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Our objective is to evaluate the effect of navigation on linkage to a PrEP provider among PrEP-eligible men who have sex with men (MSM) in THRIVE, a demonstration project in seven U.S. public health jurisdictions during 2015-2020. We describe PrEP linkage and navigation use among MSM in THRIVE. We performed multivariable probit regression modeling, controlling for demographic covariates, to estimate the association between navigation and linkage to a PrEP provider among MSM and to assess for disparities in linkage to PrEP among MSM who used navigation. Among 9538 PrEP-eligible MSM, 51.3% used navigation and 53.8% were linked to PrEP. From the three sites where navigation was optional and the main form of PrEP support, MSM who used navigation were 16.69 times (95% CI 13.07-21.32) more likely to link to PrEP compared with MSM who did not use navigation. Among 4895 MSM who used navigation from all seven sites, Black MSM were 21% less likely to link to PrEP compared with White MSM (aRR 0.79; 95% CI 0.74-0.83). Navigation is a promising strategy for improving uptake of PrEP among U.S. MSM, but disparities persist. Addressing the underlying causes of inequities will be important to end the HIV epidemic.
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http://dx.doi.org/10.1007/s10461-022-03931-y | DOI Listing |
AIDS Patient Care STDS
September 2025
Department of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
Structural inequities significantly shape disparities across the HIV care continuum, yet few validated tools exist to quantify HIV-specific structural vulnerability at the population level in the United States. This study introduces and validates the HIV-Specific Social and Structural Determinants of Health Index (HIV-SSDI), a multi-dimensional, state-level index designed to capture structural disadvantage relevant to HIV prevention and care. Using publicly available state-level index (2008-2023) spanning nine structural domains, we developed the HIV-SSDI through exploratory factor analysis with three extraction methods: principal component analysis, maximum likelihood, and minimum residual.
View Article and Find Full Text PDFBMC Health Serv Res
August 2025
Project-Malawi, University of North Carolina, Chapel Hill, Malawi.
Background: Elimination of vertical transmission of HIV remains a major global public health priority. In Malawi, more than one-third of pediatric HIV acquisitions are attributed to perinatal HIV acquisition during breastfeeding. HIV pre-exposure prophylaxis (PrEP) is a crucial biomedical tool to keep women free of HIV and eliminate vertical transmission, but effectiveness has been hampered by poor uptake and premature discontinuation.
View Article and Find Full Text PDFAIDS Behav
August 2025
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
HIV self-testing (HIVST) must lead to engagement in the HIV status neutral continuum to maximize its benefits. The objective of this research was to determine the reach of a public health HIVST program, characterize the HIV prevention continuum following self-testing, and identify correlates associated with obtaining post-test care and discussing PrEP. We prospectively recruited individuals who obtained an HIVST through a municipal program in Philadelphia, a metropolitan area with high burden of HIV.
View Article and Find Full Text PDFSouth Med J
August 2025
Department of Public Health Sciences, Clemson University, Clemson, South Carolina.
Objectives: The southern United States is facing a burden of human immunodeficiency virus (HIV) diagnoses, with 52% of new diagnoses made in the region. The emergency department (ED) is an important access point for patient care, especially given nationwide shortages in primary care appointments. The objective of our study was to assess ED (ED) clinician knowledge regarding preexposure prophylaxis (PrEP), the perceived barriers to initiation of PrEP, and clinician willingness to initiate it in the ED.
View Article and Find Full Text PDFHealth Commun
July 2025
Department of Media Studies, Penn State University.
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that dramatically lowers one's risk of acquiring HIV. However, PrEP uptake has been slow among young-adult men who have sex with men (YMSM) - one group highly vulnerable to HIV infection in the US. Drawing from health communication scholarship on information seeking and scanning, as well as on concepts from the health belief model, we convened individual interviews and focus groups with = 50 PrEP-eligible YMSM in the US to understand how and where YMSM acquire information about PrEP.
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