Abstract Body

Pre-exposure prophylaxis (PrEP) has great potential to curb the HIV epidemic. Population-level indicators of the PrEP continuum are lacking, yet are critical to monitor PrEP expansion and identify gaps. We report results of a mobile survey evaluating the PrEP continuum among MSM and transwomen (TW) in the San Francisco Bay Area (SFBA).

Participants (ppts) were recruited using social media/sexual networking sites, print ads and phone outreach. Eligible ppts were HIV-uninfected MSM or TW, age ≥18, sexually active with a man and/or trans partner in the past year, English/Spanish speaking, and SFBA residents. We used a Qualtrics mobile survey to assess metrics of the PrEP continuum including awareness, initiation, adherence, and persistence. We conducted multivariable logistic regression to identify factors associated with PrEP initiation and persistence.

From June-September 2018, 460 ppts responded to the survey. Median age was 30; 46% were White, 22% Latinx, 15% Asian, 13% Black, 4% other; 86% were men, 14% TW/non-binary (NB). Over the past 6 months, the mean number of anal/vaginal sex partners was 7, and 74% reported condomless sex; 25% reported an STI in the past year. Overall, 96% had heard of PrEP, 47% had initiated PrEP, 33% were currently on PrEP, and 32% reported high adherence. Among 244 ppts never on PrEP, most (81%) expressed interest in taking it, but only 61% knew where to get PrEP, and few (36%) had talked with a provider about PrEP. In multivariable analyses, higher education, having a primary provider, and drug use were associated with PrEP initiation; younger age, other race, and TW/NB were associated with lower persistence; number of sex partners was associated with initiation and persistence (Table). Among 63 PrEP discontinuers, median duration of use was 7 months; the most common reasons for stopping PrEP included not feeling at risk for HIV (46%), insurance/access issues (36%), side effects/concerns (13%), and travel (10%). Among never/prior PrEP users, a substantial proportion would consider starting/restarting PrEP if offered on-demand PrEP (84%/73%), long-acting injectable PrEP (56%/68%), or a pericoital rectal formulation (douche/suppository) (32%/46%).

While PrEP initiations are relatively high in the SFBA, disparities in persistence exist, particularly in youth and TW/NB. Efforts to address cost/access barriers are critical to reversing disparities. Novel PrEP regimens and formulations could increase PrEP uptake and persistence.