adults engage in sexual and drug use behaviors that place them at significant risk of acquiring HIV infection. Engagement in health care for the provision of daily oral antiretroviral medication as preexposure prophylaxis (PrEP), when clinically indicated, could substantially reduce the number of new HIV infections in these persons. However, resources to cover the financial cost of PrEP care is an anticipated barrier for many of the populations with high numbers of new HIV infections. Methods Using nationally representative data, we estimated the current national met and unmet need for financial assistance with covering the cost of PrEP medication, clinical visits, and laboratory costs among adults with indications for its use, overall and by transmission risk population. Results This study found that, of the 1.2 million adults estimated to have indications for PrEP use, <1% (∼7,300) are in need of financial assistance for both PrEP medication and clinical care, at an estimated annual cost of $89 million. An additional 7% (∼86,300) are in need of financial assistance only for PrEP clinical care at an estimated annual cost of $119 million. Conclusion This information on PrEP care costs, insurance coverage, and unmet financial need among persons in key HIV transmission risk subpopulations can inform policy makers at all levels as they consider how to address remaining financial barriers to the use of PrEP and accommodate any changes in eligibility for various insurance and financial assistance programs that may occur in coming years.

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Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi

Cited by 174 publications

References 36 publications

“Little Tablets of Gold”: An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities

“Little Tablets of Gold”: An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities

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

Estimated Coverage to Address Financial Barriers to HIV Preexposure Prophylaxis Among Persons With Indications for Its Use, United States, 2015

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