HIV Preexposure Prophylaxis Initiation at a Large Community Clinic: Differences Between Eligibility, Awareness, and
Chelsea L Shover1, Marjan Javanbakht1, Steven Shoptaw1
1Chelsea L. Shover is with the Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles; and the Department of Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, CA. Marjan Javanbakht is with the Department of Epidemiology, Fielding School of Public Health. Steven Shoptaw is with the Departments of Family Medicine and Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles. Robert K. Bolan is with the Department of Health and Mental Health Services, Los Angeles LGBT Center. Sung-Jae Lee is with the Department of Epidemiology, Fielding School of Public Health; and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine. Jeffrey T. Parsons and Jonathon Rendina are with the Department of Psychology, Hunter College of the City University of New York, New York, NY. Pamina M. Gorbach is with the Department of Epidemiology, Fielding School of Public Health; and Division of Infectious Diseases, David Geffen School of Medicine.
Objectives:
To characterize uptake of HIV preexposure prophylaxis (PrEP) in a community setting and to identify disparities in PrEP use by demographic and behavioral factors associated with increased HIV risk.
Methods:
We conducted a cross-sectional study of 19 587 men who have sex with men and transgender people visiting a Los Angeles, California, clinic specializing in lesbian, gay, bisexual, and transgender care between August 2015 and February 2018 by using clinical care data.
Results:
Seventy percent of patients met PrEP eligibility criteria, while 10% reported PrEP use. Using sex drugs, reporting both condomless anal intercourse and recent sexually transmitted infection, older age, and higher education level were associated with higher odds of PrEP use given eligibility. Latino or Asian race/ethnicity and bisexual orientation were associated with lower odds of PrEP use given eligibility. Higher odds of perceived need were associated with demographic risk factors but PrEP use was not similarly elevated.
Conclusions:
Discrepancies between PrEP eligibility, perceived need, and use reveal opportunities to improve PrEP delivery in community settings. Public Health Implications. Efforts are needed to facilitate PrEP uptake in populations with highest HIV incidence.
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