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Current US Guidelines for Prescribing HIV Pre-Exposure Prophylaxis (PrEP) Disqualify Many Women Who Are at Risk and Motivated to Use PrEP

Calabrese, Sarah K, PhD1,*,†; Willie, Tiara C, PhD2,3,*; Galvao, Rachel W, BA1,4; Tekeste, Mehrit, BA1; Dovidio, John F, PhD5,6; Safon, Cara B, MPH7; Blackstock, Oni, MD8; Taggart, Tamara, PhD, MPH9; Kaplan, Clair, MSN/APRN, MHS10; Caldwell, Abigail, MSN/APRN10; Kershaw, Trace S, PhD6

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002042
Prevention Research: PDF Only
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Background: US Centers for Disease Control and Prevention (CDC) clinical guidelines for HIV pre-exposure prophylaxis (PrEP) are widely utilized to assess patients’ PrEP eligibility. The guidelines include two versions of criteria – guidance summary criteria and recommended indications criteria – that diverge in a potentially critical way for heterosexually active women: Both require women’s knowledge of their own risk behavior, but the recommended indications also require women’s knowledge of their partners’ HIV risk or recognition of a potentially asymptomatic sexually transmitted infection (STI). This study examined women’s PrEP eligibility according to these two different versions of criteria across risk and motivation categories.

Setting/Methods: HIV-negative women (n=679) recently engaged in care at Connecticut Planned Parenthood centers were surveyed online in 2017. The survey assessed PrEP eligibility by both versions of CDC criteria, HIV risk indicators, PrEP motivation indicators, and sociodemographic characteristics.

Results: Participants were mostly non-Hispanic White (33.9%) or Black (35.8%) and low-income (<$30,000/year; 58.3%). Overall, 82.3% were eligible for PrEP by guidance summary criteria vs. 1.5% by recommended indications criteria. Women disqualified by recommended indications criteria included those reporting condomless sex with HIV-positive or serostatus-unknown male partners (n=27, 11.1% eligible); one or more recent STI(s) (n=53, 3.8% eligible); multiple sex partners (n=168, 3.0% eligible); intended PrEP use (n=211, 2.8% eligible); and high self-perceived risk (n=5, 0.0% eligible).

Conclusion: Current guidelines disqualify many women who could benefit from PrEP and may lead to discrepant assessments of eligibility. Guideline reform is needed to improve clarity and increase women’s PrEP access and consequent HIV protection.

1Department of Psychology, George Washington University, Washington, DC, USA

2Miriam Hospital, Providence, RI, USA

3Warren Alport Medical School, Brown University, Providence, RI, USA

4Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

5Department of Psychology, Yale University, New Haven, CT, USA

6Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA

7Department of Pediatrics, Boston Medical Center, Boston, MA, USA

8New York City Department of Health & Mental Hygiene, New York, NY, USA

9Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

10Planned Parenthood of Southern New England, New Haven, CT, USA

*co-1st authors

Requests for reprints and other correspondence concerning this article should be addressed to Sarah K Calabrese, 2125 G Street NW, Washington, DC 20052, USA; Email: skcalabrese@gwu.edu; Phone: 202-994-8337; Fax: N/A

Conflicts of Interest and Sources of Funding: SKC has received compensation for developing and delivering medical education related to PrEP. The authors have no other conflicts of interest to disclose.

Funding was provided by the Center for Interdisciplinary Research on AIDS (CIRA) Pilot Projects in HIV Program at Yale University. CIRA is funded by the National Institute of Mental Health (NIMH) via Award Number P30-MH062294. Effort was supported by the NIMH via Award Numbers K01-MH103080 (SKC), F31-MH113508 (TCW), and T32-MH02003 (TT). Additional support for TCW was provided by the NIMH via the Brown Initiative in HIV and AIDS Clinical Research for Minority Communities (R25-MH083620). Additional support for TT was provided by the National Institute on Drug Abuse (NIDA) via the HIV/AIDS, Substance Abuse, and Trauma Training Program at the University of California, Los Angeles (R25-DA035692). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, NIDA, or the National Institutes of Health (NIH).

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