Applying the PrEP Continuum of Care for MSM at a national and individual state level in the United States Open Access
Thure, Katie Alexandra (2016)
Abstract
In a national online survey conducted in 2014 and 2015, we applied a pre-exposure prophylaxis (PrEP) care continuum on a national and state-by-state level for 2,604 men who have sex with men (MSM). Using logistic regression, we assessed the relationship between domains of the continuum, PrEP awareness, PrEP willingness and PrEP uptake, and characteristics of interest including demographics, risk factors and access to care. On a national level, 74% of MSM had heard of PrEP previously, 70% were willing to take PrEP, and 6% were currently taking PrEP. For individual states, the continuum varied, with PrEP awareness ranging from 56% to 86%, PrEP willingness 56% to 83%, and PrEP uptake 0% to 17%. Factors associated with PrEP awareness included higher age and education. Factors associated with PrEP willingness included risk behaviors such as anal sex with serodiscordant partner and higher number of partners. MSM with residential status in a state that expanded Medicaid under the Affordable Care Act were twice as likely to be on PrEP compared to MSM living in a state that had rejected Medicaid expansion. Although addressing barriers upstream of PrEP uptake, including PrEP awareness and PrEP willingness, may engage more MSM, this is likely not sufficient to bring PrEP to scale at levels suggested by the US Centers for Disease Control and Prevention. It is imperative to address institutional barriers to uptake, particularly regarding access to PrEP care.
Table of Contents
Introduction………………………………………………………………………………………………1
Methods……………………………………………………………………………………………………3
Results……………………………………………………………………………………………………..6
Discussion………………………………………………………………………………………………..11
Tables 1 - 3……………………………………………………………………………………………....16
Appendix A……………………………………………………………………………………………….20
References………………………………………………………………………………………………..38
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