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The Effect of Navigation on Linkage to a PrEP Provider Among PrEP-Eligible Men who have Sex with Men in a U.S. Demonstration Project

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Abstract

Our objective is to evaluate the effect of navigation on linkage to a PrEP provider among PrEP-eligible men who have sex with men (MSM) in THRIVE, a demonstration project in seven U.S. public health jurisdictions during 2015–2020. We describe PrEP linkage and navigation use among MSM in THRIVE. We performed multivariable probit regression modeling, controlling for demographic covariates, to estimate the association between navigation and linkage to a PrEP provider among MSM and to assess for disparities in linkage to PrEP among MSM who used navigation. Among 9538 PrEP-eligible MSM, 51.3% used navigation and 53.8% were linked to PrEP. From the three sites where navigation was optional and the main form of PrEP support, MSM who used navigation were 16.69 times (95% CI 13.07–21.32) more likely to link to PrEP compared with MSM who did not use navigation. Among 4895 MSM who used navigation from all seven sites, Black MSM were 21% less likely to link to PrEP compared with White MSM (aRR 0.79; 95% CI 0.74–0.83). Navigation is a promising strategy for improving uptake of PrEP among U.S. MSM, but disparities persist. Addressing the underlying causes of inequities will be important to end the HIV epidemic.

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Data Availability

The data are not currently publicly available but are available from the corresponding author on reasonable request.

Code Availability

The code are not currently publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

Author contributors as part of the THRIVE Project Team: Darnell Barrington, Genevieve Barrow, Mary Beth Cox, Anthony Fox, Deann Gruber, Jacky M. Jennings, Deidra Jessie-Hill, Michael Kharfen, Elaine Martin, Kenneth Pettigrew, Jerris Raiford, William T. Robinson, Aparna Shankar, Benjamin Tsoi, Lucila Wood.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Funding

U.S. Department of Health and Human Services Minority HIV/AIDS Fund.

Author information

Authors and Affiliations

  1. Division of HIV Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA

    Anne A. Kimball, Weiming Zhu, Mary R. Tanner, Kashif Iqbal, Kenneth L. Dominguez, Kirk D. Henny & Karen W. Hoover

  2. Louisiana Office of Public Health, New Orleans, LA, USA

    Anthony James

  3. Virginia Department of Health, Richmond, VA, USA

    Fatima Elamin

  4. District of Columbia Department of Health, Washington, DC, USA

    Kate Drezner

  5. Birmingham AIDS Outreach, Birmingham, AL, USA

    Josh Bruce

  6. Philadelphia Department of Public Health, Philadelphia, PA, USA

    Mary Evelyn Torres

  7. Baltimore City Health Department, Baltimore, MD, USA

    Ashley Price

  8. New York City Department of Health and Mental Hygiene, New York, NY, USA

    Stephanie J. Hubbard

Authors
  1. Anne A. Kimball
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  2. Weiming Zhu
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  3. Mary R. Tanner
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  4. Kashif Iqbal
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  5. Kenneth L. Dominguez
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  6. Kirk D. Henny
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  7. Anthony James
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  8. Fatima Elamin
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  9. Kate Drezner
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  10. Josh Bruce
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  11. Mary Evelyn Torres
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  12. Ashley Price
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  13. Stephanie J. Hubbard
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  14. Karen W. Hoover
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Consortia

the THRIVE Project Team

  • Darnell Barrington
  • , Genevieve Barrow
  • , Mary Beth Cox
  • , Anthony Fox
  • , Deann Gruber
  • , Jacky M. Jennings
  • , Deidra Jessie-Hill
  • , Michael Kharfen
  • , Elaine Martin
  • , Kenneth Pettigrew
  • , Jerris Raiford
  • , William T. Robinson
  • , Aparna Shankar
  • , Benjamin Tsoi
  •  & Lucila Wood

Contributions

AAK conceptualized and designed the study, performed the analysis, drafted the manuscript, and revised the manuscript. WZ conceptualized and designed the study, assisted with and reviewed the analysis, and critically reviewed the manuscript for important intellectual content. MRT, KI, and KWH contributed to the conceptualization and design of the study, contributed to interpretation of the data, assisted with design and implementation of the demonstration project that generated the data, and critically reviewed the manuscript for important intellectual content. KLD, KDH, AJ, FE, KD, JB, MET, AP, and SJH contributed to design of the study and interpretation of the data, assisted with design and implementation of the demonstration project that generated the data and with data collection, and critically reviewed the manuscript for important intellectual content. DB, GB, MBC, DG, JMJ, DJH, MK, EM, KP, JR, WTR, AS, BT, and LW contributed to interpretation of the data, assisted with implementation of the demonstration project that generated the data and with data collection, and critically reviewed the manuscript for important intellectual content. All authors approve publication of the final version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Anne A. Kimball.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The THRIVE demonstration project had a non-research determination from CDC and was exempt from review by institutional review boards.

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N/A.

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N/A.

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A list of the THRIVE Project Team is listed in the Acknowledgement section.

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Kimball, A.A., Zhu, W., Tanner, M.R. et al. The Effect of Navigation on Linkage to a PrEP Provider Among PrEP-Eligible Men who have Sex with Men in a U.S. Demonstration Project. AIDS Behav 27, 1981–1988 (2023). https://doi.org/10.1007/s10461-022-03931-y

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  • DOI: https://doi.org/10.1007/s10461-022-03931-y

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