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Implementation Strategies to Increase PrEP Uptake in the South

  • Implementation Science (E Geng, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Seven years after TDF/FTC was approved for pre-exposure prophylaxis to reduce risks of HIV infection, there have been large increases in the number of persons using PrEP in the USA. However, recent data on pre-exposure prophylaxis (PrEP) use at the state level indicate that people living in the Southern United States are underserved by PrEP relative to their epidemic need. We sought to review possible reasons for inequitable uptake of PrEP in the South and identify implementation approaches to increase PrEP uptake in the South.

Recent Findings

Published literature, data on the locations of PrEP service providers, recent data on PrEP utilization from pharmacy prescription databases, HIV surveillance data and government data on healthcare providers, and health literacy indicate a confluence of factors in the South that are likely limiting PrEP uptake. A variety of approaches are needed to address the complex challenges to PrEP implementation in the South. These include considering alternative PrEP provision strategies (e.g., pharmacy-based PrEP, telemedicine-delivered PrEP), conducting gain-based stigma-reduction campaigns, increasing capacity for reimbursement for PrEP medications and services through policy change to expand Medicaid and to preserve access to Affordable Care Act–compliant health plans, expanding STI screening programs and improving integration of PrEP offering with delivery of positive STI results, using mHealth tools to screen groups at highest risk for HIV (e.g., men who have sex with men) periodically to increase correct perception of risk, and streamlining clinical procedures to allow same-day PrEP starts for patients without obvious medical contraindications.

Summary

Overcoming the structural, capacity, and policy challenges to increasing PrEP uptake in the South will require innovations in clinical approaches, leveraging technologies, and policy changes. The South has unique challenges to achieving equitable PrEP uptake, and addressing key barriers to expanded PrEP use will require multisectoral responses.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to 2020 [online national strategy document]. 2015. Available at: https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf. last accessed November 1, 2015.

  2. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321:844.

    Article  PubMed  Google Scholar 

  3. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99. https://doi.org/10.1056/NEJMoa1011205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sullivan PS, Giler RM, Mouhanna F, Pembleton ES, Guest JL, Jones J, et al. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012-2017. Ann Epidemiol. 2018;28(12):833–40. https://doi.org/10.1016/j.annepidem.2018.06.009.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28(12):841–9. https://doi.org/10.1016/j.annepidem.2018.06.005.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2016; vol. 28. http://www.cdc.gov/hiv/library/reports/surveillance/index.html. Published November 2017. Accessed December 27, 2017.

  7. Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, et al. The prevalence of PrEP use and the PrEP-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28:841–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. US Census Bureau. American fact finder [online Census data portal]. 2019. Available at: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Last accessed March 19, 2019.

  9. Weiss, K., A. Bratcher, P.S. Sullivan, and A. Siegler, Geographic access to prep clinics among us Msm: documenting PrEP deserts. Abstract 1006Presented at CROI 2018, March 4–7, 2018, Boston.

  10. McKenney J, Sullivan PS, Bowles K, Oraka E, Sanchez TH, diNenno E. Utilization of HIV prevention service among urban and rural men who have sex with men in the United States: results from a National Online Survey. AIDS and Behavior 2018;22:2127-2136.

  11. Sullivan PS, Sineath C, Kahle E, Sanchez T. Awareness, willingness and use of oral pre-exposure prophylaxis (PrEP) among a national sample of US men who have sex with men. AIDS IMPACT 2015, Amsterdam 2015 [Abstract 52.4].

  12. US Census Bureau. Health insurance coverage in the United States: 2017 [online data report]. 2018. Available at: https://www.census.gov/library/publications/2018/demo/p60-264.html. Last accessed: March 19, 2019.

  13. Serota DP, Rosenberg ES, Lockard AM, Rolle CM, Luisi N, Cutro S, et al. Beyond the biomedical: preexposure prophylaxis failures in a cohort of young Black men who have sex with men in Atlanta, Georgia. Clin Infect Dis. 2018;67(6):965–70. https://doi.org/10.1093/cid/ciy297.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kaiser Family Foundation. Status of state medicaid expansion decisions: interactive map [online data feature]. 2019. Available at: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/. Last accessed: March 19, 2019.

  15. Goparaju L, Praschan NC, Warren-Jeanpiere L, Experton LS, Young MA, Kassaye S. Stigma, partners, providers and costs: potential barriers to PrEP uptake among US women. J AIDS & Clin Res. 2017;8(9).

  16. McKenney J, Chen A, Hoover KW, Kelly J, Dowdy D, Sharifi P, et al. Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men. PLoS One. 2017;12(6):e0178170. https://doi.org/10.1371/journal.pone.0178170.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Whitfield THF, John SA, Rendina HJ, Grov C, Parsons JT. Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behav. 2018;22:3566–75. https://doi.org/10.1007/s10461-018-2045-1.

    Article  PubMed  PubMed Central  Google Scholar 

  18. US Preventive Services Task Force. Prevention of Human Immunodeficiency Virus (HIV) Infection: Pre-Exposure Prophylaxis [online task force database]. 2019. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryDraft/prevention-of-human-immunodeficiency-virus-hiv-infection-pre-exposure-prophylaxis?ds=1&s=prep. Last accessed: March 19, 2019.

  19. Bare CB, Coll J, Ruane P, Molina JM, Mayer KH,Jessen H, Grant RM, De Wet JJ, Thomson M, Dejesus E, Ebrahimi R, Mera Giler R, Das M, Brainard D, McCallister S. The Phase 3 discover study: daily F/TAF Or F/TDF for HIV preexposure prophylaxis. CROI 2019; Abstract 104. March 4–7, Seattle.

  20. National Health Literacy Mapping to Inform Health Care Policy. Health literacy data map. University of North Carolina at Chapel Hill, 2014. Web. 01 June 2015. . Available at: http://healthliteracymap.unc.edu/. Last accessed: March 17, 2019.

  21. Centers for Disease Control and Prevention. NCHHSTP Atlas. 2016. http://gis.cdc.gov/grasp/nchhstpatlas/main.html?value=atlas. Accessed 11/17/2016 2016.

  22. Smith DK, Van Handel M, Wolitski RJ, Stryker JE, Hall HI, Prejean J, et al. Vital signs: estimated percentages and numbers of adults with indications for preexposure prophylaxis to prevent HIV acquisition - United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(46):1291–5. https://doi.org/10.15585/mmwr.mm6446a4.

    Article  PubMed  Google Scholar 

  23. Golub SA. PrEP stigma: implicit and explicit drivers of disparity. Curr HIV/AIDS Rep. 2018;15(2):190–7. https://doi.org/10.1007/s11904-018-0385-0.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Haire BG. Preexposure prophylaxis-related stigma: strategies to improve uptake and adherence - a narrative review. Hiv/Aids. 2015;7:241–9. https://doi.org/10.2147/hiv.S72419.

    Article  Google Scholar 

  25. Calabrese SK, Underhill K. How stigma surrounding the use of HIV preexposure prophylaxis undermines prevention and pleasure: a call to destigmatize “Truvada whores”. Am J Public Health. 2015;105(10):1960–4. https://doi.org/10.2105/ajph.2015.302816.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, Krakower D, Novak DS, Mimiaga MJ, et al. State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. Aids. 2015;29(7):837–45. https://doi.org/10.1097/qad.0000000000000622.

    Article  PubMed  Google Scholar 

  27. Kerr JC, Valois RF, Diclemente RJ, Fletcher F, Carey MP, Romer D, et al. HIV-related stigma among African-American youth in the Northeast and Southeast US. AIDS Behav. 2014;18(6):1063–7. https://doi.org/10.1007/s10461-013-0687-6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. •• Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;29(11):1351–8. https://doi.org/10.1080/09540121.2017.1300633 This qualitative study brings a voice to the mechansisms through which stigma and racism discourage PrEP uptake among MSM. It also highlights that the barriers to PrEP uptake in the South are not monolithic, and a detailed understanding of the experiences and perceptions of Black MSM is required to consider how to improve implementation.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Arnold T, Brinkley-Rubinstein L, Chan PA, Perez-Brumer A, Bologna ES, Beauchamps L, et al. Social, structural, behavioral and clinical factors influencing retention in pre-exposure prophylaxis (PrEP) care in Mississippi. PLoS One. 2017;12(2):e0172354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. US Census Bureau. The Black Population: 2010 [online fact sheet]. 2011. Available at: https://www.census.gov/prod/cen2010/briefs/c2010br-06.pdf. Last accessed: June 3, 2019.

  31. Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health 2015;105(2):e75–82.

  32. Lehman JS, Carr MH, Nichol AJ, Ruisanchez A, Knight DW, Langford AE, et al. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS Behav. 2014;18(6):997–1006.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Centers for Disease Control and Prevention. HIV and STD criminal laws [online compilation of state laws]. 2018. Available at: https://www.cdc.gov/hiv/policies/law/states/exposure.html. Last accessed: March 19, 2019.

  34. Frost S. HIV criminalization laws: a poor public policy choice in the new era of PrEP. Wake Forest J Law Policy. 2016;6:319.

    Google Scholar 

  35. National Association of County and City Health Officials. HIV prevention, care and treatment [online policy statement]. 2018. Available at: https://www.naccho.org/uploads/downloadable-resources/18-02-HIV-Prevention-Care-and-Treatment-2.pdf. Last accessed: April 19, 2019. (Archived by WebCite at http://www.webcitation.org/77kdoTMAs).

  36. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States - 2017 update. [Clinical Practice Guideline]. Available at: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf Accessed: 2018-09-03.

  37. Kaiser Family Foundation. Primary care health professional shortage areas (HPSAs). Data as of 2018. [online data feature]. 2019. Available at: https://www.kff.org/other/state-indicator/primary-care-health-professional-shortage-areas-hpsas/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Last accessed: March 19, 2019.

  38. Hing E, Hsiao CJ. State variability in supply of office-based primary care providers: United States. NCHS data brief. 2012;2014(151):1–8.

    Google Scholar 

  39. Emory University. State-level data on poverty in national data sets from AIDSVu.org. [online data resource]. 2019. Available at: https://aidsvu.org/resources/#/2016. Last accessed: March 19, 2019.

  40. MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. J Acquir Immune Defic Syndr. 2005;38(5):603–14.

    Article  PubMed  Google Scholar 

  41. Kellerman SE, Lehman JS, Lansky A, Stevens MR, Hecht FM, Bindman AB, et al. HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing. J Acquir Immune Defic Syndr. 2002;31(2):202–10.

    Article  PubMed  Google Scholar 

  42. MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS Behav. 2007;11(2):263–70.

    Article  PubMed  Google Scholar 

  43. Parsons JT, Rendina HJ, Lassiter JM, Whitfield TH, Starks TJ, Grov C. Uptake of HIV pre-exposure prophylaxis (PrEP) in a national cohort of gay and bisexual men in the United States. J Acquir Immune Defic Syndr. 2017;74(3):285–92.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lockard A, Rosenberg ES, Sullivan PS, Kelley CF, Serota DP, Rolle C-PM, et al. Contrasting self-perceived need and guideline-based indication for HIV pre-exposure prophylaxis among Young, black men who have sex with men offered pre-exposure prophylaxis in Atlanta, Georgia. AIDS Patient Care STDs. 2019;33(3):112–9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Auerbach JD, Kinsky S, Brown G, Charles V. Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care STDs. 2015;29(2):102–10.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Golub SA, Gamarel KE, Rendina HJ, Surace A, Lelutiu-Weinberger CL. From efficacy to effectiveness: facilitators and barriers to PrEP acceptability and motivations for adherence among MSM and transgender women in New York City. AIDS Patient Care STDs. 2013;27(4):248–54.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. https://doi.org/10.1186/1748-5908-4-50.

    Article  PubMed  PubMed Central  Google Scholar 

  48. • Siegler AJ, Wirtz S, Weber S, Sullivan PS. Developing a web-based geolocated directory of HIV pre-exposure prophylaxis-providing clinics: the PrEP locator protocol and operating procedures. JMIR Public Health Surveill. 2017;3(3):e58-e. https://doi.org/10.2196/publichealth.7902 Mapping public health resources, including PrEP clinics, is an essential basic step to understanding how the accessibility of services limits PrEP uptake. Systematic assessments of prevention resources provide actionable information for program planning.

    Article  Google Scholar 

  49. University of Minnesota Center for Infectious Disease Research and Policy. Collaborative drug therapy agreement toolkit for pharmacies and public health [online summary and toolkit]. 2018. Available at: http://www.cidrap.umn.edu/practice/collaborative-drug-therapy-agreement-toolkit-pharmacies-and-public-health. (Archived by WebCite at http://www.webcitation.org/77lLFA5zx). Last accessed April 19, 2019.

  50. • Tung EL, Thomas A, Eichner A, Shalit P. Implementation of a community pharmacy-based pre-exposure prophylaxis service: a novel model for pre-exposure prophylaxis care. Sex Health. 2018;15(6):556–61. https://doi.org/10.1071/sh18084 This manuscript describes a pharmacy-based PrEP program offered through a CDTA in Seattle. Innovative ways to provide PrEP that lower client burden are critical to evaluate in the South.

    Article  PubMed  Google Scholar 

  51. John SA, Rendina HJ, Grov C, Parsons JT. Home-based pre-exposure prophylaxis (PrEP) services for gay and bisexual men: an opportunity to address barriers to PrEP uptake and persistence. PLoS One. 2017;12(12):e0189794. https://doi.org/10.1371/journal.pone.0189794.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Siegler AJ, Mayer KH, Liu AY, Patel RR, Ahlschlager LM, Kraft CS, et al. Developing and assessing the feasibility of a home-based PrEP monitoring and support program. Clin Infect Dis. 2019;68(3):501–4. https://doi.org/10.1093/cid/ciy529.

    Article  PubMed  Google Scholar 

  53. Siegler AS. Electronic pre-exposure prophylaxis (PrEP) initiation and maintenance home care system (ePrEP) [online research protocol]. Clinicaltrials.gov identifier: NCT03729570. 2018. Available at: https://clinicaltrials.gov/ct2/show/NCT03729570.

  54. Siegler AS. Pre-exposure prophylaxis (PrEP) at home (PrEP@Home) [online research protocol]. Clinicaltrials.gov identifier: NCT03569813. 2018. Available at: https://clinicaltrials.gov/ct2/show/NCT03569813.

  55. Valdiserri RO, Sullivan PS. Data visualization promotes sound public health practice: the AIDSvu example. AIDS Educ Prev. 2018;30(1):26–34. https://doi.org/10.1521/aeap.2018.30.1.26.

    Article  PubMed  Google Scholar 

  56. Ard KL, Edelstein ZR, Bolduc P, Daskalakis D, Gandhi AD, Krakower DS, et al. Public health detailing for human immunodeficiency virus pre-exposure prophylaxis. Clin Infect Dis. 2018;68(5):860–4.

    Article  Google Scholar 

  57. Smith, AD; Muhaari, A; Agwanda, C; Kowuor, D; ,van der Elst, EM; Davies, A; Graham, SM; Jaffe, H; Sanders, EJ. Female clients and partners of MSM sex workers in Mombasa, Kenya. [abstract 39] 16th Conference on Retroviruses and Opportunistic Infections, San Francisco, California (2010).

  58. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.

    Article  PubMed  Google Scholar 

  59. Sullivan PS, Driggers R, Stekler JD, Siegler A, Goldenberg T, McDougal SJ, et al. Usability and acceptability of a mobile comprehensive HIV prevention app for men who have sex with men: a pilot study. JMIR mHealth uHealth. 2017;5(3):e26. https://doi.org/10.2196/mhealth.7199.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Collier KL, Colarossi LG, Sanders K. Raising awareness of pre-exposure prophylaxis (PrEP) among women in New York City: community and provider perspectives. J Health Commun. 2017;22(3):183–9. https://doi.org/10.1080/10810730.2016.1261969.

    Article  PubMed  Google Scholar 

  61. Underhill K, Morrow KM, Colleran C, Calabrese SK, Operario D, Salovey P, et al. Explaining the efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention: a qualitative study of message framing and messaging preferences among US men who have sex with men. AIDS Behav. 2016;20(7):1514–26.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Jaramillo J. Perceptions of Pre-Exposure Prophylaxis (PrEP) and Acceptability of Peer Navigation Among HIV-Negative Latinx and Black Men Who Have Sex with Men (MSM) in Western Washington. 2018 [online masters thesis]. Available at: https://digital.lib.washington.edu/researchworks/bitstream/handle/1773/42888/Jaramillo_washington_0250O_18463.pdf?sequence=1&isAllowed=y. Last accessed: April 24, 2019.

  63. Young LE, Schumm P, Alon L, Bouris A, Ferreira M, Hill B, et al. PrEP Chicago: a randomized controlled peer change agent intervention to promote the adoption of pre-exposure prophylaxis for HIV prevention among young Black men who have sex with men. Clin Trials. 2018;15(1):44–52.

    Article  PubMed  Google Scholar 

  64. Grace D, Jollimore J, MacPherson P, Strang MJP, Tan DHS. The pre-exposure prophylaxis-stigma paradox: learning from Canada’s first wave of PrEP users. AIDS Patient Care STDs. 2018;32(1):24–30. https://doi.org/10.1089/apc.2017.0153.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Gallagher KM, Updegraff JA. Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review. Ann Behav Med. 2012;43(1):101–16. https://doi.org/10.1007/s12160-011-9308-7.

    Article  PubMed  Google Scholar 

  66. O'Keefe DJ, Jensen JD. The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease prevention behaviors: a meta-analytic review. J Health Commun. 2007;12(7):623–44. https://doi.org/10.1080/10810730701615198.

    Article  PubMed  Google Scholar 

  67. Kaiser Family Foundation. The coverage gap: uninsured poor adults in states that do not expand Medicaid. [online data feature]. 2018. Available at: https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/. Last accessed: March 19, 2019.

  68. New York State Health Department. Pre-exposure prophylaxis assistance program (PrEP-AP). [online program summary]. 2018. Available at: https://www.health.ny.gov/diseases/aids/general/resources/adap/prep.htm. Last accessed: February 11, 2018.

  69. Washington State Department of Health. Pre-exposure prophylaxis drug assistance program (PrEP DAP) [online program summary]. 2018. Available at: https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/HIVAIDS/HIVPrevention/PrEPDAP . Last accessed: February 11, 2018.

  70. National Association of State and Territorial AIDS Directors. Private PrEP co-pay assistance programs for underinsured patients. [online inventory of state PrEP assistance programs]. Available at: https://www.nastad.org/prepcost-resources/prep-assistance-programs. Last accessed: March 19, 2019.

  71. Centers for Disease Control and Prevention: US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017 Update: a clinical practice guideline. 2017. https://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2017.pdf.

  72. Jones J, Weiss K, Mermin J, Dietz P, Rosenberg ES, Gift TL, et al. Proportion of incident HIV cases among men who have sex with men attributable to gonorrhea and chlamydia: a modeling analysis. Sex Transm Dis. 2019;46:357–63.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Bednarczyk RA, Chamberlain A, Mathewson K, Salmon DA, Omer SB. Practice-, provider-, and patient-level interventions to improve preventive care: development of the P3 model. Prev Med Rep. 2018;11:131–8. https://doi.org/10.1016/j.pmedr.2018.06.009.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Sanchez TH, Zlotorzynska M, Sineath RC, Kahle E, Tregear S, Sullivan PS. National trends in sexual behavior, substance use and HIV testing among United States men who have sex with men recruited online, 2013 through 2017. AIDS Behav. 2018;22(8):2413–25. https://doi.org/10.1007/s10461-018-2168-4.

    Article  PubMed  Google Scholar 

  75. Wilson E, Free C, Morris TP, Syred J, Ahamed I, Menon-Johansson AS, et al. Internet-accessed sexually transmitted infection (e-STI) testing and results service: a randomised, single-blind, controlled trial. PLoS Med. 2017;14(12):e1002479. https://doi.org/10.1371/journal.pmed.1002479.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Siegler AJ, Mayer KH, Liu AY, Patel RR, Ahlschlager LM, Kraft CS, et al. Developing and assessing the feasibility of a home-based PrEP monitoring and support program. Clin Infect Dis. 2018;68:501–4. https://doi.org/10.1093/cid/ciy529.

    Article  PubMed Central  Google Scholar 

  77. Mustanski B, Madkins K, Greene GJ, Parsons JT, Johnson BA, Sullivan P, et al. Internet-based HIV prevention with at-home sexually transmitted infection testing for young men having sex with men: study protocol of a randomized controlled trial of keep it up! 2.0. JMIR Res Protoc. 2017;6(1):e1. https://doi.org/10.2196/resprot.5740.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Gaydos CA, Dwyer K, Barnes M, Rizzo-Price PA, Wood BJ, Flemming T, et al. Internet-based screening for chlamydia trachomatis to reach nonclinic populations with mailed self-administered vaginal swabs. Sex Transm Dis. 2006;33(7):451–7. https://doi.org/10.1097/01.olq.0000200497.14326.fb.

    Article  PubMed  Google Scholar 

  79. Patel AV, Gaydos CA, Jett-Goheen M, Barnes M, Dize L, Barnes P, et al. Assessing association between IWantTheKit risk quiz tool and sexually transmitted infection positivity in male users for sexually transmitted infection screening. Int J STD AIDS. 2017;29(2):122–7. https://doi.org/10.1177/0956462417718758.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Sullivan, PS, Driggers R, Stekler JD, Siegler A, Goldenberg T, McDougal SJ, Caucutt J, Jones J, and Stephenson R. Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study. JMIR Mhealth Uhealth. 2017:5(3):e26.

  81. Elsesser SA, Oldenburg CE, Biello KB, Mimiaga MJ, Safren SA, Egan JE, et al. Seasons of risk: anticipated behavior on vacation and interest in episodic antiretroviral pre-exposure prophylaxis (PrEP) among a large national sample of US men who have sex with men (MSM). AIDS Behav. 2016:1–2.

  82. Pines HA, Gorbach PM, Weiss RE, Shoptaw S, Landovitz RJ, Javanbakht M, et al. Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery. J Acquir Immune Defic Syndr (1999). 2014;65(5):579–86.

    Article  Google Scholar 

  83. Sullivan PS, Peterson J, Rosenberg ES, Kelley CF, Cooper H, Vaughan A, et al. Understanding racial HIV/STI disparities in black and white men who have sex with men: a multilevel approach. PLoS One. 2014;9(3):e90514. https://doi.org/10.1371/journal.pone.0090514.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Kelley CF, Rosenberg ES, O'Hara BM, Frew PM, Sanchez T, Peterson JL, et al. Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US. PLoS One. 2012;7(12):e53284. https://doi.org/10.1371/journal.pone.0053284.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. Rolle CP, Rosenberg ES, Siegler AJ, Sanchez TH, Luisi N, Weiss K, et al. Challenges in translating PrEP interest into uptake in an observational study of young black MSM. J Acquir Immune Defic Syndr. 2017;76(3):250–8. https://doi.org/10.1097/qai.0000000000001497.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Liu A, Coleman K, Bojan K, Serrano PA, Oyedele T, Garcia A, et al. Developing a mobile app (LYNX) to support linkage to HIV/sexually transmitted infection testing and pre-exposure prophylaxis for young men who have sex with men: protocol for a randomized controlled trial. JMIR Res Protoc. 2019;8(1):e10659.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Biello KB, Marrow E, Mimiaga MJ, Sullivan P, Hightow-Weidman L, Mayer KH. A mobile-based app (MyChoices) to increase uptake of HIV testing and pre-exposure prophylaxis by young men who have sex with men: protocol for a pilot randomized controlled trial. JMIR Res Protoc. 2019;8(1):e10694.

  88. Mikati T, Jamison K, Daskalakis D. Immediate PrEP initiation at New York City sexual health clinics. CROI 2019; Abstract 962. March 4–7, Seattle.

  89. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2017; vol. 29. http://www.cdc.gov/hiv/library/reports/surveillance/index.html. Published November 2018. Accessed March 17, 2019.

  90. McNulty M, Smith J, Villamar J, Burnett-Zeigler I, Vermeer W, Benbow N, et al. Implementation research methodologies for achieving scientific equity and health equity. Ethn Dis. 2019;29(Suppl 1):83–92.

    Article  PubMed  PubMed Central  Google Scholar 

  91. UNAIDS. Undetectable=untransmissable [online explainer]. Available at: http://www.unaids.org/sites/default/files/media_asset/undetectable-untransmittable_en.pdf. Last accessed: February 4, 2018.

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Acknowledgments

The authors acknowledge Kevin Weiss for his assistance in preparing the map of health literacy. We acknowledge the use of public data on health literacy from Drs. Gang Fang and Stacey Cooper Bailey (1R01AG046267). This work was facilitated by the Emory Center for AIDS Research (P30AI050409) and the National Institutes of Health (R01DA045612, R01DA038196).

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Authors and Affiliations

  1. Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Room 464, Atlanta, GA, 30322, USA

    Patrick S. Sullivan

  2. John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA

    Leandro Mena

  3. School of Medicine, University of Alabama, Birmingham, AL, USA

    Latesha Elopre

  4. Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA

    Aaron J. Siegler

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  1. Patrick S. Sullivan
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  2. Leandro Mena
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  3. Latesha Elopre
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  4. Aaron J. Siegler
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Correspondence to Patrick S. Sullivan.

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Conflict of Interest

Dr. Siegler serves as a Co-Investigator on an unrelated grant from Gilead Foundation.

Dr. Mena has received payment from Gilead Sciences and ViiV Healthcare.

Dr. Sullivan has serves as a Principal Investigator on two unrelated grants from Gilead Sciences and received payment from Gilead Sciences.

Dr. Elopre does not have any conflicts of interest.

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Sullivan, P.S., Mena, L., Elopre, L. et al. Implementation Strategies to Increase PrEP Uptake in the South. Curr HIV/AIDS Rep 16, 259–269 (2019). https://doi.org/10.1007/s11904-019-00447-4

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