Variations in PrEP uptake post-testing for CDC HIVST program Open Access
Reese, Olivia (Spring 2024)
Abstract
The uptake of PrEP is an essential tool to combat the continual spread of HIV and achieve the Ending the HIV Epidemic (EHE) goals. This analysis used survey data from the CDC/Emory collaborative program, Together TakeMeHome (TTMH), to mail free HIV self-tests to individuals who opt-in.
Order and survey data from the first 8 months from the Together TakeMeHome program were evaluated. Baseline characteristics of those who were not living with HIV or currently taking PrEP were compared using descriptive statistics. The survey assessed who initiated PrEP outside of the TTMH program after ordering an HIVST from TTMH. Multivariate logistic regression was used to explore which factors were associated with PrEP uptake post-testing.
In the first 8 months of the program, 156,678 people ordered HIVSTs from TTMH. The rate of HIV positivity was 43.7 cases/100,000 individuals in the cohort who was not on PrEP and was HIV negative prior to ordering an HIVST from TTMH. 264 people indicated through follow-up surveys that they initiated PrEP outside of TTMH after ordering an HIVST. Among those who initiated PrEP, over 44% were in the South Atlantic, whereas 23.6% of those who ordered an HIVST were in the South Atlantic. From the logistic regression model, those with private insurance, prior healthcare utilization, and 5 or more sexual partners were the most likely to initiate PrEP.
The success of the program in delivering HIVSTs across the country provides a proof of concept that HIV self-testing is likely acceptable to patients and that this model may be a helpful tool to reach the EHE goals. Low survey response rates and the opt-in format of this program drive concern for bias. However, the comparability of demographics across the follow-up surveys reduces the concern for selection bias. This study provides evidence that mailing free HIV self-tests serves to help a diverse range of people access testing and may aid in the uptake of PrEP.
Table of Contents
Introduction 1
Methods 5
Measures 5
Analytic Methods 6
Results 7
Discussion 9
Tables & Figures 12
Table 1. Baseline demographics among TTMH program participants in the post-HIVST order, Day 10, and Day 60 analytic sample. 12
Table 2. Baseline demographics among TTMH program participants who accessed PrEP after ordering an at-home HIV self-test kit. 14
Table 3. Logistic Regression Results for the Final Analytical Sample for the Odds of PrEP Usage using contrast statements to evaluate specific covariate comparisons. Adjusted model controlled for age, race, gender, and region. 16
Table 4. Expanded logistic regression results for the final analytical sample for the odds of PrEP usage to show every adjusted odds ratio output without the contrast statements from the full model. 17
Figure 1. Sample selection flow for three TTMH surveys: post-HIVST order, Day 10, and Day 60. Participants on PrEP prior to the program, living with HIV prior to the program, or banned orders were excluded from the analysis. 18
References 19
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