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Can J Public Health. 2018 Jun;109(3):342-352. doi: 10.17269/s41997-018-0064-3. Epub 2018 Apr 26.

Trends in the awareness, acceptability, and usage of HIV pre-exposure prophylaxis among at-risk men who have sex with men in Toronto.

Rana J1, Wilton J2, Fowler S3, Hart TA4,5, Bayoumi AM1,6,7,8, Tan DHS9,10,11.

Author information

1
Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
2
Ontario HIV Treatment Network, Toronto, Canada.
3
Hassle Free Clinic, Toronto, Canada.
4
Department of Psychology, Ryerson University, Toronto, Canada.
5
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
6
Department of Medicine, University of Toronto, Toronto, Canada.
7
Department of Medicine, St. Michael's Hospital, Toronto, Canada.
8
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
9
Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada. darrell.tan@gmail.com.
10
Department of Medicine, St. Michael's Hospital, Toronto, Canada. darrell.tan@gmail.com.
11
Division of Infectious Diseases, St. Michael's Hospital, 30 Bond St, 4CC - Room 4-179, Toronto, ON, M5B 1W8, Canada. darrell.tan@gmail.com.

Abstract

OBJECTIVES:

Pre-exposure prophylaxis (PrEP) with daily oral tenofovir/emtricitabine dramatically reduces HIV risk in men who have sex with men (MSM). However, uptake is slow worldwide.

METHODS:

We administered anonymous cross-sectional questionnaires to MSM presenting for anonymous HIV testing at a Toronto sexual health clinic at four successive time points during the period 2013-2016. We assessed trends in PrEP awareness, acceptability, and use over time using the Cochran-Armitage Trend Test, and identified barriers to using PrEP by constructing "PrEP cascades" using 2016 data. We assumed that to use PrEP, MSM must (a) be at risk for HIV, (b) be at objectively high risk (HIRI-MSM score ≥ 10), (c) perceive themselves to be at medium-to-high risk, (d) be aware of PrEP, (e) be willing to use PrEP, (f) have a family doctor, (g) be comfortable discussing sexual health with that doctor, and (h) have drug coverage/be willing to pay out of pocket.

RESULTS:

MSM participants were mostly white (54-59.5%), with median age 31 years (IQR = 26-38). PrEP awareness and use increased significantly over time (both p < 0.0001), reaching 91.3% and 5.0%, respectively, in the most recent wave. Willingness to use PrEP rose to 56.5%, but this increase did not reach statistical significance (p = 0.06). The full cascade, ABCDEFGH, suggested few could readily use PrEP under current conditions (11/400 = 2.8%). The largest barriers, in descending order, were low self-perceived HIV risk, unwillingness to use PrEP, and access to PrEP providers.

CONCLUSION:

To maximize its potential public health benefits, PrEP scale-up strategies must address self-perceived HIV risk and increase access to PrEP providers.

KEYWORDS:

HIV; HIV prevention; Men who have sex with men (MSM); Pre-exposure prophylaxis

PMID:
29981088
PMCID:
PMC6153704
DOI:
10.17269/s41997-018-0064-3
[Indexed for MEDLINE]
Free PMC Article

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