Referral network for the delivery of pre-exposure prophylaxis (PrEP) among organizations that serve young men who have sex with men
Young men who have sex with men (YMSM) have the highest increase in estimated annual HIV infections (23% for those aged 25–34) between 2010 and 2014. Ever since daily oral tenofovir disoproxil fumarate (TDF) and emtricitabine were approved in 2012, pre-exposure prophylaxis (PrEP) has received increased attention for preventing HIV infection among MSM. However, there are major implementation gaps primarily around successful linkage to a PrEP-providing facility, particularly for this most atrisk population. Our study identifies and describes PrEP–related resources and referral linkages between clinical and non-clinical health venues where YMSM affiliate in two large cities, Chicago and Houston. Venue interview data were collected as part of the parent study of the Young Men’s Affiliation Project (YMAP), a prospective cohort study of venue affiliation networks and HIV risk and prevention among YMSM (16-29 years old). Forty-five PrEP-related venues (n=19 in Chicago, n=26 in Houston) were recruited from the total sample of 109 venues (n=42 in Chicago and n=67 in Houston) in the third wave of venue interviews (12/2015-5/2017). Results indicate that of the total 109 venues 45% (n=19) in Chicago and 39% (n=26) in Houston engage in PrEP-related activities. Among these PrEP-related venues, a majority engage in PrEP awareness or promotion (84% in Chicago and 65% in Houston) and about a half refer their clients to other organizations for PrEP (58% in Chicago and 50% in Houston). The average number of PrEP-related partner organizations was 2.7 (SD=2.6 min=0, max=10) in Chicago and 3.1 (SD=3.1, min=0, max=11) in Houston, with 1.6 average referring ties (outdegree) (SD=1.9, min=0, max=5 in Chicago and 1.4 average referring ties (SD=1.8, min=0, max=5) in Houston and 0.8 average referred ties (indegree) (SD=1.3, min=0, max=4) in Chicago and 0.7 average referred ties (SD=1.3, min=0, max=5) in Houston. Recommendations are made based on these network factors that can be geared toward better delivery of PrEP in the U.S.
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