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Observational Study
. 2017 Nov 1;76(3):250-258.
doi: 10.1097/QAI.0000000000001497.

Challenges in Translating PrEP Interest Into Uptake in an Observational Study of Young Black MSM

Charlotte-Paige Rolle  1 , Eli S Rosenberg, Aaron J Siegler, Travis H Sanchez, Nicole Luisi, Kevin Weiss, Scott Cutro, Carlos Del Rio, Patrick S Sullivan, Colleen F Kelley
Affiliations
Observational Study

Challenges in Translating PrEP Interest Into Uptake in an Observational Study of Young Black MSM

Charlotte-Paige Rolle et al. J Acquir Immune Defic Syndr. .

Abstract

Background: HIV incidence among US young, black men who have sex with men (YBMSM) is high, and structural barriers (eg lack of health insurance) may limit access to Pre-exposure prophylaxis (PrEP). Research studies conducted with YBMSM must ensure access to the best available HIV prevention methods, including PrEP.

Methods: We implemented an optional, nonincentivized PrEP program in addition to the standard HIV prevention services in a prospective, observational cohort of HIV-negative YBMSM in Atlanta, GA. Provider visits and laboratory costs were covered; participant insurance plans and/or the manufacturer assistance program were used to obtain drugs. Factors associated with PrEP initiation were assessed with prevalence ratios and time to PrEP initiation with Kaplan-Meier methods.

Results: Of 192 enrolled YBMSM, 4% were taking PrEP at study entry. Of 184 eligible men, 63% indicated interest in initiating PrEP, 10% reported no PrEP interest, and 27% wanted to discuss PrEP again at a future study visit. Of 116 interested men, 46% have not attended a PrEP initiation appointment. Sixty-three men (63/184; 34%) initiated PrEP; 11/63 (17%) subsequently discontinued PrEP. The only factor associated with PrEP initiation was reported sexually transmitted infection in the previous year (prevalence ratio 1.50, 95% confidence interval: 1.002 to 2.25). Among interested men, median time to PrEP initiation was 16 weeks (95% confidence interval: 7 to 36).

Conclusions: Despite high levels of interest, PrEP uptake may be suboptimal among YBMSM in our cohort even with amelioration of structural barriers that can limit use. PrEP implementation as the standard of HIV prevention care in observational studies is feasible; however, further research is needed to optimize uptake for YBMSM.

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Conflict of interest statement

Conflicts of Interest: There are no conflicts of interest or financial disclosures for any author.

Figures

Figure 1
Figure 1
Framework for PrEP implementation in an observational, prospective cohort study of young black MSM in Atlanta, GA Abbreviations. PrEP, Pre-Exposure Prophylaxis; HIV, Human Immunodeficiency Virus; CDC, Centers for Disease Control and Prevention; CRF, clinical research form; STI, sexually transmitted infection
Figure 2
Figure 2
PrEP Interest and initiation among men eligible for the EleMENt PrEP programa (N=184) Abbreviations. PrEP, Pre-Exposure Prophylaxis aThese decisions are based on interest expressed at the most recent study follow-up visit when data were censored for this analysis; study enrollment and follow-up are ongoing. bThis includes 2 men who started the medication and subsequently discontinued the program and 9 men who received a PrEP prescription at an initiation visit, but never filled it and decided to discontinue the program.
Figure 3
Figure 3
Time to PrEP Interest, initiation and medication start among men eligible for PrEP in the EleMENt program (N=184) Abbreviations and Definitions. PrEP, Pre-Exposure Prophylaxis; PrEP initiation, attendance at an initiation visit; PrEP Medication start, confirmed prescription fill Solid line: Time to PrEP interest for the entire cohort, Dotted Line: Time to PrEP initiation for the entire cohort, Dashed Line: Time to PrEP Medication start for the entire cohort
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References

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