Access to Free HIV PrEP at a Sexual Health Clinic Does Little to Increase Uptake

Rapid HIV pre-exposure prophylaxis (PrEP) initiation was uncommon among eligible individuals receiving care at a sexual health clinic, indicating strategies to improve PrEP access may not be enough to increase uptake. These study findings were published in Open Forum Infectious Diseases.

Between November 2018 and February 2020, researchers conducted a study to evaluate predictors associated with HIV PreP interest, linkage, and initiation among PrEP-eligible participants receiving care at a sexual health clinic. Included participants were men who have sex with men (MSM) and transgender women who were offered a 30-day supply of PrEP at no cost, as well as access to ongoing PrEP care.

Participants who indicated interest in PrEP initiation were scheduled for an appointment with a pharmacist and were offered a 30-day supply of oral coformulated tenofovir disoproxil fumarate and emtricitabine. Predictors of PrEP uptake were determined via univariable and multivariable analyses of data on demographic-, HIV-, and sexually transmitted infection (STI)-related risk factors. Characteristics among participants who did vs did not indicate interest in PrEP initiation were compared via Chi-square and Fisher exact testing.

The final analysis included 1259 participants, of whom the mean age was 32 (IQR, 27-42) years, 99.7% were men, and 42.7% were White. Most (96.6%) participants reported receptive anal intercourse within the previous 3 months, 16.8% reported previous recreational drug use, and 1.4% reported injection drug use within the previous 3 months.

A total of 456 (36%) participants indicated interest in PrEP initiation, of whom 292 (64%) arrived for their scheduled visit with the pharmacist. Of these 292 participants, 249 subsequently initiated PrEP, and 209 were scheduled for ongoing PrEP care.

Among 126 participants who were available for follow-up at 3 months, 59 reported discontinuation of PrEP.

Significant predictors associated with interest in PrEP initiation included younger age (adjusted odds ratio [aOR], 0.97; 95% CI, 0.96-0.99; P <.01), a monthly income of less than $2000 (aOR, 1.39; 95% CI, 0.96-0.99; P <.01), and recreational drug use within the past 3 months (aOR, 1.43; 95% CI, 1.05-1.94; P =.02). Of note, interest in PrEP initiation was more likely among participants with a greater number of sexual partners within the previous 3 months compared with those who reported fewer partners.

Further analysis showed that progression to PrEP initiation was less likely among participants who reported a monthly income of less than $2000 (aOR, 0.49; 95% CI, 0.25-0.96; P =.04). Similar findings were noted among participants who tested positive for chlamydia (aOR, 0.43; 95% CI, 0.20-0.96; P =.04) and those who reported prior exchange of sex for money or goods (aOR, 0.12; 95% CI, 0.02-0.62; P =.01).

Study limitations include the lack of data captured from participants who did indicate interest in or initiate PrEP, as well as the lack of an objective measurement of PrEP adherence.

“The present report adds to a growing body of literature outlining the potential role for rapid PrEP initiation in sexual health clinics,” the researchers concluded.