PrEP Use Research Articles

HIV risk perception and PrEP uptake among black MSM in Mississippi.

Rates for HIV are disproportionately higher for Black men who have sex with men (MSM) compared to other MSM in the U.S. While there is evidence that low perceived risk of HIV infection may increase HIV vulnerability, few studies have examined this relationship among Black MSM in the Southern U.S. where the HIV rates are the highest in the country. This study examined the association between perceived HIV risk and PrEP adoption among Black MSM in a medium-size city in Mississippi. Data were drawn from a subsample of the "ACCELERATE!" intervention, an innovative and sustainable community-driven project to improve health outcomes among Black MSM. The outcome of interest was PrEP uptake, a binary variable derived from responses to the question "Have you taken PrEP in the last year?". The perceived risk of HIV, an independent variable, is measured by self-report of an individual's assessment of their vulnerability of contracting HIV defined as low versus high risk. Covariates included age and socio-environmental factors (health insurance, incarceration and discrimination) Sample characteristics were provided using means and standard deviations for continuous variables and proportions for categorical variables. Exact logistic regression was used to assess the association between perceived HIV risk and PrEP adoption, adjusting for covariates. A total of 84 HIV negative Black men with a median age of 30 (min = 18, max = 69) years were available for analyses. Approximately 16% of participants reported experiencing incarceration and 57% reported experiencing discrimination. Seven out of ten respondents reported having low perceived risk, and 28.6% (24/84) reported having high perceived risk for HIV. There were 73 participants (86.9%) who reported PrEP use in the last year. We observed a higher proportion of participants with high perceived risk that reported lower uptake of PrEP. After adjusting for age, socioeconomic variables, and risky sexual behaviors, higher levels of perceived risk of HIV were associated with decreased odds of PrEP uptake (OR = 0.20, 95% CI: 0.04-0.94, p = 0.040). The role of HIV risk perception on PrEP adoption is complex among Black MSM in Mississippi. Higher levels of perceived risk of HIV were associated with lower odds of PrEP adoption among Black MSM. This inverse relationship between HIV risk perception and PrEP adoption suggests social- and structural- factors play a critical role in decision-making on PrEP initiation among Black MSM in Jackson. In addition, further longitudinal studies are needed to understand the complex interactions between perceived risk and PrEP use.

Initiation and continued use of oral pre-exposure prophylaxis among pregnant and postpartum women in South Africa (PrEP-PP): a demonstration cohort study

When used effectively, oral pre-exposure prophylaxis (PrEP; tenofovir disoproxil fumarate and emtricitabine) prevents maternal HIV acquisition and reduces the risk of vertical transmission. Our study aimed to better understand PrEP initiation, continued use, and adherence in pregnant and postpartum women. The PrEP in Pregnancy and Postpartum (PrEP-PP) study is a demonstration cohort study that enrolled pregnant women aged 16 years and older without HIV attending their first antenatal care visit in Cape Town, South Africa, between Aug 29, 2019, and Oct 10, 2021. Eligible, consenting women were followed up quarterly up to 12 months postpartum with regular HIV testing and offer of PrEP with ongoing adherence counselling. The primary outcome was distribution of women across the PrEP cascade (ie, initiation and continuation up to 12 months postpartum) with crude and adjusted hazard ratios (HRs). We also report on HIV incidence by pregnancy and postpartum status. Overall, 1195 pregnant women were recruited and followed up (median age 26 years, IQR 23-31; median gestational age 21 weeks, IQR 15-31); 1009 (84·4%) started PrEP at enrolment. Among women who initiated PrEP at enrolment, 668 (67·5%) of 990 continued PrEP at the 1-month follow-up, 485 (49·9%) of 972 continued at 3 months, 392 (39·4%) of 994 at 6 months, and 275 (27·4%) of 1005 at 12 months. Of 186 women who did not accept PrEP at enrolment, 70 (37·6%) of 186 subsequently initiated PrEP. Overall, 200 (18·6%) of 1076 women continued PrEP at 12 months postpartum. Of 186 women who did not initiate PrEP at baseline, 70 (37·6%) subsequently initiated PrEP during the study. Factors associated with PrEP discontinuation up to 12 months postpartum included being married or cohabiting (adjusted HR 1·32, 95% CI 1·16-1·50), condomless sex since last visit (1·43, 1·23-1·65), reporting intimate partner violence (2·03, 1·59-2·59), or depression in the past 12 months (1·53, 1·14-2·05). Overall, 16 women seroconverted over 1673·8 woman-years (HIV incidence rate 0·96 per 100 woman-years, 95% CI 0·49-1·42); 14 discontinued PrEP use and two never initiated PrEP. HIV incidence was 0·28 per 100 woman-years during pregnancy (95% CI 0·22-0·33), and the incidence rate ratio was 1·77 per 100 woman-years (0·53-5·90) 0-6 months postpartum and 2·19 per 100 woman-years (0·61-7·83) 6-12 months postpartum compared with pregnant women. There is an urgent need for the integration of PrEP into antenatal and postnatal care and interventions that address barriers to continued use, including targeted counselling during pregnancy and postpartum to reduce PrEP discontinuation. National Institute of Mental Health and Fogarty International, US National Institutes of Health. For the French translation of the abstract see Supplementary Materials section.

Understanding Typology of PrEP Persistence Trajectories among Male PrEP Users in the U.S

Abstract Introduction Understanding longitudinal patterns of PrEP use among men who have sex with men (MSM) could offer insights for developing efficient and timely interventions to promote PrEP persistence. Setting We extracted two years of pharmacy fill records for 4,000 males who initiated PrEP in 2017 at a national chain pharmacy in the US. Methods Group-based trajectory models were used to develop PrEP trajectory clusters, with periods of use defined based on optimal PrEP seroprotection probabilities (i.e., PrEP use frequency ≥ 4 doses/week). Multinomial logistic regressions were used to evaluate the associations between sociodemographic covariates and identified trajectory group membership. Results We identified four distinct groups of PrEP persistence trajectories: 1) persistent use of PrEP throughout the period (persistent user), 2) brief use followed by sustained cessation of PrEP use (brief user), 3) PrEP use up to the mid-term followed by sustained cessation of PrEP use (mid-term user), and 4) PrEP use, followed by cessation and subsequent re-initiation (PrEP re-initiator). Persistent users and brief users accounted for 40.1% and 22.9% of the population, respectively, while mid-term users and re-initiators accounted for 18.9% and 18.2%, respectively. Older age at PrEP initiation, commercial insurance as the primary payer of PrEP, and use of specialty pharmacy were found to be associated with persistent PrEP use over the other patterns of non-persistence. Conclusions Subgroups of PrEP users could benefit from PrEP persistence interventions that target specific timings of likely PrEP cessation or considerations of re-initiation.

Utilization of anal cytology screening among sexual and gender minority populations in Pennsylvania.

Despite the risk of anal cancer in sexual and gender minority populations (SGM), anal cancer screening remains infrequent and inconsistent in these populations. The objective of this analysis was to identify factors associated with anal cancer screenings among sexual and gender minority populations (SGM) using the Andersen's Behavioral Model of Health Services Use. Secondary analyses of two cross-sectional surveys from the 2020 (N=1125) and 2022 (N=630) "Pennsylvania LGBTQ Health Needs Assessment." Multiple logistic regression analyses were used to identify correlates of anal cytology screening. Average age was 37.7 (SD=13.3) and 39.7 (SD=13.6) in 2020 and 2022, respectively. Approximately 16-18% reported living with HIV. A minority of respondents reported past year screening (14.0% 2020 and 13.6% 2022). Enabling and need-based factors consistently associated with screening included STI treatment, living with HIV, PrEP use, and multiple sex partners. Robust factors associated with ever being screened were age and living with HIV. Anal cytology screening is being done in Pennsylvania at a small but not insignificant rate. In accordance with existing guidelines, SGM living with HIV were most likely to be screened, but still at a low rate. Predictive factors associated with screening in this study can inform future interventions to implement guideline-specific anal cancer prevention. Factors that reflect consistent connection to healthcare are associated with increased rates of screening via anal cytology testing, indicating there are opportunities to implement anal cancer screening as part of a larger, more comprehensive SGM-focused care pathway.

B-229 Extraction-free Nucleic Acid Sample Preparation from Inhibitor Rich Samples via Hyperbaric Heating

Abstract Background Extraction-based nucleic acid sample preparation for PCR is limited by long processing times, liquid transfers, cost, and storage requirements. Extraction-free approaches enable streamlined sample prep but are severely impacted by inhibitors present in biological sample matrices. We previously reported the use of Hyperbaric Heating (HBH) for effective organism lysis and demonstrate here its effectiveness to prepare nucleic acids for PCR from various inhibitor-rich sample matrix types. Methods HBH exposes the sample to high temperature/high pressure environment for a short duration. This process effectively lyses organisms and denatures inhibitors within seconds. Samples are sealed within a pressure-tight metallic vessel, then rapidly heated using magnetic induction. Within the sealed metallic vessel, vaporization of the aqueous sample raises the internal pressure, enabling an internal temperature higher than 100°C. Proprietary sample processing beads containing chelating agents and other proteins protect nucleic acids from fragmentation during heating. Results The efficacy of HBH for PCR amplification was tested against commercial kits and extraction-free methods. HBH treatment of nasal swab samples spiked with inactivated SARS-CoV-2 elicited detection down to 125 viral copies/mL. Viruses such as RSV and Influenza spiked in nasal swab samples demonstrated comparable PCR results as extraction prepped samples. HBH treatment of microbe samples, including Candida albicans spiked in urine and Bacillus subtilis spiked in serum, had comparable PCR threshold cycles as microbe specific DNA extraction methods (Table 1). Conclusions HBH is a generalizable extraction-free nucleic acid sample prep technology affording detection capabilities comparable to commercial sample prep methods. We demonstrated the use of HBH sample prep for detection of several infectious microorganisms in common biological matrices (nasal swab, serum, urine) without additional sample purification. With its ease of use, speed, and lower cost, HBH will be a key tool in applications where nucleic acid amplification is pivotal for diagnostic and research use.

A Pilot Study of a Sibling-Based Online Intervention to Increase PrEP Uptake and Willingness Among Latino MSM

This study explored the feasibility and acceptability of Entre Herman@s, a novel sibling-based intervention designed to engage siblings to increase PrEP utilization among Latino men who have sex with men (LMSM). Siblings were trained in rudimentary motivational interviewing skills to uncover, evoke, and strengthen their brother's motivation to use PrEP, using the constructs of the Information-Motivation-Behavioral Skills (IMB) model for health behavior change. This pilot demonstrated high feasibility, meeting recruitment, retention, and intervention completion targets. Of the 23 LMSM enrolled, 16 (70%) commenced PrEP, with 12 (75%) continuing at the 3-month follow-up. Initially, 15 participants (65%) were open to PrEP, with 9 (39%) ready to start within the next month. Those who began PrEP use reported a significantly higher degree of closeness to their siblings (p = .019) than those who did not. All LMSMs affirmed that their decision to use PrEP was influenced to some degree by their sibling.

Transgender Latinas’ Perspectives on HIV PrEP Uptake, Condom Use, and Medically Supervised Gender-Affirming Hormone Therapy: Insights From ChiCAS Qualitative Interviews

There is a dearth of HIV prevention behavioral interventions for transgender Latinas, despite this population's HIV risk. ChiCAS (Chicas Creando Acceso a la Salud) is an intervention to increase PrEP, condom, and gender-affirming hormone therapy (GAHT) use among transgender Latinas. To inform future work, semistructured interviews were conducted postintervention with 28 ChiCAS participants. Thematic analysis with inductive coding was used. Six themes emerged: (1) health-related priorities include sexual health and avoiding discrimination; (2) safe and collaborative community is of high importance; (3) interactive education with time for sharing stories and discussion was valued; (4) PrEP uptake was facilitated through awareness and health care navigation; (5) accessing GAHT depends on cost, clinic location, and individual goals; (6) ChiCAS could be improved with more PrEP/GAHT details and social connection. Interventions with goals similar to those of ChiCAS should prioritize building community, PrEP and GAHT education tailored to participants’ needs, and emphasize health care options available locally.

Adolescent Girls and Young Women Overcoming Adherence Challenges with Vaginal and Oral PrEP Use: A Longitudinal Qualitative Study from a Crossover Trial in South Africa, Uganda, and Zimbabwe.

Rates of HIV acquisition remain high among adolescent girls and young women (AGYW) in sub-Saharan Africa. We explored South African, Ugandan, and Zimbabwean AGYW's experiences in a crossover trial of two HIV prevention products: Daily oral pre-exposure prophylaxis pills and a monthly dapivirine vaginal ring. A subset of participants (n = 25) across all sites completed up to three serial in-depth interviews (SIDIs). The SIDIs explored barriers to product use, coping strategies, and the resulting outcomes. Coded textual data were analyzed using a product acceptability conceptual framework. Participants in the SIDIs described managing the array of challenges they encountered through formal adherence support, strategic product disclosure, and personally adapted strategies. For both products, perceived discreetness of the product and decision-making around disclosure was an important component of participants' narratives. Participants tailored their coping strategies based on available personal resources (e.g., cell phone alarms for PrEP reminders, social support through disclosure) or study provided resources (e.g., encouragement from staff, adherence groups). Notably, challenges participants encountered with each product during the crossover period helped inform product selection during the choice period. Our findings suggest that-even in a context where AGYW have access to several options for HIV prevention-challenges to consistent product use remain, but accessible support mechanisms and informed choice can help mitigate these challenges. Enacting that choice may also empower AGYW to reach their short and long-term life goals-including for HIV prevention. (NCT03593655, 20th July 2018).

One Country, Different Reactions- How did the Gay Community in Israel Respond to the New Mpox Threat?

Mpox affected mainly men who have sex with men (MSM). This study aimed to assess MSM's response to the threat, and compare MSM living in central Israel vs. its periphery. Data were collected by anonymous electronic surveys between September and October 2022 through a geospatial application ("Grindr"). Of the 665 MSM participants, 221 (33.2%) were vaccinated against mpox. In the multivariate analysis, living in central Israel, being in steady relationships, HIV infection, PrEP use, noticing suspicious skin lesions, and changing sexual behavior predicted vaccination. Of all participants, 317 (47.6%) changed their sexual behavior. In the multivariate analysis, living in central Israel, engaging in risky sexual behavior and being vaccinated against mpox predicted sexual behavior change. Of the 444 participants who were not vaccinated, 245 (55.1%) lived in peripheral regions of Israel. Those who lived in the periphery were less likely to get vaccinated or change their sexual behavior compared with MSM who lived in central Israel. Although the study was limited in size and the study population was relatively homogeneous, MSM perceived mpox as a potential threat on health, and almost 50% changed their sexual behavior and nearly one-third were vaccinated against mpox. The trend was mainly observed in MSM who were at high risk to acquire mpox and those who lived in central Israel.

Appraising the HIV Prevention Cascade methodology to improve HIV prevention targets: Lessons learned from a general population pilot study in east Zimbabwe.

Multiple HIV Prevention Cascades (HPC) formulations have been proposed to assist advocacy, monitoring of progress of HIV prevention implementation and research to identify ways to increase use of HIV prevention methods. Schaefer and colleagues proposed a unifying formulation suitable for widespread use across different populations which could be used for routine monitoring or advocacy. Robust methods for defining and interpreting this HPC formulation using real world data is required. Data collected as part of the Manicaland Pilot HIV Prevention Cascades Study, east Zimbabwe, in 2018-19, was used to validate the HPC framework for PrEP, VMMC, male condom and combination prevention method use. Validation measures included feasibility of populating the HPC, contrasting simple vs complex measures of the HPC (using 2-sample proportion test), and testing ability of main bars to predict prevention use and testing whether sub-bars explained why people were lost from the HPC using logistic regression. It was possible to populate the HPC for both individual and combined prevention methods using pilot survey data. Most steps were associated with prevention method usage outcomes, except for VMMC. There were significant overlaps between individuals reporting positive responses for the main bar and those citing barriers to motivation. To refine the HPC's access bar definition, it is suggested to also consider individuals who report access barriers. While the HPC framework identifies barriers to individual prevention methods, challenges arise in identifying those for combined prevention. Our study successfully utilised questionnaires from the Manicaland HPC pilot survey to measure the HPC for individual and combined prevention methods. This demonstrates the feasibility of populating this framework using general population survey data and designated questionnaire modules. We propose a final formulation of the HPC, questionnaire modules and methods to create it. With proper evaluation and promotion, the HPC can enhance prevention services, aiding in the crucial reduction of HIV incidence.

Behind Prep Decisions: Understanding User Patterns and Discontinuation Factors in Real-World.

This study aimed to characterize the epidemiological aspects of PrEP use and barriers to accessing this prophylaxis. This cross-sectional study was conducted between January 2021 and April 2022, encompassing 140 PrEP users treated at the Testing and Counseling Center (CTA) in Campo Grande, Mato Grosso do Sul. Data on sociodemographic characteristics and factors associated with PrEP discontinuation were obtained using a standardized questionnaire. Most PrEP users were cisgender men (92.00%), predominantly white (51.00%), over 30years of age (56.50%), homosexual-oriented (76.50%), and had a minimum of 12years of education (77.50%). Approximately 60.00% admitted to inconsistent condom use in recent sexual encounters, primarily involving anal intercourse. Approximately 88.00% perceived themselves as at risk of contracting STIs in the upcoming year. Regarding new presentation forms, 54.00% indicated a willingness to use "on-demand PrEP," and 92.00% expressed interest in using "injectable PrEP." After 6months of follow-up, 43.60% (95.00% CI: 35.50-52.00) discontinued PrEP use, primarily due to changes in sexual behavior (38.30%) and difficulties accessing healthcare services (21.28%). This study underscores the need to involve diverse key populations and highlights the significance of PrEP as an ongoing monitoring strategy for HIV/STI prevention in addition to the importance of incorporating new formulations such as daily oral PrEP into the Brazilian National Health System (SUS).

A Cross-Sectional Study of Spanish Grindr Users: Sociodemographic Characteristics, Sexual Health Trends, and Attitudes toward HIV Testing.

Men who have sex with men are at an increased risk of acquiring sexually transmitted infections, and although behavioral and contextual interventions have improved, infections continue to spread. Therefore, a new focus on recent trends in sexual health in this population is needed. The aim of this study was to describe the relationship between sociodemographic and behavioral characteristics according to Grindr usage patterns, the prevalence of sexually transmitted infections (STIs), and attitudes toward HIV testing. In January 2020, a cross-sectional study was conducted using a sample of 881 men who have sex with men (MSM) who completed an online questionnaire. We evaluated their Grindr use patterns (moderate or intensive) and explored the associations of these with sociodemographic behavioral characteristics, STIs, and attitudes toward HIV testing. Of 881 participants in total, 587 (66.6%) were intensive Grindr users. Compared to moderate users, these participants reported significantly higher numbers of casual sexual partners (76.2% vs. 23.8%; p < 0.001), were more likely to participate in Chemsex (77.3% vs. 22.7%: p = 0.031), and had a higher self-reported number of STIs (69.9% vs. 30.1; p = 0.046). They also demonstrated better attitudes toward HIV testing (69.7% vs. 30.3%; p = 0.045) and perceived themselves to be at moderate risk of HIV (71.2% vs. 28.8%: p = 0.048). Moreover, intensive Grindr users were 1.36 times more likely than moderate users to test positive for STIs (95%CI = 1.15-1.91; p = 0.048). With some limitations, age, sexual partners, intensive Grindr users, and PrEP uses were associated with the risk of STIs in the sample of Spanish Grindr users studied. As Grindr users are vulnerable to sociodemographic and behavioral factors that determine STIs and HIV infection, mainly among intensive users, it is necessary to highlight the importance of new trends such as online dating apps, PrEP use, substance use in sex, and Chemsex, and these need to be incorporated into online public health strategies.

PrEP in the key population community: a qualitative study of perspectives on pre-exposure prophylaxis by men who have sex with men and female sex workers in Kigali, Rwanda.

Men who have sex with men (MSM) and female sex workers (FSW) are increasingly and disproportionately impacted by HIV in sub-Saharan Africa, yet current PrEP care models in this region are not optimized for these communities. Limited data exist describing experiences and preferences of MSM and FSW with respect to accessing and using PrEP. We conducted qualitative, semi-structured interviews with MSM and FSW recruited from three health centers and seven community organizations in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive approach to describe key themes related to initiating and adhering to PrEP. Participants included 18 MSM and 14 FSW; 12 were using PrEP at the time of interview, 9 had previously used PrEP, and 11 had never used it. Participants highlighted the central role of their social networks as key sources of information about and support for PrEP use, and described a strong motivation to use PrEP as a way to protect both themselves and their communities from HIV. While stigma and discrimination were pervasive, these were experienced differently by MSM and FSW. Participants suggested community access points that allowed more discreet and less frequent contact with health care workers as important and desired strategies to improve engagement. These findings suggest that leveraging community resources for disseminating information about HIV prevention and delivering PrEP could contribute to successful implementation of PrEP for MSM and FSW in Rwanda and other settings in SSA.

Effects of Substance Use on Condomless Anal Sex in a Large Sample of Adolescent Men Who Have Sex with Men: A Within and Between Relationship Design.

Substance use is a significant risk factor for HIV infection among adolescent men who have sex with men (AMSM). Substance use may reduce the use of HIV prevention measures or increase the likelihood of engaging in activities with a higher risk of HIV transmission, but there is a lack of studies dedicated to analyzing these mechanisms in adolescents and young MSM. This study aimed to explore the impact of substance use on condomless anal sex (CAS) in a large, racially diverse sample of AMSM. Additionally, we investigated how an individual's general level of substance use moderated the association between substance use before sex and CAS at the partnership level. Baseline data for an HIV prevention intervention were collected through online surveys from April 2018 to June 2020. The sample consisted of 1624 AMSM (M age, 16.69 years) who reported at least one sexual partner in the previous 3months. Participants provided information about their three most recent sexual partners, including their relationship to the partner, PrEP use, frequency of alcohol, marijuana, and non-prescription drug use before sex, and the number of CAS acts. Participants also completed measures of their substance use frequency. Multilevel modeling in Mplus was used for data analysis, accounting for sexual partnerships nested within participants. All models controlled for PrEP use and relationship status. Results revealed a significant positive association between the frequency of non-prescription drug use before sex and CAS at the partnership level. This indicates that higher non-prescription drug use frequency before sex was associated with a greater number of CAS acts with partners. Moreover, the cross-level interaction between alcohol frequency and non-prescription drug use before sex was statistically significant. Specifically, for participants with high alcohol frequency scores, there was a significant positive association between non-prescription drug use before sex and CAS at the partnership level. AMSM with higher average alcohol consumption were more likely to engage in CAS when using non-prescription drugs prior to sex with a partner, compared to those with lower alcohol consumption. This study's use of multilevel data analysis contributes innovatively to the field by shedding light on how substance use operates within sexual relationships and different partnership dynamics. Tailored interventions targeting substance use should be developed to reduce HIV risk among AMSM.

Willingness to Use Long-acting Injectable Pre-exposure Prophylaxis Among Key Populations at a Large Hiv Prevention Clinic in Kampala, Uganda: a Cross-sectional Study.

Long-acting injectable (LAI)-PrEP provides better protection against HIV compared to oral PrEP, which requires taking a daily pill. Our study aimed to assess knowledge about oral and LAI-PrEP and identify factors associated with willingness to use LAI-PrEP among key populations (KP) in Uganda. We conducted a cross-sectional study at the Most at Risk Populations Initiative (MARPI) clinic between November and December 2021. Participants were recruited through convenience sampling and interviewed using a structured questionnaire by trained interviewers. Participants were categorised into three groups based on their oral PrEP use: those who had not yet initiated PrEP, those who had discontinued oral PrEP, and those currently on oral PrEP. Modified Poisson regression analysis was performed to determine factors associated with the participant's willingness to use LAI-PrEP. Data was analysed using STATA 14 software. Of the 234 participants, 135 (56.7%) were female, 82.5% knew about LAI-PrEP, and 67.5% were willing to use it. The mean age was 28.7 years (standard deviation [SD] 5.8). Willingness to use LAI-PrEP was less likely among divorced, widowed, or separated individuals than those in relationships (adjusted prevalence ratio [aPR] 0.65, 95% CI: 0.43-0.98). Relative to current oral PrEP users, willingness to use LAI-PrEP was similar among those who discontinued oral PrEP (aPR 1.39, 95% CI: 0.92-2.11) and those who had not yet initiated PrEP but were at risk for HIV (aPR 1.26, 95% CI: 0.83-1.89). In this cross-sectional analysis of diverse members of key populations in Uganda, previous or non-use of oral PrEP was not associated with willingness to use LAI-PrEP relative to current users. Future studies should investigate effective methods for promoting the uptake of long-acting PrEP formulations among populations at high risk of HIV acquisition.

Long-Acting Injectable Pre-Exposure Prophylaxis Perceptions and Preferences Among Transgender and Nonbinary Young Adults in the United States.

Long-acting injectable pre-exposure prophylaxis for HIV prevention (LAI-PrEP) was approved for use in the United States in 2021, yet little is known about perceptions of LAI-PrEP among transgender and nonbinary young adults, a group that faces substantial barriers to HIV prevention. We investigated US transgender and nonbinary young adults' perceptions of and attitudes toward LAI-PrEP and how perceived advantages and disadvantages of LAI-PrEP related to the PrEP continuum of care. We conducted semi-structured interviews with 31 transgender and nonbinary young adults who reported oral PrEP use or were PrEP-eligible. We analyzed responses using both a deductive RADaR approach, to identify LAI-PrEP perceptions relevant to the PrEP continuum of care, and an inductive thematic analysis to explore key themes. In this study, all PrEP-experienced and most PrEP-naïve participants indicated an interest in LAI-PrEP, citing advantages over daily oral medication (e.g., fewer adherence challenges). Three key themes emerged: (1) Some participants linked perceived advantages of LAI-PrEP to experiences with gender-affirming care (e.g., familiarity with needles via hormone use). (2) Participants weighed trade-offs and contextual factors that influenced their LAI-PrEP preferences (e.g., interest contingent on whether location for receiving injection was geographically accessible). (3) Participants envisaged alternative delivery methods that could enhance LAI-PrEP acceptability and uptake (e.g., home injection). HIV prevention programs should incorporate the insights of transgender and nonbinary young adults to ensure that emerging HIV prevention technologies are accessible and responsive to the needs and concerns of people of all gender modalities.

How the Use of prep (Pre-exposure Prophylaxis) Helps to Prevent HIV Infection in Malaysia

Background: HIV remains a significant public health challenge in Malaysia, affecting key populations such as men who have sex with men (MSM), transgender individuals, sex workers, and people who inject drugs (PWID). Despite advancements in prevention and treatment, HIV continues to be a leading cause of morbidity and mortality. Pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical intervention, utilizing antiretroviral tablets (ARVs) to significantly reduce the risk of HIV infection in HIV-negative individuals. Methods and Materials: This study investigates the effectiveness of PrEP in preventing HIV transmission among high-risk groups in Malaysia. The research examines the mechanism of action of the two primary drugs used in PrEP—tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC)—and analyzes data from various studies, including the iPrEx, Partners PrEP, PROUD, and IPERGAY studies. Additionally, it addresses the challenges of implementing PrEP in Malaysia, such as stigma, adherence issues, and integration with existing HIV services. Results: PrEP has shown to reduce the risk of HIV infection by more than 90% when used consistently. The iPrEx study demonstrated a 44% reduction in HIV risk, increasing to 92% with consistent use. The Partners PrEP study indicated a 75% reduction, with a potential 90% decrease with strict adherence. The PROUD and IPERGAY studies reinforced these findings, showing 86% reductions in HIV risk. Despite its proven efficacy, the implementation of PrEP in Malaysia faces barriers such as stigma, prejudice, and adherence challenges. Conclusion: PrEP is a highly effective strategy for reducing HIV transmission among high-risk populations in Malaysia. To maximize its potential impact, it is crucial to address barriers to implementation, including stigma, adherence issues, and integration with existing healthcare services. Mathematical modeling suggests that widespread PrEP use could lead to a significant decrease in new HIV infections, potentially reducing cases among MSM by 30% over a decade. Learning from successful PrEP programs in other countries, Malaysia should focus on supportive policies, community engagement, affordability, and adherence support to effectively combat the HIV epidemic.

A Mixed Methods Investigation Examining the PrEP Cascade Among 13-18-Year-Old Latino Adolescent Sexual Minority Men.

Latino adolescent sexual minority men (ASMM) are at high risk of HIV. Limited research has explored the impact of parent-adolescent communication and beliefs on PrEP adoption among Latino ASMM. Our objective was to examine how parental support and beliefs influence decisions regarding PrEP use. We analyzed PrEP-related attitudes and behaviors within a national cohort of 524 Latino ASMM aged 13-18. Out of the participants, 60.5% were suitable for PrEP. Among them, 59.7% were in the precontemplation stage (stage 1), indicating a lack of willingness or belief of unsuitability. However, 86.4% moved to reach the contemplation stage (stage 2), demonstrating willingness and suitability for PrEP. Only 16.8% moved on to the PrEParation stage (stage 3), indicating their intention to start using PrEP. Furthermore, 4.3% progressed to the PrEP action stage and initiation (stage 4), signifying they had received a prescription, and all reported high adherence (stage 5). Factors associated with reaching later stages included older age, parental support of sexual orientation, and previous HIV/STI testing. The qualitative findings revealed diverse attitudes towards parental involvement in PrEP care among Latino ASMM, including positive, negative, and ambivalent perspectives. Notably, Spanish-speaking participants expressed specific barriers to PrEP communication between ASMM and their parents. Given that parental support and attitudes emerged as significant factors in both our quantitative and qualitative findings, it is evident that public health approaches aiming to disseminate education and awareness about PrEP to parents and families could alleviate the burden on adolescents to educate their parents and enhance support.

Effectiveness of a Counseling Intervention to Increase Vaccination Uptake among Men Who Have Sex with Men during the Mpox Outbreak.

Men who have sex with men (MSM) are disproportionately impacted by sexually transmitted infections (STIs), including HIV and those preventable through vaccination such as mpox, HPV, HAV, and HBV. A retrospective cohort study was conducted to evaluate the effectiveness of counseling provided during mpox vaccination on the uptake of other recommended vaccines (HPV, HAV, and HBV) and to identify associated factors. Relevant covariates such as nationality, age, HIV status, and use of PrEP were retrieved from electronic medical records. Vaccination status data were retrieved from the regional vaccination registry. Of the 330 participants, 98.8% were males and the mean age was 40.6 years (SD: 11.2). Following consultation, a statistically significant increase for both HPV (from 25.8% to 39.1%) and HAV (from 26.7% to 36.1%) was observed (p < 0.001). The multivariate analysis showed a significant negative association between the uptake of HPV and HBV vaccines and foreign nationality (aOR 0.25 (95%CI 0.08-0.69), p = 0.012; and aOR 0.31 (95%CI 0.11-0.81), p = 0.021). The HBV vaccine uptake was negatively associated with increasing age. Our results suggest that tailored counseling can effectively bridge the gap in vaccine acceptance among vulnerable populations, thereby improving overall public health outcomes.

Acceptability and appropriateness of information sessions to increase knowledge and awareness of PrEP and TelePrEP among Latina Women

ABSTRACT Women of color are disproportionately impacted by HIV. Although PrEP effectively prevents HIV infection, PrEP coverage and knowledge remain low in this population. To address barriers to PrEP, we implemented women-centered and culturally appropriate Information Sessions (IS) delivered by staff from the population they serve to increase knowledge, awareness, and use of PrEP through telemedicine (e.g., PlushCare). Our analysis focuses on Latina women (LW) participants, given the dearth of literature dedicated to the needs of LW. We partnered with a woman-led community-based organization (CBO) to implement the strategy with LW clients. Health educators conducted 26 IS with 94 LW (20 in Spanish and 6 in English). Participants who completed the IS were invited for interviews to assess the acceptability and appropriateness of the IS to increase knowledge and awareness of PrEP and PlushCare. Four themes emerged from the thematic analysis: (1) IS increased knowledge and awareness of PrEP and PlushCare; (2) perceived acceptability and appropriateness of IS; (3) insufficient reasons to warrant use of PrEP; and (4) positive attitudes about PlushCare. Our findings suggest that a women-centered and culturally appropriate IS implemented through a trusted, woman-led CBO is an acceptable and appropriate implementation strategy to inform LW about PrEP.