Objectives: The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational pre-exposure prophylaxis (PrEP) Cascade involving 5 stages based on the Transtheoretical Model of Change.
Methods: We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States.
Results: Nearly all (89%) participants were sexually active in the past 3 months and 65% met Centers for Disease Control criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (stage 5).
Conclusions: The large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.
*Center for HIV/AIDS Educational Studies & Training, Hunter College of the City University of New York (CUNY), New York, NY;
†Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY;
‡Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY; and
§CUNY Graduate School of Public Health and Health Policy, New York, NY.
Correspondence to: Jeffrey T. Parsons, PhD, Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065 (e-mail: firstname.lastname@example.org).
Supported by a research grant from the National Institute on Drug Abuse of the National Institutes of Health (Grant numbers R01-DA036466 to J.T.P. and C.G., K01-DA039030 to H.J.R.).
The authors have no funding or conflicts of interest to disclose.
J.T.P., H.J.R., T.J.S., and C.G. were involved in the conception, design, and implementation of the project. J.M.L. and T.H.F.W. were involved in the acquisition of data. H.J.R. and J.T. were involved in the analysis and interpretation of data. All authors contributed to article writing and critical revisions of intellectual content. All authors reviewed a final version of the article and approved it for submission.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Received June 22, 2016
Accepted November 09, 2016