Identifying Implementation Gaps in the HIV Prevention Cascade among Peruvian Men Who Have Sex with Men

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Publicly funded HIV pre-exposure prophylaxis (PrEP) programs have expanded in Peru.
• However, PrEP uptake among men who have sex with men (MSM) remains suboptimal, indicating implementation challenges.

Purpose of the Study:

• To assess progression through the PrEP cascade among eligible MSM in Peru.
• To identify implementation-relevant factors influencing PrEP seeking and initiation.

Main Methods:

• A cross-sectional online survey was conducted from June to August 2023.
• The study included 463 men who have sex with men eligible for PrEP.
• Exploratory factor analysis and multivariable logistic regression were used to identify determinants.

Main Results:

• While 78.6% of participants reported readiness to start PrEP, only 30.5% had sought it, and 17.3% had initiated.
• Actionable PrEP knowledge was strongly associated with both seeking (aOR 4.01) and initiation (aOR 3.17).
• Higher income was also linked to PrEP initiation.

Conclusions:

• Significant gaps exist between PrEP readiness and actual uptake among MSM in Peru.
• Multi-level strategies focusing on enhanced knowledge delivery and addressing structural barriers are crucial for improving PrEP cascade progression.