Research Article
Healthcare Provider Contact and Pre-exposure Prophylaxis in Baltimore Men Who Have Sex With Men

https://doi.org/10.1016/j.amepre.2016.07.031Get rights and content

Introduction

Pre-exposure prophylaxis (PrEP) safely and effectively prevents HIV in populations at high risk, including men who have sex with men (MSM). PrEP scale-up depends upon primary care providers and community-based organizations (CBOs) sharing PrEP information. This study aimed to determine whether healthcare provider or CBO contact was associated with PrEP awareness among Baltimore MSM.

Methods

This study used 2014 Baltimore MSM National HIV Behavioral Surveillance data, which included data on health care, HIV and sexually transmitted infection testing, and receipt of condoms from CBOs. In 2015, associations were estimated between healthcare contacts and PrEP awareness through logistic regression models controlling for age, race, and education and clustering by venue. Comparative analyses were conducted with HIV testing as outcome.

Results

There were 401 HIV-negative participants, of whom 168 (42%) were aware of PrEP. Visiting a healthcare provider in the past 12 months, receiving an HIV test from a provider, and having a sexually transmitted infection test in the past 12 months were not significantly associated with PrEP awareness. PrEP awareness was associated with being out to a healthcare provider (OR=2.97, 95% CI=1.78, 4.96, p<0.001); being tested for HIV (OR=1.50, 95% CI=1.06, 2.13, p=0.023); and receiving condoms from an HIV/AIDS CBO (OR=2.59, 95% CI=1.43, 4.64, p=0.001). By contrast, HIV testing was significantly associated with most forms of healthcare contact.

Conclusions

PrEP awareness is not associated with most forms of healthcare contact, highlighting the need for guidelines and trainings to support provider discussion of PrEP with MSM.

Section snippets

INTRODUCTION

Clinical trials have shown that oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine is a safe and effective approach to reducing HIV transmission.1, 2, 3, 4 Men who have sex with men (MSM) have the highest HIV prevalence in the U.S., making up 66% of new HIV infections in 2014.5 In 2011, the estimated HIV prevalence among MSM was 18%.6 In the multicountry Chemoprophylaxis for HIV Prevention in Men (iPrEx) study, Grant and colleagues1 found that PrEP reduced

Study Sample

Data were from the 2014 MSM wave of National HIV Behavioral Surveillance (NHBS) in Baltimore.30, 31 The HIV prevalence in Baltimore is among the highest in the country, and an estimated 31% of MSM in Baltimore are infected with HIV.32 The NHBS is a repeated, cross-sectional HIV survey conducted in 20 cities in the U.S. Annual NHBS cycles rotate between MSM, injection drug users, and high-risk heterosexuals. Data from the MSM wave is collected through venue-based sampling, with men recruited

RESULTS

The study included 417 participants, of whom 61% identified as non-Hispanic black, 24% as non-Hispanic white, 5% as Hispanic, and 10% as multiracial (Table 1). Mean participant age was 34 years. About 60% of participants graduated high school or obtained further education. Slightly more than half of participants had household income <$25,000. Most participants had a usual source of health care, with 42% visiting a doctor, 34% a clinic, and 23% an emergency department; 82% of participants had

DISCUSSION

This study documented that PrEP awareness was significantly greater among those who reported recent HIV testing and being out to a healthcare provider. However, STI testing, healthcare visits within the past year, healthcare provider recommendation of an HIV test, and other forms of healthcare provider contact were not significantly associated with PrEP awareness among MSM in Baltimore. By contrast, HIV testing was significantly associated with most forms of healthcare provider contact. These

CONCLUSIONS

This study provides new evidence that contact with healthcare providers is not associated with PrEP awareness among MSM in Baltimore, MD. These findings provide important insight into PrEP awareness in Baltimore, which represents essential baseline data as the city begins a large-scale initiative to increase PrEP awareness and utilization. Findings highlight the need to support healthcare providers’ PrEP knowledge and ability to discuss PrEP with key populations at risk of HIV as well as to

Acknowledgments

The National HIV Behavioral Surveillance System (NHBS) is funded by the Centers for Disease Control and Prevention (CDC). Baltimore activities are funded through a cooperative agreement with the Maryland Department of Health and Mental Hygiene, who contracts with the Johns Hopkins Bloomberg School of Public Health. This study was also supported by NIH grant number T32AI102623 and by the Johns Hopkins University Center for AIDS Research (NIH P30AI094189). The authors wish to acknowledge and

REFERENCES (38)

  • CDC. HIV Surveillance Report 2014. www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf....
  • C. Wejnert et al.

    HIV infection and awareness among men who have sex with men–20 cities, United States, 2008 and 2011

    PLoS One

    (2013)
  • CDC. Preexposure prophylaxis for the prevention of HIV infection in the United States—2014....
  • A. Liu et al.

    Early experiences implementing pre-exposure prophylaxis (PrEP) for HIV prevention in San Francisco

    PLoS Med

    (2014)
  • K.H. Mayer et al.

    Differences in PrEP knowledge and use in U.S. MSM users of a popular sexual networking site surveyed in August 2013 and January 2014

    AIDS Res Hum Retroviruses

    (2014)
  • Hamel L, Firth J, Hoff T, Levine S, Dawson L. HIV/AIDS in the lives of gay and bisexual men in the United States....
  • L.A. Eaton et al.

    Minimal awareness and stalled uptake of pre-exposure prophylaxis (PrEP) among at risk, HIV-negative, black men who have sex with men

    AIDS Patient Care STDs

    (2015)
  • D. Krakower et al.

    Engaging healthcare providers to implement HIV pre-exposure prophylaxis

    Curr Opin HIV AIDS

    (2012)
  • D. Tellalian et al.

    Pre-exposure prophylaxis (PrEP) for HIV infection: results of a survey of HIV healthcare providers evaluating their knowledge, attitudes, and prescribing practices

    AIDS Patient Care STDs

    (2013)

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    © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.