Predictors of Human Immunodeficiency Virus Pre-Exposure Prophylaxis (PrEP) Uptake in a Sexual Health Clinic With Rapid PrEP Initiation

Gabriel A Wagner, Kuan-Sheng Wu, Christy Anderson, Alina Burgi, Susan J Little, Gabriel A Wagner, Kuan-Sheng Wu, Christy Anderson, Alina Burgi, Susan J Little

Abstract

Background: Improved pre-exposure prophylaxis (PrEP) uptake is essential for human immunodeficiency virus (HIV) prevention initiatives. Offering PrEP at the time of HIV and sexually transmitted infection (STI) testing can improve uptake. We offered rapid PrEP initiation in a sexual health clinic and assessed predictors of PrEP interest, initiation, linkage, and retention.

Methods: Between November 2018 and February 2020, PrEP-eligible individuals who presented to a sexual health clinic were offered a free 30-day supply of PrEP plus linkage to continued PrEP care. Univariable and multivariable analyses of demographic and HIV risk data were conducted to determine predictors of PrEP uptake.

Results: Of 1259 adults who were eligible for PrEP (99.7% male, 42.7% White, 36.2% Hispanic), 456 were interested in PrEP, 249 initiated PrEP, 209 were linked, and 67 were retained in care. Predictors of PrEP interest included younger age (P < .01), lower monthly income (P = .01), recreational drug use (P = .02), and a greater number of sexual partners (P < .01). Negative predictors of PrEP initiation included lower monthly income (P = .04), testing positive for chlamydia (P = .04), and exchanging money for sex (P = .01). Negative predictors of linkage included self-identifying as Black (P = .03) and testing positive for an STI (P < .01). Having health insurance positively predicted both linkage (P < .01) and retention (P < .03).

Conclusions: A minority of PrEP-eligible HIV and STI testers initiated PrEP when offered, suggesting that easy PrEP access in sexual health clinics alone may not improve uptake. Predictors of uptake included established HIV risk factors and markers of higher socioeconomic status, suggesting that those aware of their risk and with the means to utilize health services engaged best with this model.

Keywords: HIV prevention; rapid prEP.

Conflict of interest statement

Potential conflicts of interest. SJL has received research funding to her institution from Gilead Sciences. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Pre-exposure prophylaxis (PrEP) continuum of care. Bar graph illustrating the proportion of study participants along each step of the PrEP initiation continuum. The steps include the following: Tested (ie, the total number of participants who underwent human immunodeficiency virus/sexually transmitted infection testing during the study period); Eligible (ie, the proportion of participants who were eligible for PrEP); Interested (ie, the proportion who were interested in starting PrEP); Pharmacy Visit (ie, the proportion who were seen by the study pharmacist for PrEP); Started (ie, the proportion who initiated PrEP); Linked (ie, the proportion who were linked to community PrEP clinics); Follow-up Visit (ie, the proportion who completed a study follow up phone call visit); and Retained (ie, the proportion who were retained in care at 3 months). The percentage indicated on the bar is the percentage of the previous bar, except where indicated with an asterisk. Some participants with missing data were removed from analysis as indicated by a typographical symbol on the label of some bars (for details, see Supplementary Figure 1).
Figure 2.
Figure 2.
Predictors of pre-exposure prophylaxis (PrEP) uptake. Forest plot showing 4 multivariable logistic regression models for each of the 4 PrEP continuum outcomes: interest in PrEP, PrEP initiation, linkage to community PrEP care, and retention in PrEP care at 3 months. Outcomes are displayed across the top and significant predictors are listed on the left. Diamonds represent adjusted odds ratios and whisker bars represent 95% confidence intervals. Where indicated, human immunodeficiency virus (HIV) risk factors and behaviors correspond to the 3-month period before HIV and sexually transmitted infection (STI) testing. For the retention outcome, a multivariable model was not produced because no other variables were retained in the univariable model. CT, chlamydia; GC, gonorrhea.

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