Pre-Exposure Prophylaxis Interventions among Black Sexual Minority Men: A Systematic Literature Review.

Rodman E Turpin,Andre D Rosario,David J Hawthorne

doi:10.3390/ijerph19041934

Abstract

Background: Interventions to promote HIV pre-exposure prophylaxis (PrEP) among Black sexual minority men (BSMM) are especially important, given the disproportionate HIV incidence and relatively low uptake of PrEP among BSMM. Methods: We conducted a systematic literature review to identify the characteristics of interventions between 2016 and 2021 promoting PrEP use among BSMM. We synthesized these studies based on sample size, location, the use of peer-based delivery, and key intervention targets. Results: Of the starting total 198 articles, 10 were included in the final review, with the majority of included studies being randomized controlled trials. We identified providing PrEP access, PrEP counseling, HIV and PrEP education, linkage to general health care, and peer-based support as key successful intervention components. The starkest difference between interventions with and without demonstrated PrEP improvements was the outcome: all interventions focused on PrEP initiation led to large improvements, but those focused on PrEP adherence did not. No other factors demonstrated distinct differences between successful and unsuccessful interventions. Conclusion: We identified notable differences in intervention efficacy between PrEP initiation and PrEP adherence outcomes; PrEP adherence is necessary for optimal HIV prevention. Future interventions promoting and measuring PrEP adherence, with a focus on cultural competence and peer components, are recommended.

Highlights

Black sexual minority men (BSMM) are at the greatest risk of HIV acquisition across race and sexual minority status, accounting for 26% of all new HIV diagnoses in the U.S.A., yet comprising less than 1% of the U.S.A. population [1,2]
Articles were excluded based on the abstract if it was evident that they were not interventions focused on pre-exposure prophylaxis (PrEP)
We identified several commonalities in intervention approaches to PrEP promotion among BSMM, including providing PrEP access and counseling

Summary

Introduction

Black sexual minority men (BSMM) are at the greatest risk of HIV acquisition across race and sexual minority status, accounting for 26% of all new HIV diagnoses in the U.S.A., yet comprising less than 1% of the U.S.A. population [1,2]. The incidence rates among BSMM have remained stable since 2015, it is estimated that if the current incidence persists, one in two BSMM will be diagnosed with HIV in their lifetime [2]. For this reason, biomedical approaches to HIV prevention, including the use of HIV Pre-exposure Prophylaxis (PrEP), are important to health equity goals for this population. Several studies have identified barriers to PrEP uptake among many populations of SMM [3,5,8]. Previous research has identified the following barriers to HIV prevention: difficulties accessing healthcare (e.g., lack of health insurance, geographic distance), infrequent routine healthcare utilization, socioeconomic difficulties, low self-perceived

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