Journal
CLINICAL INFECTIOUS DISEASES
Volume 61, Issue 10, Pages 1590-1597Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/civ664
Keywords
men who have sex with men; pre-exposure prophylaxis; continuum of care
Categories
Funding
- National Institutes of Health [KL2TR000455, K23AI108335, R01MH085600]
- Atlanta Clinical and Translational Science Institute [UL1TR000454]
- Emory Center for AIDS Research [P30 AI050409]
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Reductions in human immunodeficiency virus (HIV) incidence with pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) will require significant coverage of those at risk. We propose a simplified framework, similar to the HIV care continuum, to achieve protection with PrEP as follows: 1. At-risk MSM; 2. Awareness of and willingness to take PrEP; 3. Access to healthcare; 4. Receiving a prescription; and 5. Adhering to effective PrEP. We evaluated the PrEP care continuum on an Atlanta cohort of MSM and projected how many MSM might achieve protection from HIV. Even with optimistic estimates, few Atlanta MSM (15%) are projected to achieve protection from HIV with PrEP given the significant barriers described. Each continuum step represents an important point for intervention that could substantially increase the overall effectiveness of PrEP. In addition, novel strategies for PrEP delivery are needed to achieve the necessary effectiveness for Atlanta MSM at risk of HIV.
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