1. Health Service- and Provider-Level Factors Influencing Engagement in HIV Pre-Exposure Prophylaxis Care Among Male Sex Workers
- Author
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Valente, Pablo K, Mimiaga, Matthew J, Chan, Philip A, and Biello, Katie B
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Behavioral and Social Science ,Health Services ,Clinical Research ,Clinical Trials and Supportive Activities ,Infectious Diseases ,Prevention ,7.1 Individual care needs ,Management of diseases and conditions ,Health and social care services research ,8.1 Organisation and delivery of services ,Good Health and Well Being ,Adult ,Anti-HIV Agents ,HIV Infections ,Health Services Accessibility ,Homosexuality ,Male ,Humans ,Male ,Pre-Exposure Prophylaxis ,Sex Workers ,Sexual Behavior ,men who have sex with men ,sex workers ,HIV ,AIDS ,pre-exposure prophylaxis ,health services ,health care provider ,HIV/AIDS ,Public Health and Health Services ,Virology ,Clinical sciences ,Public health - Abstract
Multilevel barriers to pre-exposure prophylaxis (PrEP) care among male sex workers (MSW) include aspects of interactions with health services and providers. We examined relationships between health service- and provider-level factors and PrEP care among MSW. Between 2017 and 2019, we enrolled 111 MSW in the Northeast United States who were not on PrEP, but expressed interest in potentially using PrEP, in a behavioral intervention to promote PrEP uptake and adherence. Using baseline data, we examined whether having a primary care provider, past year frequency of medical visits, comfort discussing sexual practices with providers, and transportation difficulties to accessing general health care were associated with PrEP use self-efficacy, anticipated barriers to PrEP uptake, adherence, and retention (linear regression), and intention to initiate PrEP (logistic regression). Models adjusted for age, race/ethnicity, sexual identity, education, and income. Participants' mean age was 34.2 [standard deviation (SD) = 8.5], and 47% were non-White. Three-quarters (76%) intended to initiate PrEP within the next month. Comfort discussing sexual practices with providers was associated with PrEP use self-efficacy (b = 0.41, p = 0.008). Comfort discussing sexual practices with providers was negatively associated with anticipated barriers to PrEP uptake (b = -0.29, p = 0.006). Transportation difficulties to accessing general health care were associated with barriers to PrEP uptake (b = 0.30, p = 0.007) and barriers to PrEP adherence and retention (b = 0.57, p
- Published
- 2021