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Monitoring HIV Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Washington State

Findings From an Internet-Based Survey

Rao, Darcy White, MPH*; Carr, Jason, MPH; Naismith, Kelly, MPH; Hood, Julia E., MPH, PhD; Hughes, James P., PhD§; Morris, Martina, PhD∥¶; Goodreau, Steven M., PhD***; Rosenberg, Eli S., PhD††; Golden, Matthew R., MD, MPH*‡‡‡§§

Sexually Transmitted Diseases: April 2019 - Volume 46 - Issue 4 - p 221–228
doi: 10.1097/OLQ.0000000000000965
Original Studies

Background Many state and local health departments now promote and support the use of HIV preexposure prophylaxis (PrEP), yet monitoring use of the intervention at the population level remains challenging.

Methods We report the results of an online survey designed to measure PrEP use among men who have sex with men (MSM) in Washington State. Data on the proportion of men with indications for PrEP based on state guidelines and levels of awareness, interest, and use of PrEP are presented for 1080 cisgender male respondents who completed the survey between January 1 and February 28, 2017. We conducted bivariate and multivariable logistic regression to identify factors associated with current PrEP use. To examine patterns of discontinuation, we conducted Cox proportional hazards regression and fit a Kaplan-Meier curve to reported data on time on PrEP.

Results Eighty percent of respondents had heard of PrEP, 19% reported current use, and 36% of men who had never used PrEP wanted to start taking it. Among MSM for whom state guidelines recommend PrEP, 31% were taking it. In multivariable analysis, current PrEP use was associated with older age, higher education, and meeting indications for PrEP use. Our data suggest that 20% of PrEP users discontinue within 12 months, and men with lower educational attainment were more likely to discontinue.

Conclusions Despite high levels of use, there is significant unmet need for PrEP in Washington. Our experience indicates that Internet surveys are feasible and informative for monitoring PrEP use in MSM.

Data from an Internet-based survey indicate that use of HIV preexposure prophylaxis is high among Washington State men who have sex with men, although there remains substantial unmet need.

From the *Department of Epidemiology, University of Washington, Seattle;

Infectious Disease Assessment Unit, Disease Control and Health Statistics, Washington State Department of Health, Olympia;

Public Health–Seattle and King County HIV/STD Program; Departments of



Sociology, and

**Anthropology, University of Washington, Seattle, WA;

††Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY; and

‡‡Department of Medicine, University of Washington;

§§Center for AIDS and STD, University of Washington, Seattle, WA

Acknowledgments: With the Washington State Department of Health, Tom Jaenicke and Elizabeth Crutsinger-Perry provided management and contract support, and April Gilreath and Lori Delaney helped translate survey materials into Spanish. Tanya Avoundjian contributed to the design of survey advertisements, and the University of Washington/Fred Hutch Center for AIDS Research Community Action Board (funded by P30 AI27757) provided feedback on advertisement design. Thanks to Patrick Sullivan, Jeremy Grey, Nicole Luisi, Travis Sanchez, Maria Zlotorzynska, Eric Hall, and Adam Vaughan of PRISM Health at the Emory University Rollins School of Public Health for their technical support, whose contributions were partly supported by grants 1R01DA038196 and 5P30AI050409 from the Emory Center for AIDS Research. The authors would also like to thank the participants who took the time to complete this survey.

Conflicts of Interest and Sources of Funding: M.R.G. receives research support from Hologic and has consulted for GSK. All other authors declare that they have no conflict of interest. This work was funded by the University of Washington STD/AIDS Research Training Program (NIH T32 AI07140) and the Washington State Department of Health.

Correspondence: Darcy White Rao, MPH, Department of Epidemiology, University of Washington, 1959 NE Pacific St, Health Sciences Bldg, F-262 Box 357236, Seattle, WA 98195. E-mail:

Received for publication July 11, 2018, and accepted December 16, 2018.

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