Correlates of Linkage to HIV Preexposure Prophylaxis Among HIV-Testing Clients

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 77; no. 4; pp. 365 - 372
• Main Authors: Flash, Charlene A, Adegboyega, Oluwatobi O, Yu, Xiaoying, Avalos, Carmen, Johnson, Syundai, Mayer, Kenneth H, Giordano, Thomas P
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-04-2018; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adolescent; Adult; Aged; Condoms; Correlation; Disease prevention; Disease Transmission, Infectious - prevention & control; Ethnicity; Female; Health Knowledge, Attitudes, Practice; Health risk assessment; Health risks; HIV; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Male; Medical tests; Middle Aged; Patient Acceptance of Health Care; Polls & surveys; Pre-Exposure Prophylaxis; Prophylaxis; Prospective Studies; Risk assessment; Risk perception; Texas; Young Adult; Texas
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0000000000001605

BACKGROUND:Publicly funded HIV-testing sites can identify HIV preexposure prophylaxis (PrEP) candidates and provide PrEP linkage.
SETTING:Harris Health Systemʼs HIV clinic, HIV-testing program, and HIV-prevention program (HPP) in Houston, TX, a high HIV-incidence city.
METHODS:A prospective assessment of individuals aged 18 years and older recruited from walk-in HIV testing from December 2013 to April 2015 included risk assessment, HIV testing, and self-administered survey, with follow-up surveys at 6 and 12 months and medical record review.
RESULTS:The mean age of our sample (n = 300) was 38.3 ± 11.7 years. Men constituted 63.1% of the sample and 53.7% were black non-Hispanic, 26.3% Hispanic, and 14.7% white non-Hispanic. Most were uninsured (63.5%). Only 27% always used condoms, although 67% perceived personal HIV risk. Of 300 participants, 64 (21.3%) linked to PrEP care and 49 (16.3%) took PrEP. In multivariable analysis, compared with heterosexual men, women [adjusted OR (aOR) 4.1, 95% CI1.5 to 11.1] and MSM (aOR 10.2, 95% CI3.4 to 31.0) were more likely to attend HPP and to take PrEP (aOR 3.0, 95% CI1.6 to 15.1 and 3.0, 95% CI1.1 to 8.3, respectively). Serodiscordance and PrEP interest correlated with program attendance (aOR 14.0, 95% CI6.1 to 32.3 and aOR 6.7, 95% CI1.8 to 25.4) and taking PrEP (aOR 13.1, 95% CI5.2 to 32.8 and 14.4, 95% CI1.8 to 166.9), respectively.
CONCLUSIONS:Preexposure prophylaxis interest, being female or MSM, and serodiscordance correlated with PrEP linkage. Safety-net health systems can facilitate PrEP access in marginalized populations, but the PrEP initiation rates remain low.