The Future of HIV PrEP Care: Evaluating HIV preexposure prophylaxis care to reduce health inequities in the era of multiple PrEP modalities Restricted; Files Only
Chandra, Christina (Summer 2025)
Abstract
HIV preexposure prophylaxis (PrEP) is an effective tool to prevent HIV acquisition, but inequitable implementation of PrEP has contributed to racial and ethnic inequities in HIV incidence among gay, bisexual, and other men who have sex with men (MSM). Routine sexually transmitted infection (STI) testing in PrEP care improves detection and treatment of asymptomatic infections, potentially reducing STI incidence and disparities. Expanded PrEP options (e.g., daily and event-driven oral PrEP and long-acting injectable PrEP) offer opportunities to reduce inequities in HIV among MSM. We examined how PrEP care engagement across modalities can be leveraged to reduce racial and ethnic inequities in HIV and STIs in the United States.
In Aim 1, we used electronic health records of MSM in Boston to compare the incidence of gonorrhea and chlamydia testing and diagnoses across race and ethnicity groups and clinics during periods of PrEP use and no PrEP use. Our findings suggest that routine STI testing in PrEP care reduces racial and ethnic disparities in STI testing and diagnoses.
In Aim 2, we used a network-based model of HIV transmission among MSM to evaluate the potential impact of PrEP interventions focused on improving uptake, persistence, and reinitiation on HIV outcomes. Compared to PrEP uptake and persistence interventions, PrEP reinitiation interventions led to more HIV infections averted over 10 years. However, racial and ethnic inequities were amplified without tailored interventions for Black and Hispanic MSM.
In Aim 3, we used a network-based model of HIV and STI transmission among MSM to assess the impact of varying testing intervals on HIV and STI outcomes across multiple PrEP modalities. Reducing STI testing frequencies increases gonorrhea and chlamydia infections by as much as 45%. There were no impacts on racial and ethnic inequities.
These findings demonstrate that if implemented equitably, PrEP can play an important role in reducing racial and ethnic inequities in HIV and STI incidence. PrEP reinitiation is an important but often overlooked aspect of the PrEP care continuum and should be leveraged to improve overall PrEP coverage. Future research should continue to investigate interventions to improve inequities in HIV and STIs among MSM.
Table of Contents
Chapter 1. Background and Significance
Chapter 2. Racial and Ethnic Inequities in STI Testing and Cases among Gay, Bisexual, and Other Men Who Have Sex with Men, 2012–2023
Chapter 3. Comparing the impacts of PrEP uptake, persistence, and reinitiation on racial and ethnic inequities in HIV incidence among men who have sex with men: A modeling study
Chapter 4. Modeling routine HIV and sexually transmitted infection testing strategies for daily, event-driven, and long-acting PrEP users
Chapter 5. Technical Supplemental Appendix
About this Dissertation
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File download under embargo until 21 August 2031 | 2025-08-07 10:51:48 -0400 | File download under embargo until 21 August 2031 |
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