Chan Philip A, Goedel William C, Li Yu, Mena Leandro, Patel Rupa R, Marshall Brandon D L, Yelena Malyuta, Ward Lori, Underwood Ashley, Johnson Catrell J, Gomillia Courtney E, Almonte Alexi, Tao Jun, Curoe Kate, Villalobos Jesus, Nunn Amy S
Brown University, Providence, RI.
University of Mississippi Medical Center, Jackson, MS; and.
J Acquir Immune Defic Syndr. 2025 Apr 15;98(5):465-472. doi: 10.1097/QAI.0000000000003601.
HIV continues to disproportionately affect men who have sex with men (MSM) in the United States. Pre-exposure prophylaxis (PrEP) is effective, but disparities persist. Limited studies have conducted systematic evaluations of social determinants of health (SDOH) and their effects on PrEP persistence among MSM.
We enrolled MSM into a prospective observational cohort to assess progression through the PrEP care continuum. We enrolled patients from 3 diverse settings in the United States from 2018 to 2022.
We explored the impact of SDOH on PrEP persistence (defined as successfully obtaining PrEP prescriptions and/or clinical documentation of retention in PrEP care) at 6 and 12 months using multilevel, mixed-effects logistic models.
A total of N = 300 MSM were enrolled. Median age was 28 years; 40% were Black/African American, and 11% were Hispanic/Latino (H/L). PrEP persistence was 84.7% and 49.3% at 6- and 12-months, respectively. In the unadjusted analysis, Black/African American and H/L individuals were 56% and 54%, respectively, less likely to demonstrate PrEP persistence at 6-and 12-months compared with White/non-H/L individuals. Findings were no longer significant after adjusting for economic stability and educational attainment. Individuals with higher levels of internalized homophobia were less likely to persist on PrEP. Every 1-unit increase on a validated measure of internalized homophobia was independently and negatively associated with PrEP persistence (adjusted odds ratio = 0.95, 95% confidence interval: 0.93 to 0.98).
SDOH are important predictors of racial and ethnic disparities in PrEP persistence among MSM. Addressing these factors could help mitigate racial disparities in PrEP persistence in the United States.
在美国，艾滋病毒对男男性行为者（MSM）的影响仍然不成比例。暴露前预防（PrEP）是有效的，但差异依然存在。有限的研究对健康的社会决定因素（SDOH）及其对男男性行为者中PrEP持续使用情况的影响进行了系统评估。
我们将男男性行为者纳入一个前瞻性观察队列，以评估其在PrEP护理连续过程中的进展情况。我们在2018年至2022年期间从美国3个不同地点招募了患者。
我们使用多层次混合效应逻辑模型，探讨了健康的社会决定因素在6个月和12个月时对PrEP持续使用情况（定义为成功获得PrEP处方和/或PrEP护理留存的临床记录）的影响。
总共招募了N = 300名男男性行为者。中位年龄为28岁；40%为黑人/非裔美国人，11%为西班牙裔/拉丁裔（H/L）。PrEP持续使用率在6个月和12个月时分别为84.7%和49.3%。在未调整的分析中，与白人/非H/L个体相比，黑人/非裔美国人和H/L个体在6个月和12个月时PrEP持续使用的可能性分别低56%和54%。在对经济稳定性和教育程度进行调整后，研究结果不再具有统计学意义。内化恐同程度较高的个体坚持使用PrEP的可能性较小。内化恐同有效测量指标每增加1个单位，与PrEP持续使用呈独立负相关（调整后的优势比 = 0.95，95%置信区间：0.93至0.98）。
健康的社会决定因素是男男性行为者中PrEP持续使用的种族和族裔差异的重要预测因素。解决这些因素有助于减轻美国PrEP持续使用方面的种族差异。
