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Rogers BG, Chan PA, Sutten-Coats C, Zanowick-Marr A, Patel RR, Mena L, Goedel WC, Chu C, Silva E, Galipeau D, Arnold T, Gomillia C, Curoe K, Villalobos J, Underwood A, Sosnowy C, Nunn AS. Perspectives on long-acting formulations of pre-exposure prophylaxis (PrEP) among men who have sex with men who are non-adherent to daily oral PrEP in the United States. BMC Public Health 2023; 23:1643. [PMID: 37641018 PMCID: PMC10463714 DOI: 10.1186/s12889-023-16382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) persistence among men who have sex with men (MSM) in real world clinical settings for HIV prevention is suboptimal. New longer-acting formulations of PrEP are becoming available, including injectables, subdermal implants, and other oral medications. These longer-acting formulations have the potential to improve retention among those who have challenges remaining adherent to daily oral PrEP. METHODS We interviewed 49 MSM who had initiated but discontinued oral PrEP at three diverse clinics across the United States. We examined participants' perspectives about long-acting PrEP formulations and how long-acting options could affect PrEP use using thematic analysis. RESULTS Participants were not very knowledgeable about long-acting formulations of PrEP but were open to learning about them and considering use. Participants were concerned about safety and efficacy of products given that they were still newer and/or in development. Finally, participants had clear preferences for oral pills, injectables, and then subdermal implants and were most interested in options that reduced the number of visits to the clinic. CONCLUSION Long-acting formulations of PrEP are acceptable to MSM with suboptimal PrEP persistence and have the potential to improve PrEP persistence. However, many felt they needed more information on safety, efficacy, and use to consider these options. As these long-acting formulations are implemented, public health campaigns and clinical interventions to encourage may maximize uptake particularly among those who are not currently adherent to daily oral PrEP.
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Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
| | - P A Chan
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Rhode Island, Providence, 02903, USA
| | - C Sutten-Coats
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Rhode Island, Providence, 02903, USA
| | - A Zanowick-Marr
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - R R Patel
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - L Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - W C Goedel
- Department of Epidemiology, Brown University School of Public Health, Rhode Island, Providence, 02903, USA
| | - C Chu
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - E Silva
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - D Galipeau
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - T Arnold
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - C Gomillia
- Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - K Curoe
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - J Villalobos
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - A Underwood
- Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - C Sosnowy
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - Amy S Nunn
- Department of Medicine, Division of Infectious Diseases,, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Rhode Island, Providence, 02903, USA.
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Rogers BG, Sosnowy C, Zanowick-Marr A, Chan PA, Mena LA, Patel RR, Goedel WC, Arnold T, Chu C, Galipeau D, Montgomery MC, Curoe K, Underwood A, Villalobos J, Gomillia C, Nunn AS. Facilitators for retaining men who have sex with men in pre-exposure prophylaxis care in real world clinic settings within the United States. BMC Infect Dis 2022; 22:673. [PMID: 35931953 PMCID: PMC9354303 DOI: 10.1186/s12879-022-07658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) can significantly reduce HIV acquisition especially among communities with high HIV prevalence, including men who have sex with men (MSM). Much research has been finding suboptimal PrEP persistence; however, few studies examine factors that enhance PrEP persistence in real-world settings. METHODS We interviewed 33 patients who identified as MSM at three different PrEP clinics in three regions of the U.S. (Northeast, South, Midwest). Participants were eligible if they took PrEP and had been retained in care for a minimum of 6 months. Interviews explored social, structural, clinic-level and behavioral factors that influencing PrEP persistence. RESULTS Through thematic analysis we identified the following factors as promoting PrEP persistence: (1) navigation to reduce out-of-pocket costs of PrEP (structural), (2) social norms that support PrEP use (social), (3) access to LGBTQ + affirming medical providers (clinical), (4) medication as part of a daily routine (behavioral), and (5) facilitation of sexual health agency (belief). DISCUSSION In this sample, persistence in PrEP care was associated with structural and social supports as well as a high level of perceived internal control over protecting their health by taking PrEP. Patients might benefit from increased access, LGBTQ + affirming medical providers, and communications that emphasize PrEP can promote sexual health.
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Affiliation(s)
- Brooke G. Rogers
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA ,grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - C. Sosnowy
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - A. Zanowick-Marr
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - P. A. Chan
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA ,grid.40263.330000 0004 1936 9094Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI 02903 USA
| | - L. A. Mena
- grid.410721.10000 0004 1937 0407Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216 USA ,grid.410721.10000 0004 1937 0407Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - R. R. Patel
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - W. C. Goedel
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903 USA
| | - T. Arnold
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - C. Chu
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - D. Galipeau
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - M. C. Montgomery
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - K. Curoe
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - A. Underwood
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - J. Villalobos
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - C. Gomillia
- grid.410721.10000 0004 1937 0407Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - A. S. Nunn
- grid.40263.330000 0004 1936 9094Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI 02903 USA
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Clement ME, Johnston BE, Eagle C, Taylor D, Rosengren AL, Goldstein BA, Seña AC. Advancing the HIV Pre-Exposure Prophylaxis Continuum: A Collaboration Between a Public Health Department and a Federally Qualified Health Center in the Southern United States. AIDS Patient Care STDS 2019; 33:366-371. [PMID: 31233329 DOI: 10.1089/apc.2019.0054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Uptake of pre-exposure prophylaxis (PrEP) has been limited among black and Latino men who have sex with men (MSM), especially in the southern United States. Public health departments and federally qualified health centers (FQHCs) serving predominantly uninsured populations are uniquely positioned to improve access. We evaluated a novel PrEP collaboration between a public health department and an FQHC in North Carolina (NC). In May 2015, a PrEP program was initiated that included no-cost HIV/sexually transmitted infection screening at a public health department, followed by referral to a colocated FQHC for PrEP services. We profiled the PrEP continuum for patients entering the program until February 2018. PrEP initiators and noninitiators were compared using Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact tests for categorical variables. Of 196 patients referred to the FQHC, 60% attended an initial appointment, 43% filled a prescription, 38% persisted in care for >3 months, and 30% reported >90% adherence at follow-up. Among those presenting for initial appointments (n = 117), most were MSM (n = 95, 81%) and black (n = 62, 53%); 21 (18%) were Latinx and 9 (8%) were trans persons. Almost half (n = 55) were uninsured. We found statistically significant differences between PrEP initiators versus noninitiators based on race/ethnicity (p = 0.02), insurance status (p = 0.05), and history of sex work (p = 0.05). In conclusion, this collaborative model of PrEP care was able to reach predominantly black and Latino MSM in the southern United States. Although sustainable, program strategies to improve steps along the PrEP care continuum are vital in this population.
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Affiliation(s)
- Meredith E Clement
- 1Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Barbara E Johnston
- 2Lincoln Community Health Center, Durham, North Carolina
- 3Duke University Medical Center, Durham, North Carolina
| | - Cedar Eagle
- 4Durham County Department of Public Health, Durham, North Carolina
| | - Destry Taylor
- 2Lincoln Community Health Center, Durham, North Carolina
| | - Anna Lina Rosengren
- 5Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin A Goldstein
- 6Department of Biostatistics and Bioinformatics, Duke University, Durham, North C1arolina
| | - Arlene C Seña
- 4Durham County Department of Public Health, Durham, North Carolina
- 7Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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