Implementing PrEP in a real world setting raises concerns of access, cost, medication adherence and identifying barriers individuals who would otherwise qualify for PrEP.
CCTG 595 is a PrEP demonstration project providing daily TDF/FTC to MSM and male to female (MTF) trans people at high risk for HIV infection. Over 3 months, we collected data regarding health insurance status, knowledge of PrEP coverage and intent to continue PrEP after study completion. Discussions were timed to coincide with Covered California’s open enrollment period to encourage obtaining coverage. Subject characteristics and possible barriers to PrEP were compared for insured and uninsured and by intent to continue PrEP post-study using t-tests and Fisher’s exact tests.
From November 2014 to February 2015 281 subjects were surveyed. Average time on study was 36 weeks. Mean age was 35 with 72% identifying as White, 17% Black, 28% Hispanic ethnicity and 1% MTF transgender. 80% (n=220) subjects reported having insurance with no statistically significant differences by demographics (age, race, education or income). Subjects reporting logistical healthcare barriers such as cost, time and transportation to visits were significantly less likely to have insurance compared to those not reporting barriers (71 vs 87%, p=0.001). Insured individuals were more likely to report problematic alcohol use (AUDIT score, p=0.014). Of insured individuals only 44% had inquired about their plan’s PrEP coverage despite 81% of subjects intending to continue PrEP post-study. By intention to continue PrEP, there were no differences by demographics, substance use or sexual behavior; however, there was a non-significant trend in Hispanics intending to continue PrEP more than non-Hispanics (p=0.07). Those reporting logistical barriers were less likely to continue PrEP (76 vs 81%, p=0.016). The most frequently cited barriers to PrEP continuation were cost (35%), time (12%) and unable to schedule appointment (12%).
Most subjects were insured and planned to continue PrEP post-study, but we identified barriers that may make real world PrEP transition difficult. Although cost was a concern, time-efficient provider visits were noted, suggesting PrEP delivery models emphasize ease of access and streamlined service delivery.
S. Jain, None
X. Sun, None
J. Young, None
K. Corado, None
M. Dubé, None
D. Moore, None
S. Morris, None
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