Reductions in human
immunodeficiency virus (HIV) incidence with pre-exposure prophylaxis (PrEP) for
men who have sex with men (MSM) will require significant coverage of those at risk.
We propose a simplified framework, similar to the HIV care continuum, to
achieve protection with PrEP as follows: 1. At-risk MSM; 2. Awareness of and
willingness to take PrEP; 3. Access to healthcare; 4. Receiving a prescription;
and 5. Adhering to effective PrEP. We evaluated the PrEP care continuum on an
Atlanta cohort of MSM and projected how many MSM might achieve protection from
HIV. Even with optimistic estimates, few Atlanta MSM (15%) are projected to
achieve protection from HIV with PrEP given the significant barriers described.
Each continuum step represents an important point for intervention that could
substantially increase the overall effectiveness of PrEP. In addition, novel
strategies for PrEP delivery are needed to achieve the necessary effectiveness
for Atlanta MSM at risk of HIV.
Below: Theorectical model of the PrEP care continuum, factors relevant to uptake, and areas for intervention. Abbreviation: PrEP, pre-exposure prophylaxis
Below: The PrEP care continuum for (A) the total InvolveMENt cohort, (B) black MSM (C) white MSM and (D) HIV seroconverters in the InvolveMENt cohort. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men; PrEP, pre-exposure prophylaxis.
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By:
- 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Department of Epidemiology.
- 2Department of Epidemiology.
- 3Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
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