Indicators of PrEP Uptake Among Men Who Have Sex with Men in New York, Atlanta, and Detroit: An application of the Information-Motivation-Behavioral Skills (IMB) Model Open Access
Mafi, Mele (Spring 2026)
Abstract
Introduction: Although Pre-Exposure Prophylaxis (PrEP) prevents HIV acquisition, those at the greatest risk of acquiring HIV are disproportionately less likely to use PrEP. Our study aimed to identify methods of improving uptake in men that have sex with men (MSM) who meet guidelines for recommended PrEP use. The Information-Motivation-Behavioral Skills (IMB) behavioral framework categorizes indicators of health behaviors and can aid in identifying predictors of behavior, such as PrEP uptake.
Methods: We identified 360 men from the M-cubed study that met requirements for recommended PrEP use but had not begun using PrEP at baseline. All participants were adult MSM from New York City, Atlanta, or Detroit who completed a maximum of four surveys, assigned in three-month intervals from January 2018 to September 2019. IMB model indicators of PrEP use were defined as follows: Information was measured inversely by reporting previous cessation or avoidance of PrEP use due to personal inapplicability; Motivation was measured by perceived protection from PrEP use; and self-efficacy, a Behavioral Skill, was measured by self-reported likelihood of taking PrEP in the future. Primary findings were cumulative incident PrEP use by IMB indicator, bivariate hazard ratios, and multivariate hazard ratios adjusting for IMB characteristics, age, education, insurance, race, city, income, and intervention arm.
Results: 58 participants initiated PrEP throughout the study; the cumulative probability of uptake of 34.6%. Unadjusted cumulative probability of PrEP uptake differed significantly by the information (p<0.001), motivation (p<0.001), and behavioral skills indicators (p<0.001). All IMB indicators were significantly associated with PrEP use both with and without adjustment for covariates. The single strongest indicator for PrEP uptake was reporting a very likely chance of future PrEP use (behavioral skills indicator) vs neutral or unlikely chance of future PrEP use (HR 5.5 CI 2.2, 13.8).
Conclusion: The IMB framework accurately identifies factors indicating PrEP initiation. These findings support the implementation of interventions designed to improve patient understanding of personal PrEP applicability, increase perceived PrEP efficacy, and strengthen confidence in future PrEP use.
Table of Contents
Distribution Agreement 1
Approval Sheet 2
Abstract Cover Page 3
Abstract 4
Thesis Cover Page 5
Thesis 6-22
Tables and Figure 23-30
References 31-34
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Indicators of PrEP Uptake Among Men Who Have Sex with Men in New York, Atlanta, and Detroit: An application of the Information-Motivation-Behavioral Skills (IMB) Model () | 2026-05-05 18:30:42 -0400 |
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