UCLA

BACKGROUND: Gay, bisexual and other men who have sex with men (GBMSM) remain most at risk of HIV acquisition in the US. Despite the increasing number of providers reporting PrEP prescribing in recent years, uptake remains sub-optimal. This analysis examines sexual and substance use factors influencing consistent PrEP care engagement and the impact of the COVID-19 pandemic on PrEP services.

METHODS: Chapter 2 uses data from the mSTUDY cohort to describe the association between relationship-level substance use factors and consistent PrEP care engagement. Chapters 3 and 4 use health record data from the Los Angeles LGBT Center. Chapter 3 includes a survival analysis describing the median time to PrEP discontinuation in this population and associations between gender identity and substance use factors on time to PrEP discontinuation. Chapter 4 uses an interrupted time series analysis to review the population-level impact of facility closures related to the COVID-19 pandemic on PrEP follow up care retention.

RESULTS: Patients reporting chemsex at the LA LGBT Center had significantly longer follow up time on PrEP than those who did not. After controlling for chemsex, cisgender men had significantly longer follow up time on PrEP than non-cis PrEP users in this facility. Participants in mSTUDY who reported that either they or their partner used methamphetamine or that both they and their partner used methamphetamine had nearly 2.5 or 3.8 times higher odds, respectively, of inconsistent PrEP care engagement compared to those who reported no methamphetamine use. COVID-19 significantly impacted PrEP follow up at the LA LGBT Center compared to the pre-COVID-19 period, resulting in a nearly 40% decrease in follow up visits. The extent to which PrEP follow up visits decreased varied by important demographic factors including race/ethnicity, experiences of homelessness, sexual identity and chemsex.

CONCLUSION: The reach and impact of HIV prevention tools like PrEP can be maximized through better targeting of services and better integration of psychosocial and substance use treatment services. Further examination of novel PrEP follow up strategies will be essential in the changing PrEP method landscape and in the context of the changing healthcare landscape as a result of COVID-19.