Multiple, active-offer referrals for HIV pre-exposure prophylaxis by nurses yields high uptake among gay, bisexual, and other men who have sex with men.

Abstract

Current Canadian guidelines focus on indications and uptake of preexposure prophylaxis (PrEP) among groups at-risk for HIV, such as gay, bisexual, and men who have sex with men (GBM). Less, however, is known about the outcomes of PrEP offers. This study presents on the responses of GBM to multiple offers for PrEP. In Ottawa, Canada, we instituted Canada's first nurse-led PrEP program, pre-exposure prophylaxis by nurses (PrEP-RN), where nurses offered PrEP referrals to persons with indicators for HIV. Responses to offers from nurses and HIV diagnoses were recorded and assessed for multiple occurrences based on responses. Descriptive analyses were used to report frequencies and percentages of findings and chi-square analyses were conducted to determine significance based on HIV risk for those who accepted versus declined PrEP. Over a 4-year period, 644 PrEP offers were made to 236 unique patients, all of whom were GMB, the majority of whom identified as male. Of the eligible patients, 50.8% accepted and 50.0% declined after multiple offers. Seven trajectories were identified in terms of reasons for accepting or declining PrEP. PrEP referrals made based on clinical guidelines and to those who had changes in risk factors over time were significantly correlated with PrEP acceptance. We noted five HIV diagnoses, all of which were among GBM who declined PrEP at least once. Based on these findings, it appears multiple PrEP may yield increased PrEP acceptance among a sample of GBM.