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Factors Associated with Being PrEP-Naïve Among a U.S. National Cohort of Former-PrEP and PrEP-Naïve Participants Meeting Objective Criteria for PrEP Care

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Abstract

There is an urgent need to increase uptake and persistence in HIV pre-exposure prophylaxis (PrEP) in PrEP-eligible candidates. Little is known about the similarities and differences between groups of PrEP-naïve and former users, an important consideration for future interventions. We explored factors associated with being PrEP-naïve in a U.S. national cohort of naïve and former-PrEP users, all of whom met objective criteria for PrEP care at enrollment. Data were derived from the Together 5000 cohort study, an Internet-based U.S. national cohort of cisgender and trans men and trans women who have sex with men. Participants were recruited via ads on men-for-men geosocial networking apps. All participants were not on PrEP at the time of enrollment. We conducted bivariate analysis to explore differences between the two groups and used multivariable logistic regression to assess factors associated with being PrEP-naïve. Of the 6283 participants, 5383 (85.7%) were PrEP-naïve and 900 (14.3%) were former-PrEP users. There were significant differences between PrEP-naïve and former-PrEP users across multiple demographic variables, in addition to PrEP-related and psychosocial variables. Factors associated with being PrEP-naïve included younger age, sexual identity other than gay/queer, lower perception of candidacy for PrEP care, less willingness to take PrEP, lower access to PrEP care, and individual-level barriers such as health- and provider-related concerns. Programs and policies designed to address uptake and persistence of PrEP should be aware of these differences. Providing care in non-traditional LGBTQ-care settings, home-based PrEP interventions, and provision by healthcare providers other than physicians could improve uptake. Future research should investigate mechanisms that can improve uptake and persistence in communities in need of PrEP.

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Funding

Funding was provided by National Institute of Allergy and Infectious Diseases (Grant No. UG3 AI 133675), National Institute of Mental Health (Grant No. K23MH102118).

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Authors and Affiliations

  1. Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St., 7th Floor Mailroom, New York, NY, 10027, USA

    Pedro B. Carneiro & Christian Grov

  2. CUNY Institute for Implementation Science in Population Health, New York, NY, USA

    Drew A. Westmoreland & Christian Grov

  3. Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York, NY, USA

    Viraj V. Patel

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  1. Pedro B. Carneiro
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  2. Drew A. Westmoreland
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  3. Viraj V. Patel
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  4. Christian Grov
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Correspondence to Christian Grov.

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All research methods and process were approved and overseen by the CUNY Institutional Review Board.

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Carneiro, P.B., Westmoreland, D.A., Patel, V.V. et al. Factors Associated with Being PrEP-Naïve Among a U.S. National Cohort of Former-PrEP and PrEP-Naïve Participants Meeting Objective Criteria for PrEP Care. Arch Sex Behav 50, 1793–1803 (2021). https://doi.org/10.1007/s10508-020-01791-y

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