Background Pre-exposure prophylaxis (PrEP) is a potential tool for reducing racial HIV disparities by reducing HIV acquisition among those at greatest risk. A recent bacterial STI is an important biomarker of HIV acquisition risk and represents one target for prioritizing PrEP in populations with the greatest HIV burden. Receipt of a PrEP prescription is an important step of the PrEP cascade. This study assessed whether race and recent STI diagnoses were associated with receipt of a PrEP prescription among men who have sex with men (MSM) in a PrEP program.
Methods Race (non-Hispanic black, non-Hispanic white, other), recent STI diagnosis (self-reported diagnosis in past 3 months) and data on receipt of a PrEP prescription among MSM who met clinical eligibility criteria for PrEP were collected from September 2015 through March 2018. Participants were enrolled at one of six clinical sites participating in IMPACT, a multi-site PrEP demonstration project. Multivariable logistic regression analysis was used to determine the associations between race and recent STI diagnosis with receipt of a PrEP prescription.
Results IMPACT screened 308 MSM as clinically eligible for PrEP and 287(93.2%) received a PrEP prescription; 153(49.7%) were non-Hispanic black and 109(35.4%) reported an STI diagnosis. MSM with black race (compared to white) (AOR=0.170; 95% CI=0.047–0.607) were significantly less likely to receive a PrEP prescription. MSM with a recent STI diagnosis (AOR=4.874; 95% CI=1.377–17.249) were more likely to receive a PrEP prescription.
Conclusion MSM with recent STI diagnosis were more likely to receive PrEP prescriptions. The finding that black MSM are less likely to receive prescriptions suggest a barrier to PrEP delivery that may widen rather than reduce HIV disparities. Identifying and understanding these barriers to PrEP delivery are an important target for future research.
Disclosure No significant relationships.
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