Dr. Christian Grov, Professor at the CUNY Graduate School of Public Health and Health Policy, and colleagues examined the uptake of HIV pre-exposure prophylaxis in a national cohort of gay and bisexual men in the United States. The findings were published in the Journal of Acquired Immune Deficiency Syndromes.
[Photo: Dr. Christian Grov]
The HIV care cascade provides milestones with which to track the progress of HIV-positive individuals from seroconversion through viral suppression. The research team utilized the stages in the Transtheoretical Model of Change to understand the pre-exposure prophylaxis cascade.
The data were from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States.
Nearly all (89%) participants were sexually active in the past 3 months and 65% met Centers for Disease Control criteria for pre-exposure prophylaxis candidacy. Of those identified as appropriate candidates, 53% were stage 1 of change (precontemplative) meaning they were unwilling to take pre-exposure prophylaxis or believed they were inappropriate candidates for pre-exposure prophylaxis. 23% were in stage 2 of change (contemplation) meaning they were willing and self-identified as appropriate candidates. Only 11% were in stage 3 (preparation), meaning they saw pre-exposure prophylaxis as accessible and planned to initiate pre-exposure prophylaxis. 4% were in state 4 (action), meaning the men had been prescribed pre-exposure prophylaxis. Although few of those who were identified as appropriate candidates were on pre-exposure prophylaxis, nearly all pre-exposure prophylaxis users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of pre-exposure prophylaxis candidates reaching stage 5 (maintenance and adherence).
The large majority of participants were appropriate candidates for pre-exposure prophylaxis, yet fewer than 1 in 10 were using and adherent to pre-exposure prophylaxis. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.