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Review
. 2015 Nov 15;61(10):1590-7.
doi: 10.1093/cid/civ664. Epub 2015 Aug 13.

Applying a PrEP Continuum of Care for Men Who Have Sex With Men in Atlanta, Georgia

Colleen F Kelley  1 , Erin Kahle  2 , Aaron Siegler  2 , Travis Sanchez  2 , Carlos Del Rio  3 , Patrick S Sullivan  2 , Eli S Rosenberg  2
Affiliations
Review

Applying a PrEP Continuum of Care for Men Who Have Sex With Men in Atlanta, Georgia

Colleen F Kelley et al. Clin Infect Dis. .

Abstract

Reductions in human immunodeficiency virus (HIV) incidence with pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) will require significant coverage of those at risk. We propose a simplified framework, similar to the HIV care continuum, to achieve protection with PrEP as follows: 1. At-risk MSM; 2. Awareness of and willingness to take PrEP; 3. Access to healthcare; 4. Receiving a prescription; and 5. Adhering to effective PrEP. We evaluated the PrEP care continuum on an Atlanta cohort of MSM and projected how many MSM might achieve protection from HIV. Even with optimistic estimates, few Atlanta MSM (15%) are projected to achieve protection from HIV with PrEP given the significant barriers described. Each continuum step represents an important point for intervention that could substantially increase the overall effectiveness of PrEP. In addition, novel strategies for PrEP delivery are needed to achieve the necessary effectiveness for Atlanta MSM at risk of HIV.

Keywords: continuum of care; men who have sex with men; pre-exposure prophylaxis.

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Figures

Figure 1.
Figure 1.
Theorectical model of the PrEP care continuum, factors relevant to uptake, and areas for intervention. Abbreviation: PrEP, pre-exposure prophylaxis.
Figure 2.
Figure 2.
Distribution of health insurance status and Affordable Care Act (ACA) eligibility for (A) the total InvolveMENt cohort, (B) black MSM, (C) white MSM, and d) HIV seroconverters in the InvolveMENt cohort. *P < .001 for difference between white MSM, black MSM, and HIV serocoveters by chi-square test. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men.
Figure 3.
Figure 3.
The PrEP care continuum for (A) the total InvolveMENt cohort, (B) black MSM (C) white MSM and (D) HIV seroconverters in the InvolveMENt cohort. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men; PrEP, pre-exposure prophylaxis.
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References

    1. Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. HIV Surveillance Supplemental Report 2012. December 2012. Vol. 17, 2012.
    1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2013. Vol. 25, 2015.
    1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2011. Vol. 23, 2013.
    1. Georgia Department of Public Health. National HIV Behavioral Surveillance Secondary Data Report: Men Who Have Sex With Men, Cycle 3. 2011.
    1. Sullivan PS, Peterson J, Rosenberg ES et al. . Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PloS One 2014; 9:e90514. - PMC - PubMed

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