WITHDRAWN: Implementation Science Research to Understand HIV Pre-Exposure Prophylaxis (PrEP) Uptake Among Young Black Men Who Have Sex with Men and Transgender Women: Implications for an Integrated Model for HIV Prevention and Care

Introduction: Men who have sex with men (MSM) and transgender persons are disproportionately impacted by HIV according to the Centers for Disease Control and Prevention (CDC). As an HIV prevention strategy, the CDC recommends once-daily oral Truvada for use as pre-exposure prophylaxis (PrEP). Despite high efficacy and increasing awareness, PrEP uptake is low, particularly among individuals at highest risk for HIV infection (e.g., young MSM, transgender women (TW), racial/ethnic minorities). Barriers to widespread PrEP implementation include individual- and system-level factors, yet research is limited on how to improve PrEP uptake. This mixed methods study aims to examine multilevel factors associated with successful PrEP implementation and uptake, and to inform a public health model that integrates PrEP into the HIV care continuum.

Methods: This research is a collaboration among the Third Coast Center for AIDS Research, the Chicago Department of Public Health (CDPH), and CDC’s Project PrIDE – a nationwide initiative supporting health departments’ implementation and evaluation of PrEP demonstration projects. This project combined multiple sources of data (e.g., local and national HIV/STI surveillance, evaluation/ research projects) and used Integrative Data Analysis to generate a holistic picture of local PrEP implementation. To understand stakeholder experiences with the current PrEP and HIV continuums of care, this project conducted four focus groups with young Black MSM and four focus groups with young Black TW. All participants (N=34) were 18-29 years old, HIV-negative, and received HIV and/or STI screening in the past 12 months. The project performed thematic analysis on the focus group transcripts.

Results: Integrative data analyses revealed that individuals ages 25-29 reported lower access to PrEP care than all other age groups, and Black individuals were less likely to reach each stage of the PrEP continuum and did so at a slower rate than White individuals. Qualitative analyses revealed that participants reported positive experiences in the current care continuum, particularly relating to HIV prevention outreach and HIV/STI screening. In terms of PrEP access, facilitators included the availability of same-day prescriptions and pharmacy knowledgeable of Truvada; barriers included not having consistent healthcare, lack of provider-initiated discussions about PrEP, and cost issues.

Conclusions: This line of research identifies key gaps in the current PrEP continuum, informs PrEP service delivery, and may refine the integrated HIV continuum model proposed by CDPH. Increasing PrEP uptake, particularly among groups most at-risk for HIV infection represents a significant step toward achieving the long-term goal of preventing HIV transmission.