Correlates of Linkage to HIV Pre-exposure Prophylaxis (PrEP) among HIV Testing Clients.

BACKGROUND: Publicly funded HIV testing sites can identify HIV pre-exposure prophylaxis (PrEP) candidates and provide PrEP linkage.

SETTING: Harris Health System's HIV clinic, HIV testing program and HIV Prevention Program in Houston, TX, a high HIV incidence city.

METHODS: A prospective assessment of individuals ≥18 years old recruited from walk-in HIV testing December, 2013 to April, 2015 included risk assessment, HIV testing and self-administered survey, with follow-up surveys at 6 and 12 months and medical record review.

RESULTS: The mean age of our sample (n=300) was 38.3 ± 11.7 years. Males constituted 63.1% of the sample and 53.7% were Black non-Hispanic, 26.3% Hispanic, and 14.7% White non-Hispanic. Most were uninsured (63.5%). Only 27% always used condoms although 67% perceived personal HIV risk. Of 300 participants, 64 (21.3%) linked to PrEP care and 49 (16.3%) took PrEP. In multivariable analysis, compared to heterosexual males, females (adjusted OR [aOR] 4.1, 95% CI 1.5, 11.1) and MSM (aOR 10.2, 95% CI 3.4, 31.0) were more likely to attend HPP and to take PrEP (aOR 3.0, 95% CI 1.6, 15.1 and 3.0, 95% CI 1.1, 8.3 respectively). Serodiscordance and PrEP interest correlated with program attendance (aOR 14.0, 95% CI 6.1, 32.3 and aOR 6.7, 95% CI 1.8, 25.4) and taking PrEP (aOR 13.1, 95% CI 5.2, 32.8 and 14.4, 95% CI 1.8, 166.9) respectively.

CONCLUSION: PrEP interest, being female or MSM, and serodiscordance correlated with PrEP linkage. Safety-net health systems can facilitate PrEP access in marginalized populations, but the PrEP initiation rates remains low.