Research Track
Oral Presentations
Kolbi Parrish, MA
Research Scientist
California Department of Public Health, Office of AIDS, Prevention Evaluation and Monitoring Section
Nothing to disclose
Hannah Johnson, MA
Research Scientist
California Department of Public Health, Office of AIDS, Prevention Evaluation and Monitoring Section
Nothing to disclose
Sheryl Williams, Ph.D.
Chief
California Department of Public Health, Office of AIDS, Prevention Evaluation and Monitoring Section
Nothing to disclose
Background : Annually, approximately 5,000 Californians are newly-diagnosed with HIV infection. PrEP is a daily pill individuals at high risk for HIV can take to lower their chances of being infected with HIV. Yet, AIDSVu estimated only 12,778 Californians in 2017 were on PrEP out of the estimated 221,528-238,628 Californians who were indicated for PrEP. Improving PrEP uptake can reduce new HIV infections, particularly if increased among young Latinx and African American MSM and non-cisgender people. Achieving optimal PrEP uptake among these priority populations will require adequate PrEP access and demand. Using the Centers for Disease Control and Prevention PS15-1506 (Project PrIDE) funds, OA supported activities designed to increase PrEP awareness and access to PrEP among priority populations. This presentation will highlight evaluation methodology and findings pertaining to PrEP service delivery activities, specifically among trans women, trans men, and gender non-binary persons.
Methods : Through Project PrIDE, OA contracted with three grantees who documented and submitted client service data using standardized data collection tools. OA used this data to analyze demographic characteristics of clients and key program indicators using frequencies and crosstabs. PrEP uptake cascades were constructed to highlight gaps in PrEP uptake and areas of client drop-off. Quantitative data were supplemented with qualitative data from open text fields on service delivery data collection tools, progress reports, and site visits, adding depth to analyses and highlighting lessons learned but not captured by the quantitative data alone.
Results : PrEP service delivery data collected throughout the three-year project (October 2015-September 2018) indicated 1,090 persons (including 146 trans women, 15 trans men, and 20 gender non-binary persons) were screened for PrEP eligibility, of which 407 initiated PrEP (including 79 trans women, six trans men, and six gender non-binary persons). Overall, the largest drop-off along the PrEP cascade was between “referred to a PrEP provider” and “linked to a PrEP provider,” primarily because: (1) it was unknown to the service provider whether the client attended the medical appointment and (2) the client did not show up to / cancelled their medical appointment. PrEP cascades filtered by priority populations indicated the largest drop-off along the PrEP cascade varied by priority population. The largest drop-off along the PrEP cascade for trans women was between: (1) “eligible for PrEP” and “referred to a PrEP provider” and (2) “referred to a PrEP provider” and “linked to a PrEP provider.” The largest drop-off along the PrEP cascade for trans men was between: (1) “screened for PrEP eligibility” and “eligible for PrEP” and (2) “eligible for PrEP” and “referred to a PrEP provider.” The largest drop-off along the PrEP cascade for gender non-binary persons was between “eligible for PrEP” and “referred to a PrEP provider.”
The primary reported explanation for drop-off between “screened for PrEP eligibility” and “eligible for PrEP” on the PrEP cascade for trans men was the client did not have risk indications for PrEP. The primary reported explanation for drop-off between “eligible for PrEP” and “referred to a PrEP provider” on the PrEP cascades for trans women, trans men, and gender non-binary persons was the client was not interested in PrEP. The primary reported explanations for drop-off between “referred to a PrEP provider” and “linked to a PrEP provider” on the PrEP cascade for trans women were: (1) it was unknown to the service provider whether the client attended the medical appointment and (2) the client did not show up to / cancelled their medical appointment. Qualitative data review revealed that trans men, trans women, and gender non-binary persons who were not interested in PrEP reported that they were often not ready for PrEP yet, were not sexually active, preferred to use condoms, or did not see themselves at risk for acquiring HIV.
Conclusions : PrEP uptake and reasons for drop-off along the PrEP cascade can vary across priority populations. Trans and gender non-binary inclusive data collection and analyses can enhance understanding of PrEP uptake among priority populations. Although helpful to understanding PrEP uptake, service delivery data alone are not enough to capture PrEP uptake barriers among priority populations, particularly barriers that make it difficult for these populations to access services. Although this evaluation focused on PrEP uptake, PrEP retention is the key to achieving an optimal public health impact. Future projects should focus on PrEP retention in addition to PrEP uptake.