Impact of Social Determinants of Health on Pre-Exposure Prophylaxis Care for HIV Prevention.

Background: HIV continues to disproportionately affect men who have sex with men (MSM) in the United States. Pre-exposure prophylaxis (PrEP) is effective, but disparities persist. Limited studies have conducted systematic evaluations of social determinants of health (SDOH) and their effects on PrEP persistence among MSM.

Methods: We enrolled MSM into a prospective observational cohort to assess progression through the PrEP care continuum. We enrolled patients from 3 diverse settings in the United States from 2018 to 2022. Methods: We explored the impact of SDOH on PrEP persistence (defined as successfully obtaining PrEP prescriptions and/or clinical documentation of retention in PrEP care) at 6 and 12 months using multilevel, mixed-effects logistic models.

Results: A total of N = 300 MSM were enrolled. Median age was 28 years; 40% were Black/African American, and 11% were Hispanic/Latino (H/L). PrEP persistence was 84.7% and 49.3% at 6- and 12-months, respectively. In the unadjusted analysis, Black/African American and H/L individuals were 56% and 54%, respectively, less likely to demonstrate PrEP persistence at 6-and 12-months compared with White/non-H/L individuals. Findings were no longer significant after adjusting for economic stability and educational attainment. Individuals with higher levels of internalized homophobia were less likely to persist on PrEP. Every 1-unit increase on a validated measure of internalized homophobia was independently and negatively associated with PrEP persistence (adjusted odds ratio = 0.95, 95% confidence interval: 0.93 to 0.98).

Conclusions: SDOH are important predictors of racial and ethnic disparities in PrEP persistence among MSM. Addressing these factors could help mitigate racial disparities in PrEP persistence in the United States.