title: Social, structural, behavioral and clinical factors influencing retention in Pre-Exposure Prophylaxis (PrEP) care in Mississippi.
abstract: Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.|Jackson State University, Jackson, Mississippi, United States of America.
authors.forename: Trisha
authors.initials: T
authors.lastname: Arnold
authors.affiliation: Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America.|Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Brinkley-Rubinstein
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.|The Miriam Hospital, Providence, Rhode Island, United States of America.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Chan
authors.affiliation: Department of Sociomedical Sciences, Columbia University, New York City, New York, United States of America.
authors.forename: Amaya
authors.initials: A
authors.lastname: Perez-Brumer
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.|Jackson State University, Jackson, Mississippi, United States of America.
authors.forename: Estefany S
authors.initials: ES
authors.lastname: Bologna
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Beauchamps
authors.affiliation: Mississippi State Department of Health, Jackson, Mississippi, United States of America.
authors.forename: Kendra
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States of America.
authors.forename: Leandro
authors.initials: L
authors.lastname: Mena
authors.affiliation: Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.|The Miriam Hospital, Providence, Rhode Island, United States of America.|School of Public Health, Brown University, Providence, Rhode Island, United States of America.
authors.forename: Amy
authors.initials: A
authors.lastname: Nunn
mesh_terms: D000328:Adult; D001741:Black or African American; D000367:Age Factors; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D018451:Homosexuality, Male; D006801:Humans; D019458:Insurance Coverage; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008922:Mississippi; D010352:Patient Dropouts; D065129:Pre-Exposure Prophylaxis / Q000191:economics; D012309:Risk-Taking; D012747:Sexual Partners; D064890:Social Determinants of Health; D057545:Social Stigma; D044465:White People; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents