M Bryant Howren1,2,3,4, Shelby L Francis5, Linnea A Polgreen6, Cody Shafer7, Angela Hoth5, Michael E Ohl3,4,5. 1. 7823 Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA. 2. Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University, Tallahassee, FL, USA. 3. 12243 Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA. 4. VHA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City, VA Iowa City Healthcare System, Iowa City, IA, USA. 5. 4083 Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. 6. 4083 Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA. 7. HIV Special Projects Division, NuCara Pharmacy, Des Moines, IA, USA.
Abstract
OBJECTIVE: Preexposure prophylaxis (PrEP) is a safe and effective method for HIV prevention, but little is known about PrEP uptake in rural and small urban areas. We described rates and predictors of HIV PrEP initiation among public health clients in rural and small urban areas in Iowa. METHODS: This was a prospective cohort study of clients with PrEP indications served by HIV testing and disease intervention specialist/partner services (DIS/PS) programs in public health departments in Iowa from February 1, 2018, through February 28, 2019. Eligible participants were aged 18-70 and referred for PrEP by public health personnel. Participants completed surveys at enrollment addressing demographic characteristics; sexual history; previous drug use; PrEP experiences; and knowledge, attitudes, and beliefs about PrEP. A follow-up survey assessed PrEP initiation at 30 days. We compared baseline characteristics of PrEP initiators and non-initiators. RESULTS: Two hundred thirty-four public health clients consented to participate in the study; 189 completed the baseline survey, and 117 (61.9%) completed the follow-up survey. The mean age of participants in the baseline survey was 30 (range, 18-68); 109 (57.7%) were male, 127 (67.2%) were White, and 169 (89.4%) lived in a rural or small urban area. Of 117 participants in the follow-up survey, those who initiated PrEP were significantly more likely than those who did not initiate PrEP to be referred by DIS/PS programs (46.7% vs 7.8%, P < .001) and to recognize that PrEP was ≥90% effective (86.7% vs 35.3%, P = .001). No PrEP initiators and 8 PrEP non-initiators agreed that PrEP is for promiscuous people (0% vs 7.8%, P = .04). Perceived PrEP stigma was low and not associated with PrEP initiation. CONCLUSIONS: PrEP initiation rates were low among rural and small urban health department clients. Interventions are needed to improve linkage to PrEP among rural and small urban public health clients.
OBJECTIVE: Preexposure prophylaxis (PrEP) is a safe and effective method for HIV prevention, but little is known about PrEP uptake in rural and small urban areas. We described rates and predictors of HIV PrEP initiation among public health clients in rural and small urban areas in Iowa. METHODS: This was a prospective cohort study of clients with PrEP indications served by HIV testing and disease intervention specialist/partner services (DIS/PS) programs in public health departments in Iowa from February 1, 2018, through February 28, 2019. Eligible participants were aged 18-70 and referred for PrEP by public health personnel. Participants completed surveys at enrollment addressing demographic characteristics; sexual history; previous drug use; PrEP experiences; and knowledge, attitudes, and beliefs about PrEP. A follow-up survey assessed PrEP initiation at 30 days. We compared baseline characteristics of PrEP initiators and non-initiators. RESULTS: Two hundred thirty-four public health clients consented to participate in the study; 189 completed the baseline survey, and 117 (61.9%) completed the follow-up survey. The mean age of participants in the baseline survey was 30 (range, 18-68); 109 (57.7%) were male, 127 (67.2%) were White, and 169 (89.4%) lived in a rural or small urban area. Of 117 participants in the follow-up survey, those who initiated PrEP were significantly more likely than those who did not initiate PrEP to be referred by DIS/PS programs (46.7% vs 7.8%, P < .001) and to recognize that PrEP was ≥90% effective (86.7% vs 35.3%, P = .001). No PrEP initiators and 8 PrEP non-initiators agreed that PrEP is for promiscuous people (0% vs 7.8%, P = .04). Perceived PrEP stigma was low and not associated with PrEP initiation. CONCLUSIONS: PrEP initiation rates were low among rural and small urban health department clients. Interventions are needed to improve linkage to PrEP among rural and small urban public health clients.
Entities:
Keywords:
HIV/AIDS; preexposure prophylaxis (PrEP); public health; rural health
Authors: Sanae Inagami; Shasha Gao; Hassan Karimi; Martine M Shendge; Janice C Probst; Roslyn A Stone Journal: J Rural Health Date: 2015-09-23 Impact factor: 4.333
Authors: H Jonathon Rendina; Thomas H F Whitfield; Christian Grov; Tyrel J Starks; Jeffrey T Parsons Journal: Soc Sci Med Date: 2016-11-18 Impact factor: 4.634
Authors: Angela B Hoth; Cody Shafer; Dena Behm Dillon; Randy Mayer; George Walton; Michael E Ohl Journal: Sex Transm Dis Date: 2019-08 Impact factor: 2.830
Authors: Peter L Anderson; David V Glidden; Albert Liu; Susan Buchbinder; Javier R Lama; Juan Vicente Guanira; Vanessa McMahan; Lane R Bushman; Martín Casapía; Orlando Montoya-Herrera; Valdilea G Veloso; Kenneth H Mayer; Suwat Chariyalertsak; Mauro Schechter; Linda-Gail Bekker; Esper Georges Kallás; Robert M Grant Journal: Sci Transl Med Date: 2012-09-12 Impact factor: 17.956
Authors: Brian Dodge; Jessie V Ford; Na Bo; Wanzhu Tu; John Pachankis; Debby Herbenick; Kenneth Mayer; Mark L Hatzenbuehler Journal: J Acquir Immune Defic Syndr Date: 2019-12-01 Impact factor: 3.731
Authors: Dawn K Smith; Michelle Van Handel; Richard J Wolitski; Jo Ellen Stryker; H Irene Hall; Joseph Prejean; Linda J Koenig; Linda A Valleroy Journal: MMWR Morb Mortal Wkly Rep Date: 2015-11-27 Impact factor: 17.586