Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study

Christine M Khosropour; Taylor Riley; Elise Healy; Kandis V Backus; Courtney E Gomillia; Leandro Mena; Khadijra R Lockwood; Felicia M Gordon; Arianna R Means; Lori M Ward

doi:10.1186/s12889-023-16072-1

Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study

BMC Public Health. 2023 Jun 13;23(1):1130. doi: 10.1186/s12889-023-16072-1.

Authors

Affiliations

¹ Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA. ckhosro@uw.edu.
² Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
³ Department of Medicine, Health Sciences Building, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
⁴ Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA.
⁵ Department of Global Health, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.

Abstract

Introduction: Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence.

Methods: This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior.

Results: There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals' desire to stay healthy and the support of PrEP clinic staff were facilitators.

Conclusions: The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.

Keywords: Barriers; HIV; Mississippi; Pre-exposure prophylaxis; Retention.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
HIV Infections* / prevention & control
Homosexuality, Male
Humans
Male
Mississippi
Pharmacists
Sexual and Gender Minorities*

Grants and funding

R21 MH125608/MH/NIMH NIH HHS/United States