Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073

Donte T Boyd^{1

2}, LaRon E Nelson^{2

3

4}, Mandy J Hill⁵, Darren Whitfield⁶, S Raquel Ramos^{2

3}, Samuel Akyirem³, Lynda Emel⁷, Leo Wilton^{8

9}, Lisa Hightow-Weidman¹⁰, Steve Shoptaw¹¹, Manya Magnus¹², Kenneth H Mayer¹³, Estelle Piwowar-Manning¹⁴, Stephaun E Wallace¹⁵, Sheldon D Fields¹⁶, Darrell P Wheeler¹⁷

Affiliations

¹ College of Social Work, The Ohio State University, Columbus, Ohio, USA.
² Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.
³ Yale School of Nursing, New Haven, Connecticut, USA.
⁴ Unity Health Toronto-St. Michael's, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada.
⁵ Department of Emergency Medicine, University of Texas Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA.
⁶ School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA.
⁷ Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
⁸ State University of New York at Binghamton, Binghamton, New York, USA.
⁹ Department of Humanities, University of Johannesburg, Johannesburg, South Africa.
¹⁰ Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
¹² Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
¹³ Fenway Health, The Fenway Institute, Boston, Massachusetts, USA.
¹⁴ Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore Maryland, USA.
¹⁵ Vaccine and Infectious Disease Division, Fred Hutch, Seattle, Washington, USA.
¹⁶ Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
¹⁷ State University of New York, New Paltz, New Paltz, New York, USA.

PMID: 36626154
PMCID: PMC10024067
DOI: 10.1089/apc.2022.0139

Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073

Donte T Boyd et al. AIDS Patient Care STDS. 2023 Jan.

. 2023 Jan;37(1):22-30.

doi: 10.1089/apc.2022.0139.

Authors

Affiliations

¹ College of Social Work, The Ohio State University, Columbus, Ohio, USA.
² Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.
³ Yale School of Nursing, New Haven, Connecticut, USA.
⁴ Unity Health Toronto-St. Michael's, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada.
⁵ Department of Emergency Medicine, University of Texas Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA.
⁶ School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA.
⁷ Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
⁸ State University of New York at Binghamton, Binghamton, New York, USA.
⁹ Department of Humanities, University of Johannesburg, Johannesburg, South Africa.
¹⁰ Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
¹² Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
¹³ Fenway Health, The Fenway Institute, Boston, Massachusetts, USA.
¹⁴ Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore Maryland, USA.
¹⁵ Vaccine and Infectious Disease Division, Fred Hutch, Seattle, Washington, USA.
¹⁶ Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
¹⁷ State University of New York, New Paltz, New Paltz, New York, USA.

PMID: 36626154
PMCID: PMC10024067
DOI: 10.1089/apc.2022.0139

Abstract

Autonomy support is a concept that is derived from self-determination theory. Autonomy refers to the freedom to act as one chooses. The current study aimed to examine if autonomy support was associated with dried blood spot validated pre-exposure prophylaxis (PrEP) adherence, and whether the association was mediated by PrEP adherence goal setting and progress toward PrEP adherence goals. Our sample was drawn from Black men who have sex with men (MSM) from across three cities (Chapel Hill, NC; Los Angeles, CA; and Washington, DC) in the United States between February 2013 and September 2014. We used logistic regression to evaluate associations between study variables and path analysis to test mediation effects. Participants were, on average, 28 [standard deviation (SD) = 1.12] years old and 25% were unemployed. We found that MSM who experienced high autonomy support were more likely to adhere to PrEP [odds ratio (OR) = 1.17; 95% confidence interval: 1.00-1.38]. MSM who set PrEP adherence goals were more likely to adhere to PrEP. Moreover, MSM who reported making progress toward their goals were also more likely to adhere to PrEP. Finally, client perception of coordination quality enhanced the magnitude of the association between goal setting and goal progress and the effect size of goal progress on PrEP adherence. Autonomy support, goal setting, goal monitoring/evaluation, and care coordination quality influenced PrEP adherence among Black MSM. Our findings indicate that while it is important to set goals for PrEP adherence, goal setting may need to be accompanied by progress monitoring to achieve the maximal effect.

Keywords: Black MSM; HIV prevention; PrEP adherence; autonomy support.

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Conflict of interest statement

No competing financial interests exist.

Figures

**FIG. 1.**
Pathways to PrEP adherence, indirect and direct effects, moderating effects, and betas reported. PrEP, pre-exposure prophylaxis.

See this image and copyright information in PMC

References

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Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073

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Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073

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