Factors associated with suboptimal retention in HIV pre-exposure prophylaxis care among men who have sex with men

ABSTRACT

Despite the efficacy of HIV pre-exposure prophylaxis (PrEP), retention in care in the United States remains suboptimal. The goal of this study was to explore factors that lead to suboptimal retention in PrEP care for men who have sex with men (MSM) in real-world clinical settings in the United States. Trained interviewers conducted semi-structured interviews with MSM (N = 49) from three clinics who had been engaged in PrEP care in the Midwest (n = 15), South (n = 15), and Northeast (n = 19) geographic regions and had experienced a lapse in PrEP use. Factors that emerged as related to suboptimal retention in PrEP care included structural factors such as transportation and out-of-pocket costs; social factors such as misinformation on media and in personal networks; clinical factors such as frequency and timing of appointments; and behavioral factors such as changes in sexual behavior and low perceived risk for HIV. Participants suggested reducing the out-of-pocket costs of medications and lab visits, having flexible appointment times, culturally responsive services, and comprehensive patient navigation to help retention in care. These findings leveraged real-world experiences and opinions of patients to inform gaps in current services and how to make changes to optimize PrEP care.

KEYWORDS:

• Pre-exposure prophylaxis
• HIV prevention
• men who have sex with men
• retention

Disclosure statement

Dr. Brooke Rogers reports research support from Gilead Sciences #IN-US-276-5463. Dr. Philip Chan is staff at Rhode Island Public Health Institute and consults for the Rhode Island Department of Health. Dr. Leandro A. Mena reports consultant and research grants from Gilead Sciences, ViiV Healthcare/Glaxo-Smith Kline, Merck, Roche and research grants from TaiMed and Janssen. There are no other financial or scientific conflicts of interest to report.

Additional information

Funding

This work was supported by the National Institutes of Mental Health under Grant #R01MH114657. Dr. Trisha Arnold was also supported by T32MH078788 and R25MH083620. This work was also facilitated by the Providence/Boston Center for AIDS Research (P30AI042853) Division of Intramural Research, National Institute of Allergy and Infectious Diseases.