PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

被引:47
作者
Nieto, Omar [1 ]
Brooks, Ronald A. [1 ,2 ]
Landrian, Amanda [1 ,3 ]
Cabral, Alejandra [1 ,3 ]
Fehrenbacher, Anne E. [2 ,4 ]
机构
[1] Univ Calif Los Angeles, Dept Family Med, Los Angeles, CA 90024 USA
[2] Univ Calif Los Angeles, Ctr HIV Identificat Prevent & Treatment Serv CHIP, Los Angeles, CA 90024 USA
[3] Univ Calif Los Angeles, Dept Community Hlth Sci, Fielding Sch Publ Hlth, Los Angeles, CA USA
[4] Univ Calif Los Angeles, Dept Psychiat & Biobehav Sci, Semel Inst Neurosci & Human Behav, Los Angeles, CA 90024 USA
来源
PLOS ONE | 2020年 / 15卷 / 11期
关键词
PREEXPOSURE PROPHYLAXIS; HIV PREVENTION; ADHERENCE; HEALTH; MEN; ACCEPTABILITY; FACILITATORS; BARRIERS; CARE;
D O I
10.1371/journal.pone.0241340
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Purpose Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen. Methods In-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data. Results Four themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence. Conclusions PrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.
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页数:13
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