O13.6 Determinants of PrEP uptake, intention and awareness in the Netherlands: a socio-spatial analysis

IntroductionPre‐exposure prophylaxis (PrEP) is a key HIV prevention technology, and is a pillar of a comprehensive HIV prevention approach for men who have sex with men (MSM). Because there have been no national data to characterize trends in the PrEP continuum in the United States, overall and for key demographic groups of MSM, we aimed to describe the extent to which PrEP awareness, willingness and use changed over time, overall and for specific groups of MSM critical for HIV prevention (e.g. Black and Hispanic MSM, younger MSM, MSM in rural areas and MSM without health coverage).MethodsThe American Men's Internet Survey (AMIS) is an annual survey of US MSM conducted in the United States among MSM aged ≥15 years since 2013. We analysed data on trends in elements of the PrEP continuum (awareness, willingness and use of PrEP) in a sample of 37,476 HIV‐negative/unknown status MSM from December 2013 through November 2017. We evaluated trends in continuum steps overall and among demographic subgroups using Poisson models with Generalized Estimating Equations. For 2017 data, we used logistic regression to compare the prevalence of PrEP use among demographic groups.ResultsOverall, 51.4% (n = 19,244) of AMIS respondents were PrEP‐eligible across study years. Between 2013 and 2017, PrEP awareness increased from 47.4% to 80.6% willingness to use PrEP increased from 43.9% to 59.5% and PrEP use in the past 12 months increased from 1.7% to 19.9%. In 2017, use of PrEP was lower for men who were younger, lived outside of urban areas, and lacked health insurance; PrEP use was not different among Black, Hispanic and white MSM.ConclusionsOur data show progress in use of PrEP among US MSM, but also reveal mismatches between PrEP use and epidemic need. We call for additional support of PrEP initiation, especially among young, non‐urban and uninsured MSM. Black and Hispanic MSM report levels of PrEP use no different from white MSM, but given higher HIV incidence for Black and Hispanic MSM, parity in use is not sufficient for epidemic control or health equity.

Authors' Reply: Race and the Public Health Impact Potential of Pre-Exposure Prophylaxis in the United States.

BackgroundSince approval in 2012, the uptake of PrEP in high-risk patients remains low, especially among primary care providers (PCPs) who lack knowledge and confidence regarding its use. Continuing education (CE) has been extensively used to address such knowledge and practice gaps, yet little evidence exists supporting the impact of these initiatives on direct patient care and cost.MethodsVindico Medical Education partnered with Improve CME to assess the impact of seven CE programs targeted to PCPs from 2015 to 2017 regarding the use of PrEP in high-risk patients. An outcomes analysis model was used and designed to estimate (1) patients newly identified as HIV+ or HIV−, (2) patients newly on PrEP or HIV treatment, and (3) associated costs of care due to the CE.ResultsPrescribing providers (n = 4,550) who each see an average of 16.8 patients at high-risk for HIV infection per month, participated. Prior to learning only 44% of participants reported that they frequently offer HIV testing to high-risk patients; and only 13% frequently use PrEP clinical guidelines. Six-month post-education, however, 83% and 68% of providers reported using HIV testing and PrEP guidelines, respectively. We then used evidence-based parameters to project the number of high-risk patients who, based on our pool of patients directly impacted by the education, would be willing to accept an HIV test, those who would be HIV+ vs. HIV−, and those who would be willing to accept and adhere to either HIV treatment or PrEP. The model estimated that over the course of 1 year, 135,941 high-risk patients would be newly offered an HIV test. Of those accepting the test (n = 54,376), 163 would be newly identified as HIV+. Of the 54,213 newly identified as HIV−, at least 3,914 would be placed on PrEP. Using accepted values for direct cost of care, this translates to $1.26 million per year for patients newly treated for HIV and $92.4 million per year for those patients newly on PrEP.ConclusionTargeted CE to PCPs increased screening rates for HIV infection in high-risk patients, increased awareness and use of PrEP, and linked patients with appropriate care. These findings validate the need for ongoing CE programs to address persisting unmet needs and show that modeling can be used to estimate patient outcomes from CE programs.DisclosuresR. Elion, gilead: Investigator, Scientific Advisor and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. ViiV: Consultant, Consulting fee.

BackgroundPre-exposure prophylaxis (PrEP) is highly protective against sexual acquisition of HIV among men having sex with men (MSM). The cost-effectiveness of PrEP will play a major role in deciding whether...

Reaching racial/ethnic and sexual and gender minorities with HIV prevention information via social marketing

Interventions that utilize the influence of peer change agents (PCAs) have been shown to be effective strategies for engaging key populations in HIV prevention. To date, little is known about the characteristics of PCAs associated with their effectiveness. Drawing on data from a peer leader PrEP intervention for young Black men who have sex with men (YBMSM) (N = 423), we evaluated the effects of experiential (i.e., living with HIV, PrEP awareness, PrEP use), psychographic (i.e., self-perceived leadership, innovativeness), and network (i.e., degree centrality, eigenvector centrality, and brokerage) characteristics on three effectiveness outcomes: (1) recruiting peers into the study; (2) completing "booster" sessions; and (3) linking peers to PrEP care. For each outcome, multivariable regressions were performed. On average, PCAs recruited 0.89 peers, completed 1.99 boosters, and had 1.33 network peers linked to PrEP care. Experiential factors: Prior PrEP awareness was positively associated with booster completion. Network factors: Being a network broker (i.e., connecting otherwise disconnected communities) was positively associated with peer recruitment but negatively associated with linking peers to PrEP, and degree centrality (i.e., the number of network connections someone has) and eigenvector centrality (i.e., being connected to well-connected network associates) were positively associated with linking peers to PrEP. Psychographic characteristics were not associated with any outcome. These findings can be used to inform PCA selection and to identify subpopulations who require additional support to excel as PCAs.

Named sex- or needle-sharing partners of HIV-positive individuals are a priority prevention population due to their known HIV exposure. Understanding postexposure and preexposure prophylaxis (PEP and PrEP) awareness and use among them is important for successful interventions. Data from notified partners of HIV-positive individuals (New York City, May 2015-April 2017) were analyzed to describe PEP/PrEP awareness, provider discussion, and use by sociodemographic and risk characteristics. Multivariate logistic regression was used to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of partners' PEP and PrEP awareness. Among notified partners (n = 621), PEP and PrEP awareness were 34% and 44%, respectively; provider discussion of PEP was reported by 32% and of PrEP by 42%; PEP use was reported by 2% and PrEP use by 14%. PEP awareness was higher among men who have sex with men sex partners than among heterosexual sex partners (aOR: 4.21; 95% CI: 2.10 to 8.44). Odds of PrEP awareness were lower among black (aOR: 0.34; 95% CI: 0.15 to 0.75) and Hispanic partners (aOR: 0.37; 95% CI: 0.17 to 0.84) than among white partners, and higher among men who have sex with men than heterosexual sex partners (aOR: 4.60; 95% CI: 2.38 to 8.87). Black partners were less likely than whites to report a provider discussion of PrEP. Postnotification HIV-positive test results were significantly lower among partners reporting PEP awareness than among those who had not heard of PEP. Low levels of PEP/PrEP awareness and of provider PEP/PrEP discussion among notified partners, particularly blacks, Hispanics, and heterosexual sex partners, indicate the timeliness of tailored prevention messaging, provider training, and sensitization, to avoid disparities in PEP/PrEP use.

This study investigates PrEP willingness, adherence self-efficacy and potential impact of PrEP among HIV-negative, Chinese men who have sex with men (MSM; n = 622) with recent condomless anal sex. Facilitative factors of PrEP willingness included migrant status, sexual risk, and prior PrEP use, whereas barriers included concerns over being treated as an HIV/AIDS patient, recent HIV testing, identity concealment, and HIV prevention service usage. Adherence self-efficacy was associated with PrEP knowledge and confidence in PrEP efficacy of HIV prevention. A total of 39.3% anticipated increase in sex partners, 25.6% anticipated decrease in condom use, and 38.0% anticipated increased HIV testing following PrEP uptake. Results suggest a two-step approach to (1) promote PrEP acceptance among Chinese MSM and (2) enhance adherence and risk monitoring among PrEP-willing MSM. Efforts to reduce stigma, incorporate PrEP in the HIV prevention continuum, and increase PrEP knowledge will be crucial to optimize PrEP implementation.

Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) is efficacious in preventing HIV among men-who-have-sex-with-men (MSM) and will be soon available in Europe. This study investigated the intention and preference to use LAI-PrEP among MSM in the Netherlands by employing a diffusion of innovation approach. This study had a cross-sectional design nested within a cohort study established in 2017 to understand oral PrEP use among MSM. 309 MSM completed the survey on their awareness, interest, intention, and preference for LAI-PrEP in June 2022. Among them, 83% showed high/very-high interest in, and 63% showed high/very-high intention to use LAI-PrEP. A repeated innovator effect from the early adopters to LAI-PrEP was not observed. Early adopters did not show increased intention to use LAI-PrEP compared to other MSM subgroups, but neither did PrEP-naïve nor PrEP-discontinued MSM. However, among the 218 current oral PrEP users, suboptimal adherence was associated with preference for LAI-PrEP but not with intention to use it. In conclusion, our findings indicated that an effective, available, and affordable LAI-PrEP would be welcomed in the Netherlands, but that its introduction may not significantly expand PrEP coverage. However, the introduction of LAI-PrEP in the Netherlands could prove beneficial to MSM with suboptimal adherence to oral PrEP.

AIDS Research and Human RetrovirusesVol. 30, No. S1 Policy, Advocacy and ModelingDifferences in PrEP Knowledge and Use in U.S. MSM Users of a Popular Sexual Networking Site Surveyed in August 2013 and January 2014Kenneth H. Mayer, Catie Oldenburg, David S. Novak, Douglas Krakower, and Matthew J. MimiagaKenneth H. MayerFenway Health & Harvard University, The Fenway Institute, Boston, MA, United StatesBeth Israel Deaconess Medical Center, Infectious Disease Division, Boston, MA, United StatesSearch for more papers by this author, Catie OldenburgFenway Health, The Fenway Institute, Boston, MA, United StatesHarvard School of Public Health, Epidemiology, Boston, MA, United StatesSearch for more papers by this author, David S. NovakOn-Line Buddies, On-Line Buddies Research Institute, Cambridge, MA, United StatesSearch for more papers by this author, Douglas KrakowerFenway Health & Harvard University, The Fenway Institute, Boston, MA, United StatesBeth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA, United StatesSearch for more papers by this author, and Matthew J. MimiagaFenway Health & Harvard University, The Fenway Institute, Boston, MA, United StatesHarvard School of Public Health, Epidemiology, Boston, MA, United StatesMassachusetts General Hospital / Harvard Medical School, Psychiatry, Boston, MA, United StatesSearch for more papers by this authorPublished Online:30 Oct 2014https://doi.org/10.1089/aid.2014.5168a.abstractAboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Differences in PrEP Knowledge and Use in U.S. MSM Users of a Popular Sexual Networking Site Surveyed in August 2013 and January 2014." AIDS Research and Human Retroviruses, 30(S1), pp. A91–A92FiguresReferencesRelatedDetailsCited ByAn Information–Motivation–Behavioral Skills Model of PrEP Uptake20 March 2018 | AIDS and Behavior, Vol. 363Are Hiv Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity To Recently Or Long-Term Hiv-Infected Individuals?JAIDS Journal of Acquired Immune Deficiency SyndromesExploring Patterns of Awareness and Use of HIV Pre-Exposure Prophylaxis Among Young Men Who Have Sex with Men11 July 2016 | AIDS and Behavior, Vol. 21, No. 5Healthcare Provider Contact and Pre-exposure Prophylaxis in Baltimore Men Who Have Sex With MenAmerican Journal of Preventive Medicine, Vol. 52, No. 1 Volume 30Issue S1Oct 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Kenneth H. Mayer, Catie Oldenburg, David S. Novak, Douglas Krakower, and Matthew J. Mimiaga.Differences in PrEP Knowledge and Use in U.S. MSM Users of a Popular Sexual Networking Site Surveyed in August 2013 and January 2014.AIDS Research and Human Retroviruses.Oct 2014.A91-A92.http://doi.org/10.1089/aid.2014.5168a.abstractPublished in Volume: 30 Issue S1: October 30, 2014PDF download

BackgroundYoung men who have sex with men (YMSM) and transgender women (YTGW) are at high risk for HIV acquisition. In attempt to end the HIV epidemic, the comprehensive HIV prevention packages should be offered. However, the PrEP persistent among this population in western studies was low. The acceptability, uptake and persistent among Thai YMSM/YTGW PrEP clients were explored.MethodsThis is a sub-study of PrEP implementation project in Chiang Mai Thailand which was conducted during December 2015–February 2017. In the main study, PrEP@PIMAN, 105 participants who were 18 years and older, able to read and write in Thai, creatinine clearance ≥60 mL/minute, negative urine protein, and HBs-Ag-negative YMSM/YTGW were enrolled. Twelve months of PrEP along with quarterly visit and comprehensive HIV prevention package were offered. The data were collected through interview and computer-assisted self-interview. Each participant voluntary made their own decision about PrEP uptake.ResultsSixty participants (57% of the main study) were youth, aged 16–24 years old. Of those, 82% were gay men and 12% were TGW (self-identified). Mean age was 21 years old and 80% were university/college students. At baseline, median partner in past 3 month was 3 (range 0–52). Approximately one-fourth of the participants reported history of sexually transmitted diseases (STDs) and 8% has positive TPHA at baseline. Majority (72%) initiated PrEP with 70% at the enrollment 2% during the study. PrEP was discontinued in 25% (10/42) due to nonserious side effects, participant preference or lost to follow-up (see Figure 1). The retention rate at 12 month were 70%. PrEP use was not consistent (see Figure 2). Only 30% reported adherence ≥60% (or equivalent to ≥4 pills/ week) throughout the study period. There was no seroconversion during 49 person-year of follow-up with 5 confirmed new STDs (incidence of 10/100 person-year).ConclusionThis project demonstrated a good uptake with varying PrEP adherence rate among Thai YMSM and YTGW. The PrEP persistent was persistence could be improved. Further interventions and strategies should be explored to enhance PrEP adherence among this population.DisclosuresAll authors: No reported disclosures.

HIV continues to disproportionately affect Latino men who have sex with men (MSM) and disparities are even greater in the South. This study examines the implications of socioeconomic status (SES) associated with awareness, access, and usage of PrEP. Latino MSM (N = 154) from San Antonio, TX, completed a self-administered survey. Results revealed that PrEP uptake was significantly lower for low SES Latino MSM. PrEP related barriers included lack of awareness, stigmas, and side effects. Findings underscore the importance for a multisystemic approach to enhance awareness and access of PrEP for Latino MSM with varying levels of SES in the South.

134. A Decade Into PrEP: Trends in PrEP Awareness and Use in Young Trans Women

The purpose of this qualitative study was to identify barriers and motivators to PrEP uptake from the perspective of Black and Latina transgender women (TW) who are currently using PrEP to suggest intervention and outreach activities to increase PrEP uptake in this population. The Information-Motivation-Behavioral Skills Model guided the development of the semi-structured interview guide. A thematic analysis approach was used to analyze the data. Perceived barriers to PrEP uptake included structural and logistic barriers, language and cultural barriers to medical engagement, lack of transgender competent or gender-affirming care, and prioritizing hormone therapy over the use of PrEP. To increase PrEP uptake among BLTW, participants recommended disseminating PrEP information through a variety of methods, highlighting relationship and sexual health benefits of using PrEP, and developing effective patient-provider communication. Our findings highlight several ways to promote PrEP among BLTW. PrEP promotion should be integrated into gender-affirming care and supported by peer education and navigation services that reach BLTW in both clinic and community settings.

Objective Identify factors associated with PrEP awareness, willingness, and future prevention modalities among undergraduate college students. Participants Undergraduates (N = 701) were recruited from a private university, a public research university, and a private historically Black college and university for an online survey. Methods Upon multiple imputations, a multivariate logistic model, a multivariate multinomial model, and independent multivariate ordinal logistic models were used to calculate Rubin’s rules-pooled adjusted odds ratios for PrEP awareness, willingness, and future HIV prevention methods. Results Only 33.4% of students had heard of and 32.4% were willing to take PrEP. PrEP willingness was higher among sexual minority students compared to heterosexual/straight students (OR = 1.65; 95% CI: 1.03–2.63); p = .036). The likelihood to take a future vaccine or antibody prophylaxis treatment was higher than the likelihood to take injectable PrEP or implants. Conclusions Interventions to increase PrEP uptake and willingness among undergraduates should emphasize equity in HIV education and include future prevention modalities.