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AIDS Care. 2018 Oct 10:1-9. doi: 10.1080/09540121.2018.1533238. [Epub ahead of print]

Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California.

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a Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA.
b Kaiser Permanente Division of Research , Oakland , CA , USA.
c Kaiser Permanente Oakland Medical Center , Oakland , CA , USA.
d Oregon Health & Science University-Portland State University , Portland , OR , USA.
e Kaiser Permanente San Francisco Medical Center , San Francisco , CA , USA.


Barriers to HIV preexposure prophylaxis (PrEP) use have not been well-characterized in people who became HIV-infected, all of whom could have benefited from PrEP. We invited Kaiser Permanente Northern California members diagnosed with HIV during 2014-2016, following a negative HIV test in the prior year, to complete a survey assessing barriers to PrEP use before HIV diagnosis. Of 268 patients surveyed, 122 (46%) responded. Median age was 36, most (84%) were men who have sex with men, and 64% were of minority racial/ethnic background. Thirty-six (30%) had discussed PrEP with a provider, of whom 10 were diagnosed with HIV at PrEP intake. Overall, only 5 (4.1%) had used PrEP, and all 5 discontinued before diagnosis. Among all respondents, the most common barrier to PrEP use was lack of PrEP awareness (51%). Among those aware of PrEP, the most common barriers were cost/insurance concerns (36%) and perceived low risk for HIV (24%). Lack of PrEP awareness ranged from 39% among those aged 25-34 to 88% among those aged <25 (P = 0.011), and from 33% among Hispanics to 69% among Blacks (P = 0.055). Increasing awareness and affordability of PrEP, and facilitating accurate assessment of HIV risk, are critical to reducing missed opportunities for PrEP.


Human immunodeficiency virus (HIV); awareness; cost; implementation; preexposure prophylaxis (PrEP)

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