The Pre-exposure Prophylaxis (PrEP) care continuum is a measurement tool developed to monitor PrEP implementation and identify areas in need of additional scale up. We sought to compare differences in knowledge, attitudes, and use of PrEP among MSM and transgender male-to-females (TG) compared to females and heterosexual males (HET) and trends over time.
A convenience sample of 460 STD clinic attendees in Washington DC were surveyed in 2012 (n=174) and 2016 (n=286). Demographics, self-reported risk behaviors, and self-perceived risk were measured. Stages of the PrEP continuum were assessed ranging from ‘self-perceived HIV risk’ to ‘have taken PrEP’. Uni-, and bivariate analyses were conducted to assess for differences in populations, risk behaviors, and PrEP continuum outcomes. Multivariate analyses were done adjusting for survey year, race, insurance, income, number of casual partners, HIV tests in the last year, and having heard of and used post-exposure prophylaxis (PEP).
Among 460 participants, 53 (12%) were MSM/TG, 81% were Black, 21% had private insurance, 49% had some college education, and 60% had a regular healthcare provider. Comparing MSM/TG participants to HET, significant differences were observed by race, insurance, and income (all p<0.05). MSM/TG participants had more casual sex partners (OR 1.12; 95%CI:1.06-1.18), and were more likely to be at the STD clinic due to symptoms (OR 2.15; 95%CI:1.01-4.58), or having a partner with an STD (OR 5.07; 95%CI:1.86-13.83), had heard of PEP (OR 5.05; 95%CI:2.79-9.14) and used PEP (OR 11.08; 95%CI:3.33-36.84) compared to HET. In terms of the PrEP continuum, while MSM/TG participants had higher self-perceived risk for HIV (43% vs. 18%, aOR 3.79; 95%CI:1.47-9.82), there were no significant differences in having heard of PrEP (38% vs. 12%, aOR 2.41; 95%CI:1.00-5.83), likelihood of taking PrEP if it were free (68% vs. 54%, aOR 1.84; 95%CI:0.76-4.46), having health insurance (78% vs. 77%, aOR 0.68; 95%CI: 0.24-1.89), having discussed PrEP with a provider (11% vs. 3%, aOR 1.37; 95%CI:0.31-6.16), and having used PrEP (8% vs. 0.7%, aOR 3.06; 95%CI: 0.40-23.32) compared to HET (Figure). PrEP awareness (18% vs. 29%; p=0.0138) and use (0.6% vs. 2.5%; p<0.0001) increased from 2012 to 2016.
PrEP awareness and use was low among both groups, with minor increases over time. PrEP education and risk-reduction programs should be implemented in STD clinics to facilitate high-risk groups’ advancement along the PrEP continuum.