Abstract
Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by the HIV epidemic. Despite the promise of pre-exposure prophylaxis (PrEP) in reducing HIV transmission risk, barriers for uptake and persistence exist. We sought to identify whether GBM in a nationwide cohort who have not yet initiated PrEP (n = 906) would prefer to get PrEP-related care from a primary care provider (PCP) compared to a specialist clinic or provider. We then sought to identify their level of interest and factors associated with preference for using home-based PrEP services (i.e., HB-PrEP), defined to participants as conducting HIV/STI self-testing from home with PrEP prescription mailing after an initial in-person clinic visit. We examined the associations of demographics, sexual HIV transmission risk, concern about frequent medical checkups associated with PrEP, health care access, and PrEP intentions with preferences for healthcare provider type and HB-PrEP. Concern about frequent medical checkups were associated with preferring a PCP for PrEP-related care, but men who perceived a barrier to bringing up the topic of PrEP with a doctor preferred a specialist clinic or provider more than a PCP. HB-PrEP was more appealing for younger men and those engaged in sexual HIV transmission risk, suggesting HB-PrEP could help reach GBM most vulnerable to HIV and in need of PrEP. HB-PrEP expansion has potential to increase PrEP uptake and persistence among GBM, particularly for men with barriers to clinic-based care and higher intentions to initiate PrEP. Clinical guidelines regarding HB-PrEP are needed to expand its use.
Highlights
Over 1.2 million people are living with HIV in the United States (US), and over 40,000 new cases of HIV are diagnosed each year nationally [1]
One-third of the sample had engaged in sexual HIV transmission risk in the past three months, and 41.7% were tested for HIV in the past 6 months between our survey and testing assessments
This is important because men who worried more about the quarterly medical checkups currently recommended for pre-exposure prophylaxis (PrEP) would prefer to engage in the frequent care with a primary care provider (PCP), yet men who had more concern about bringing up the topic of PrEP with a doctor preferred to get PrEP-related care from a specialist clinic or provider
Summary
The purpose of this paper was to study the preferences of GBM who have not yet initiated PrEP (i.e., PrEP-naïve GBM) to fill critical gaps in the literature
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