Recommendations, Side Effects Influence Likelihood of PrEP Uptake

Recommendations from health care providers and attitudes about side effects were among the biggest factors influencing likelihood of taking HIV pre-exposure prophylaxis (PrEP), according to a recent study of heterosexual individuals in high-risk areas of Philadelphia.

The study, published in the journal Sexual Health, included 192 HIV-negative heterosexual participants from areas in Philadelphia with a high prevalence of HIV with the aim of better understanding barriers and facilitators to PrEP uptake.

“In a diverse sample of heterosexual persons accessing HIV testing in Philadelphia assessing attitudes towards PrEP, uptake intentions were significantly influenced by receiving a PrEP recommendation from a healthcare provider,” corresponding author Alexis Roth, PhD, MPH, assistant professor Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, told Contagion^®. “This suggests providers could play an important role in increasing PrEP uptake, specifically through assessing client HIV risk, via a non-judgmental sexual and drug use history, and providing PrEP recommendations. Our research also suggests patient concerns about PrEP side effects also impact PrEP intentions. Thus, increasing self-efficacy related to dealing with side-effects is likely to help patients get on and stay on PrEP.”

The participants were recruited from HIV testing sites between August 2016 and April 2017, 86% were persons of color, and the median age was 43 years. The volunteers completed surveys to assess sociodemographic factors, risk behaviors, and likelihood of PrEP uptake.

The study examined factors expected to influence PrEP uptake using the Theory of Planned Behavior, which says initiation of a new behavior is most strongly predicted by intention, which is informed by attitudes about the behavior, beliefs about others’ attitudes about the behavior, and beliefs about their ability to be successful.

Participants answered sociodemographic and risk behavior questions, were given information about PrEP, and then answered questions designed to assess their likelihood of using PrEP. Among the participants, 17.7% had heard of PrEP before the study, 12.5% had more than 5 sexual partners within the prior 6 months, 72.4% used condoms inconsistently, 16.7% engaged in transactional sex, and 7.8% used shared needles.

Among those in the sample, 25% believed they were at-risk for HIV, yet 50% indicated willingness to take PrEP. Most (83.3%) said they would not feel anxious about taking PrEP, and 79.7% said they would use it if their doctor recommended it.

Most participants indicated willingness to disclose PrEP use to sexual partner (72.9%) and attend quarterly clinic visits (73.4%), and few expressed concerns about talking with their provider about PrEP (16.2%). Cost was a consideration, with 76% of participants saying they would take PrEP if it were offered at no cost, and 47.4% willing to do so for a monthly co-pay of $20.

Using a multivariable model, the study found that participants who expressed willingness to take PrEP if it were recommended by their health care provider were 4.17 times more likely to report an intention to take PrEP. Those who indicated a willingness to take PrEP even if it caused side effects were associated with a 1.98-fold increase in intention to use PrEP.

The study noted that although most research related to PrEP has focused on men who have sex with men, the majority of HIV cases worldwide are among heterosexual men and women. It also pointed out that a US Centers for Disease Control and Prevention survey estimated that 624,000 heterosexual individuals may benefit from PrEP, 75% of whom are women.

A recent study suggested that training for health care providers in safety-net family planning clinics significantly increases the likelihood that vulnerable women will learn about and embrace PrEP.

Efforts to expand access to PrEP are ongoing. Gilead Sciences and the Trump administration reached an agreement to donate PrEP for as many as 200,000 patients each year between now and 2030, according to a recent announcement.