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. 2025 Jan;41(1):e12916.
doi: 10.1111/jrh.12916.

Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: A scoping review framed by the PrEP care continuum

Andrew M O'Neil  1 , Randolph D Hubach  2 , Christopher Owens  3 , Jennifer L Walsh  1 , Katherine G Quinn  1 , Steven A John  1
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Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: A scoping review framed by the PrEP care continuum

Andrew M O'Neil et al. J Rural Health. 2025 Jan.

Abstract

Background: HIV pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the United States remain suboptimal, particularly in rural areas.

Objective: The present study presents a scoping review of the self-reported barriers and facilitators of PrEP use among MSM living in rural areas of the United States.

Design: Preferred Items for Systematic Reviews-Extension for Scoping Reviews (PRISMA-ScR) guidelines informed this review. Seven online databases were searched to identify papers published from 2012 to 2023 in English with keywords related the concepts of MSM, rural, and HIV PrEP.

Results: From an initial 340 articles, nine were selected. Awareness significantly impacts PrEP uptake in rural areas, with challenges including limited dissemination of information through mainstream channels and low perceived HIV risk among rural MSM. However, nonmainstream information sources can enhance PrEP awareness and use. Several barriers hinder rural residents from accessing PrEP, such as a lack of competent providers, geographic isolation, cost, and stigma. High PrEP care costs, lack of financial assistance for lab work, and limited telePrEP options are key challenges in retaining individuals in PrEP care.

Conclusions: Suboptimal PrEP uptake in rural areas with high HIV burden remains a concern, hindered by limited information dissemination, low perceived HIV risk, geographic isolation, nonaffirming medical providers, and expensive PrEP care. Leveraging telePrEP, co-pay assistance, 340B drug pricing, and geospatial networking apps can enhance PrEP use. Multilevel interventions are crucial to combat the HIV epidemic in rural regions.

Keywords: HIV; men who have sex with men; pre‐exposure prophylaxis; rural; scoping review.

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References

REFERENCES

    1. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587‐2599. doi:10.1056/NEJMoa1011205
    1. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2021. HIV Surveill Suppl Rep. 2023;28(4):130‐132. https://stacks.cdc.gov/view/cdc/160195/cdc_160195_DS1.pdf
    1. Centers for Disease Control and Prevention. HIV surveillance in urban and nonurban areas (2018) preliminary. Published online 2019. Accessed July 23, 2024. https://web.archive.org/web/20240417141220/https://www.cdc.gov/hiv/pdf/l...
    1. Hall HI, Li J, McKenna MT. HIV in predominantly rural areas of the United States. J Rural Health. 2005;21(3):245‐253. doi:10.1111/j.1748‐0361.2005.tb00090.x
    1. McKinney MM. Variations in rural AIDS epidemiology and service delivery models in the United States. J Rural Health. 2002;18(3):455‐466. doi:10.1111/j.1748‐0361.2002.tb00910.x

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