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AIDS Patient Care STDS. 2019 Jun;33(6):253-261. doi: 10.1089/apc.2018.0290. Epub 2019 May 16.

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men.

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1 Department of Psychology, Hunter College of the City University of New York, New York, New York.
2 Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York.
3 Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York.
4 Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York.


Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.


MSM; PrEP; implementation; pre-exposure prophylaxis

[Available on 2020-06-01]

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