title: Healthcare Access and PrEP Continuation in San Francisco and Miami After the US PrEP Demo Project.
abstract: Pre-exposure prophylaxis (PrEP) for prevention of HIV infection has demonstrated efficacy in randomized controlled trials and in demonstration projects. For PrEP implementation to result in significant reductions in HIV incidence for men who have sex with men in the United States, sufficient access to PrEP care and continued engagement outside of demonstration projects is required.
  
  
  
  We report the results of a follow-up survey of 173 former participants from the Miami and San Francisco sites of the US PrEP Demo Project, administered 4-6 months after study completion.
  
  
  
  Survey respondents continued to frequently access medical care and had a high incidence of sexually transmitted infections after completion of the Demo Project, indicating ongoing sexual risk behavior. Interest in continuing PrEP was high with 70.8% indicating that they were "very interested" in continuing PrEP. Among respondents, 39.9% reported continuation of PrEP after completion of the Demo Project, largely through their primary care providers and frequently at low or no cost. Variability in access and engagement was seen, with participants from the San Francisco site, those with medical insurance, and those with a primary care provider at the end of the Demo Project more likely to successfully obtain PrEP medication. Two respondents reported HIV seroconversion in the period between study completion and the follow-up survey.
  
  
  
  Additional effort to increase equitable access to PrEP outside of demonstration projects is needed to realize the potential impact of this evidence-based prevention intervention.
authors.affiliation: *Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL; †Department of Medicine, University of California; Bridge HIV, San Francisco Department of Public Health, San Francisco, CA; and ‡Population Health Division, Disease Prevention and Control Branch; Division of Infectious Diseases, University of California San Francisco (UCSF), San Francisco, CA.
authors.forename: Susanne
authors.initials: S
authors.lastname: Doblecki-Lewis
authors.forename: Albert
authors.initials: A
authors.lastname: Liu
authors.forename: Daniel
authors.initials: D
authors.lastname: Feaster
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Cohen
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cardenas
authors.forename: Oliver
authors.initials: O
authors.lastname: Bacon
authors.forename: Erin
authors.initials: E
authors.lastname: Andrew
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kolber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D065129:Pre-Exposure Prophylaxis / Q000706:statistics & numerical data*; D012495:San Francisco; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult