New York City’s public Sexual Health Clinics reach many people at high risk for HIV acquisition. Staff provide on-site PrEP navigation, and follow up to maximize patient-linkage to ongoing PrEP care. Our aim was to understand uptake of this intervention and related patient-level factors, which is critical to improving the PrEP cascade.
We analyzed medical record data for HIV-negative men who have sex with men (MSM) with clinic visits during April-June 2017. Hierarchical PrEP priority criteria were: 1) HIV post-exposure (PEP) use (past-year); 2) selected sexually transmitted infections (STI) (past-year); 3) higher-risk (HR) partners (HIV-positive sex/needle-sharing); 4) interest in PrEP. We constructed a PrEP cascade and used multivariable regression to identify factors (priority group, race/ethnicity, age, insurance status) associated with acceptance of PrEP navigation and referral, linkage to PrEP provider (<60 days), and PrEP prescription.
Over a 3-month period, 1470 of 4761 MSM were PrEP priority patients: 13% PEP users, 32% with prior STI, 9% with HR partners, 46% with PrEP interest. Of those offered navigation, 62% (890/1437) accepted; prior STI and PEP patients had lowest acceptance (34-37%). 70% of acceptors (627/890) received navigation. Of MSM eligible for referral, 60% (317/526) accepted referral; 45% (143/317) linked to a PrEP provider, and 72% (103/143) were prescribed PrEP; overall 20% (103/526) of referred MSM received PrEP. Compared to MSM with PrEP interest, MSM with PEP history (OR 0.07, 95% CI 0.05-0.10), prior STI (OR 0.06, 95% CI 0.05-0.09), or HR partners (OR 0.18, 95% CI 0.11-0.28) were much less likely to accept navigation. Black (OR 1.63, 95% CI 1.15-2.30), Hispanic (OR 1.85, 95% CI 1.34-2.57) and MSM of other races (OR 1.64, 95% CI 1.08-2.49) were more likely than white MSM to accept navigation. Once navigated, MSM with STI or HR partners were twice as likely as those with PrEP interest to accept referrals; referral acceptance did not differ by other factors. Probability of linkage and prescription did not vary by patient factors.
Although MSM in key priority groups (e.g., prior STI) showed low navigation uptake, those who accepted navigation had higher referral rates than other groups, suggesting a need for up-front engagement. Clinics offering sexual health services are ideal PrEP implementation settings, reaching racial minority populations likely to accept PrEP, and helping 1 in 5 MSM benefit from these HIV prevention services.