Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California

ABSTRACT

Barriers to HIV preexposure prophylaxis (PrEP) use have not been well-characterized in people who became HIV-infected, all of whom could have benefited from PrEP. We invited Kaiser Permanente Northern California members diagnosed with HIV during 2014–2016, following a negative HIV test in the prior year, to complete a survey assessing barriers to PrEP use before HIV diagnosis. Of 268 patients surveyed, 122 (46%) responded. Median age was 36, most (84%) were men who have sex with men, and 64% were of minority racial/ethnic background. Thirty-six (30%) had discussed PrEP with a provider, of whom 10 were diagnosed with HIV at PrEP intake. Overall, only 5 (4.1%) had used PrEP, and all 5 discontinued before diagnosis. Among all respondents, the most common barrier to PrEP use was lack of PrEP awareness (51%). Among those aware of PrEP, the most common barriers were cost/insurance concerns (36%) and perceived low risk for HIV (24%). Lack of PrEP awareness ranged from 39% among those aged 25–34 to 88% among those aged <25 (P = 0.011), and from 33% among Hispanics to 69% among Blacks (P = 0.055). Increasing awareness and affordability of PrEP, and facilitating accurate assessment of HIV risk, are critical to reducing missed opportunities for PrEP.

KEYWORDS:

• Human immunodeficiency virus (HIV)
• preexposure prophylaxis (PrEP)
• implementation
• awareness
• cost

Acknowledgments

This work was supported by a grant from the Kaiser Permanente Northern California Community Benefit Program and by the National Institute of Allergy and Infectious Diseases [K01 AI122853 to JLM].

Disclosure statement

No potential conflict of interest was reported by the authors.

Previously presented

This work will be presented at the HIV Research for Prevention Conference in Madrid, October 21–25, 2018.

ORCID

Julia L. Marcus http://orcid.org/0000-0002-8552-414X

Additional information

Funding

This work was supported by a grant from the Kaiser Permanente Northern California Community Benefit Program and by the National Institute of Allergy and Infectious Diseases [K01 AI122853 to JLM].