Keywords
Men Who Have Sex with Men
Transgender women
Pre-exposure Prophylaxis
Motivational PrEP cascade
How to Cite
Abstract
Background: Despite overwhelming evidence supporting the efficacy and effectiveness of Pre-Exposure Prophylaxis (PrEP) in HIV prevention, its adoption has been marginal. In Colombia, more information about eligibility, awareness, and intentions to use PrEP in target populations and how these relate to social determinants is needed. Aim: to assess PrEP awareness, the motivational cascade, and the social conditions related to the cascade. Methods: A cross-sectional study in a non-probabilistic sample was conducted between April 2020 and February 2021 among 552 Men with Sex with Men (MSM) and 158 Transgender Women (TGW). We used the Poisson regression to explore the associations between PrEP eligibility, awareness, and elements of the motivational PrEP cascade (willingness, intention, and self-perceived need to take) and their sociodemographic characteristics. Results: 51.2 % of the participants were aware of PrEP, 58.7 % were willing to use it, 45 % were self-perceived as PrEP candidates, and 56.2 % intended to take it.TGW were less likely to be aware but more willing to use PrEP than the sample of MSM interviewed face-to-face. Low education was related to low PrEP awareness and low income to low willingness to start PrEP. Conclusions: These results support the pertinence of the cascade concept to describe the stage of the target population regarding eligibility and motivation to take it. To accelerate PrEP implementation, efforts are needed to increase awareness among MSM and TGW with focalized strategies for those with low socioeconomic status.
References
ONUSIDA [Internet]. Colombia. Colombia HIV and AIDS Estimates 2022 [cited 2023 Feb]; Available from: https://www.unaids.org/en/ regionscountries/countries/colombia.
Rick F, Odoke W, van den Hombergh J, Benzaken AS, Avelino-Silva VI. Impact of coronavirus disease (COVID-19) on HIV testing and care provision across four continents. HIV med. 2022;23(2):169-177.
Berbesi Fernández DY, Segura Cardona A, Martínez Rocha A, Molina Estrada A,, Ramos Jaraba SM, Bedoya Mejía S, et al. Comportamiento sexual y prevalencia de VIH en hombres que tienen relaciones sexuales con hombres en tres ciudades de Colombia: Bogotá, Medellín y Santiago de Cali, 2019. Medellín, Colombia: Editorial CES; 2019.
Berbesi Fernández DY, Segura Cardona AM, Martínez Rocha A, Molina Estrada AP, Martínez A, Ramos Jaraba SM, Bedoya Mejía S, et al. Vulnerabilidad al VIH y prevalencia de VIH en mujeres transgénero en tres ciudades de Colombia: Bogotá, Medellín y Santiago de Cali, 2019. Medellín, Colombia: Editorial CES; 2019.
Montana JF, Ferreira GRON, Cunha CLF, de Queiroz AAR, Fernandes WAA, Polaro SHI, et al. The HIV epidemic in Colombia: spatial and temporal trends analysis. BMC public health. 2021;21(1):178.
Frescura L, Godfrey-Faussett P, Feizzadeh AA, ElSadr W, Syarif O, Ghys PD. Achieving the 95 95 95 targets for all: A pathway to ending AIDS. PLoS One. 2022;17(8):e0272405.
Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabinetenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012;4(151):151ra125.
Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, et al. Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS. 2016;30(12):1973-1983.
O Murchu E, Marshall L, Teljeur C, Harrington P, Hayes C, Moran P, et al. Oral pre-exposure prophylaxis (PrEP) to prevent HIV: a systematic review and meta-analysis of clinical effectiveness, safety, adherence and risk compensation in all populations. BMJ Open. 2022;12(5):e048478.
Traeger MW, Schroeder SE, Wright EJ, Hellard ME, Cornelisse VJ, Doyle JS, et al. Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis.
Clin Infect Dis. 2018;67(5):676-686. 11. Jin F, Amin J, Guy R, Vaccher S, Selvey C, Zablotska I, et al. Adherence to daily HIV pre-exposure prophylaxis in a large-scale implementation study in New South Wales, Australia. AIDS. 2021;35(12):1987- 1996.
Koss CA, Havlir DV, Ayieko J, Kwarisiima D, Kabami J, Chamie G, et al. HIV incidence after preexposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda. PLoS medicine. 2021;18(2):e1003492.
World Health Organization [Internet]. Global data shows increasing PrEP use and widespread adoption of WHO PrEP recommendations. Available in: https://www.who.int/news-room/ feature-stories/detail/global-data-showsincreasing-prep-use-and-widespread-adoptionof-who-prep-recommendations.
Grulich AE, Jin F, Bavinton BR, Yeung B, Hammoud MA, Amin J, et al. Long-term protection from HIV infection with oral HIV preexposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPICNSW prospective implementation study. The lancet HIV. 2021;8(8):e486-e94.
Pan American Health Organization and Joint United Nations Programme on HIV/AIDS [Internet]. Washington, D.C.: PAHO, UNAIDS. HIV Prevention in the Spotlight: An Analysis from the Perspective of the Health Sector in Latin America and the Caribbean, 2017.2017. Available in: https://iris.paho.org/handle/10665.2/34381.
Luz PM, Veloso VG, Grinsztejn B. The HIV epidemic in Latin America: accomplishments and challenges on treatment and prevention. Curr Opin HIV AIDS. 2019;14(5):366-73.
Departamento del Programa Nacional de Prevención y Control del VIH/SIDA e ITS. Orientaciones técnicas 2019 profilaxis preexposición (PrEP) a la infección por VIH. Chile. Ministerio de salud; 2019. https://diprece. minsal.cl/wp-content/uploads/2019/08/OT2019-Profilaxis-Pre-Exposici%C3%B3n-PrEP-a-lainfecci%C3%B3n-por-VIH.pdf (Accessed february, 2022).
Luz PM, Benzaken A, Alencar TM, Pimenta C, Veloso VG, Grinsztejn B. PrEP adopted by the brazilian national health system: What is the size of the demand? Medicine (Baltimore). 2018;97(1S Suppl 1):S75-S77.
Colombia. Ministerio de Salud y Protección Social. Resolución número 0002292 de 2021. Por la cual se actualizan y establecen los servicios y tecnologías de salud financiados con recursos de la Unidad de Pago por Capitación (UPC). (Dic. 23, 2021).
Ministerio de Salud y Protección Social, Empresa Nacional Promotora del Desarrollo Territorial e Instituto de Evaluación Tecnológica en Salud. Guía de Práctica Clínica basada en la evidencia científica para la atención de la infección por VIH/SIDA en personas adultas, gestantes y adolescentes. Versión para profesionales de salud. Bogotá D.C. Colombia; 2021. https://www.minsalud.gov.co/ sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/ gpc-vih-adultos-version-profesionales-salud.pdf (Accessed octuber, 2023).
Ministerio de Salud y Protección Social. Dirección de Promoción y Prevención. Profilaxis Preexposición al VIH (PrEP). Lineamiento para la implementación de la PrEP en Colombia. Bogotá D.C. Colombia; 2023. https://prep-colombia.org/ wp-content/uploads/2023/07/Lineamiento-PrEP_ FINAL_Junio2023.pdf (Accessed octuber,2023).
. Mueses HF, Alvarado B, Torres J, Camargo P, Bolívar MC, Galindo X, et al. Scales to Assess Knowledge, Motivation, and Self-Efficacy for HIV PrEP in Colombian MSM: PrEP-COL Study. AIDS Res Treat. 2021.
Martínez J, Alvarado B, Martínez E, Torres J, Arrivillaga M, Camargo P, et al. HIV care providers’ familiarity, concerns, and attitudes about HIV PrEP in Colombia: insights from the PrEP-Col-Study. AIDS Care. 2022;34(11):1428- 1434.
Bolívar MC, Gomez SA, Camargo P, Peralta MdP, Mueses HF, Alvarado B, et al. Barriers and facilitators to HIV pre-exposure prophylaxis uptake among transgender women in Colombia: A qualitative analysis using the COM-B model. PLOS Glob Public Health. 2023;3(9):e0001395.
Parsons JT, Rendina HJ, Lassiter JM, Whitfield THF, Starks TJ, Grov C. Uptake of HIV PreExposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States: The Motivational PrPEP cascade. J Acquir Immune Defic Syndr. 2017;74(3):285-292.
Torres TS, Konda KA, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, Hoagland B, et al. Factors Associated With Willingness to Use Pre-Exposure Prophylaxis in Brazil, Mexico, and Peru: Web-Based Survey Among Men Who Have Sex With Men. JMIR Public Health Surveill. 2019;5(2):e13771.
Walsh JL. Applying the Information–Motivation– Behavioral Skills Model to Understand PrEPIntentions and Use Among Men Who Have Sex with Men. AIDS Behav. 2019;23(7):1904-1916.
Wilton J, Kain T, Fowler S, Hart TA, Grennan T, Maxwell J, et al. Use of an HIV-risk screening tool to identify optimal candidates for PrEP scale-up among men who have sex with men in Toronto, Canada: disconnect between objective and subjective HIV risk. J Int AIDS Soc. 2016;19(1):20777.
Coutinho LM, Scazufca M, Menezes PR. Methods for estimating prevalence ratios in cross-sectional studies. Rev Saúde Publica. 2008;42(6):992–998.
Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3(21):1–13.
Reisner SL, Moore CS, Asquith A, Pardee DJ, Sarvet A, Mayer G, et al. High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States. J Int AIDS Soc. 2019;22(9):e25391.
Assaf RD, Konda KA, Torres TS, Vega-Ramirez EH, Elorreaga OA, Diaz-Sosa D, et al. Are men who have sex with men at higher risk for HIV in Latin America more aware of PrEP? PLoS One. 2021;16(8):e0255557.
Jalil EM, Grinsztejn B, Velasque L, Ramos Makkeda A, Luz PM, Moreira RI, et al. Awareness, Willingness, and PrEP Eligibility Among Transgender Women in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr. 2018;79(4):445-452.
Huang YA, Zhu W, Smith DK, Harris N, Hoover KW. HIV Preexposure Prophylaxis, by Race and Ethnicity — United States, 2014–2016. MMWR Morb Mortal Wkly Rep. 2018;67(41):1147–1150.
Yi S, Tuot S, Mwai GW, Ngin C, Chhim K, Pal K, et al. Awareness and willingness to use HIV preexposure prophylaxis among men who have sex with men in low- and middle-income countries: a systematic review and meta-analysis. J Int AIDS Soc. 2017;20(1):21580.
Powers KA, Miller WC. Critical Review: Building on the HIV Cascade: A Complementary “HIV States and Transitions” Framework for Describing HIV Diagnosis, Care, and Treatment at the Population Level. J Acquir Immune Defic Syndr. 2015;69(3):341-347.
Seckinelgin H. People don’t live on the care cascade: The life of the HIV care cascade as an international AIDS policy and its implications.Glob Public Health. 2020;15(3):321-333.
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399-410.
Mueses-Marín HF, Alvarado-Llano BE, TelloBolívar IC, Martínez-Cajas JL, Galindo-Quintero J. Examining a syndemic framework for HIV and sexually transmitted infections risk in Cali, Colombia. Hacia Promoc. Salud. 2020;25(2):140- 153.
Edeza A, Galarraga O, Novak D, Mayer K, Rosenberger J, Mimiaga M, et al. The role of sexual risk behaviors on PrEP awareness and interest among men who have sex with men in Latin America. Int J STD AIDS. 2019;30(6):542- 549.
Torres TS, Luz PM, De Boni RB, de Vasconcellos MTL, Hoagland B, Garner A, et al. Factors associated with PrEP awareness according to age and willingness to use HIV prevention technologies: the 2017 online survey among MSM in Brazil. AIDS Care. 2019;31(10):1193-1202.
Mosley T, Khaketla M, Armstrong HL, Cui Z, Sereda P, Lachowsky NJ, et al. Trends in Awareness and Use of HIV PrEP Among Gay, Bisexual, and Other Men who have Sex with Men in Vancouver, Canada 2012-2016. AIDS Behav. 2018;22(11):3550-3565.
McMahan VM, Moreno C, Al-Tayyib A, Menza TW, Orellana ER, Bhattarai A, et al. Pre-exposure Prophylaxis Awareness and Use Among Cisgender Men Who Have Sex With Men and Use Methamphetamine in 3 Western US Cities. Sex Transm Dis. 2020;47(4):217-223.
Pacífico de Carvalho N, Mendicino CCP, Cândido RCF, Alecrim DJD, Menezes de Pádua CA. HIV pre-exposure prophylaxis (PrEP) awareness and acceptability among trans women: a review. AIDS Care. 2019;31(10):1234-1240.
Sevelius JM, Poteat T, Luhur WE, Reisner SL, Meyer IH. HIV Testing and PrEP Use in a National Probability Sample of Sexually Active Transgender People in the United States. J Acquir Immune Defic Syndr. 2020;84(5):437-442.
Zea MC, Reisen CA, del Río-González AM, Bianchi FT, Ramirez-Valles J, Poppen PJ. HIV Prevalence and Awareness of Positive Seorstatus Among Men Who Have Sex Whit Men and Transgender Women in Bogotá, Colombia. Am J Public Health. 2015;105(8):1588-1595.
Galea JT, Kinsler JJ, Salazar X, Lee SJ, Giron M, Sayles JN, et al. Acceptability of pre-exposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. 2011;22(5):256-262.
Hoagland B, De Boni RB, Moreira RI, Madruga JV, Kallas EG, Goulart SP, et al. Awareness and Willingness to Use Pre-exposure Prophylaxis (PrEP) Among Men Who Have Sex with Men and Transgender Women in Brazil. AIDS Behavior. 2017;21(5):1278-1287.
Camila-Bolívar M, Gomez-Peñaloza SA,CamargoPlazas P, Peralta-Ardila MDP, Mueses-Marín HF, Alvarado-Llano B, et al. Barriers and facilitators to HIV pre-exposure prophylaxis uptake among transgender women in Colombia: A qualitative analysis using the COM-B model. PLOS Global Public Health. 2023;3(9): e0001395.
Corporación de lucha contra el sida [Internet]. Colombia: Corporación de lucha contra el sida; 1992-2024. Estudio PREP COL; [Citado 2024, mayo 19]; Disponible en: https://cls.org.co/ proyecto-prep/.
Keen P, Bavinton BR. Could disparities in PrEP uptake limit the public health benefit?. Lancet Public Health. 2020;5(9):e467-e468.
Holt M, Lee E, Lea T, Bavinton B, Broady T, Mao L, et al. HIV Preexposure Prophylaxis Cascades to Assess Implementation in Australia: Results From Repeated, National Behavioral Surveillance of Gay and Bisexual Men, 2014–2018. J Acquiur Immune Defic Syndr. 2020;83(3):e16-e22.
Hanum N, Cambiano V, Sewell J, Phillips AN, Rodger AJ, Speakman A, et al. Use of HIV preexposure prophylaxis among men who have sex with men in England: data from the AURAH2 prospective study. Lancet Public Health. 2020;5(9):e501-e511.
Annequin M, Villes V, Delabre RM, Alain T, Morel S, Michels D, et al. Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017). AIDS Care. 2020;32(sup2):47-56.
Morgan J, Ferlatte O, Salway T, Wilton J, Hull M. Awareness of, interest in, and willingness to pay for HIV pre-exposure prophylaxis among Canadian gay, bisexual, and other men who have sex with men. Can J Public Health. 2018;109(5- 6):791-799.
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