Evaluating the Screening and Enrollment of People at Risk of HIV in Mexico's Preexposure Prophylaxis Demonstration Project, 2018-2020

Overview

Journal Public Health Rep

Publisher Sage Publications

Specialty Public Health

Date 2024 Mar 16

PMID 38491784

Authors

Heleen Vermandere

Gisela Martinez-Silva

Santiago Aguilera-Mijares

Araczy Martinez-Davalos

Sergio Bautista-Arredondo

Affiliations

Soon will be listed here.

Abstract

Objectives: Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor.

Methods: We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference.

Results: Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%).

Conclusion: The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.

References

Storholm E, Siconolfi D, Huang W, Towner W, Ling Grant D, Martos A . Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care. AIDS Behav. 2021; 25(8):2348-2357. PMC: 8556139. DOI: 10.1007/s10461-021-03197-w. View

Gomez G, Borquez A, Case K, Wheelock A, Vassall A, Hankins C . The cost and impact of scaling up pre-exposure prophylaxis for HIV prevention: a systematic review of cost-effectiveness modelling studies. PLoS Med. 2013; 10(3):e1001401. PMC: 3595225. DOI: 10.1371/journal.pmed.1001401. View

Veloso V, Caceres C, Hoagland B, Moreira R, Vega-Ramirez H, Konda K . Same-day initiation of oral pre-exposure prophylaxis among gay, bisexual, and other cisgender men who have sex with men and transgender women in Brazil, Mexico, and Peru (ImPrEP): a prospective, single-arm, open-label, multicentre implementation.... Lancet HIV. 2022; 10(2):e84-e96. PMC: 9889521. DOI: 10.1016/S2352-3018(22)00331-9. View

Riddell 4th J, Amico K, Mayer K . HIV Preexposure Prophylaxis: A Review. JAMA. 2018; 319(12):1261-1268. DOI: 10.1001/jama.2018.1917. View

Kamis K, Marx G, Scott K, Gardner E, Wendel K, Scott M . Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care. Open Forum Infect Dis. 2019; 6(7):ofz310. PMC: 6641790. DOI: 10.1093/ofid/ofz310. View

Marrazzo J, Del Rio C, Holtgrave D, Cohen M, Kalichman S, Mayer K . HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. 2014; 312(4):390-409. PMC: 6309682. DOI: 10.1001/jama.2014.7999. View

Matacotta J, Rosales-Perez F, Carrillo C . HIV Preexposure Prophylaxis and Treatment as Prevention - Beliefs and Access Barriers in Men Who Have Sex With Men (MSM) and Transgender Women: A Systematic Review. J Patient Cent Res Rev. 2020; 7(3):265-274. PMC: 7398630. DOI: 10.17294/2330-0698.1737. View

Wilton J, Kain T, Fowler S, Hart T, Grennan T, Maxwell J . 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. PMC: 4911732. DOI: 10.7448/IAS.19.1.20777. View

Hoenigl M, Weibel N, Mehta S, Anderson C, Jenks J, Green N . Development and validation of the San Diego Early Test Score to predict acute and early HIV infection risk in men who have sex with men. Clin Infect Dis. 2015; 61(3):468-75. PMC: 4542926. DOI: 10.1093/cid/civ335. View

10.

McNulty M, Acree M, Kerman J, Williams H, Schneider J . Shared decision making for HIV pre-exposure prophylaxis (PrEP) with black transgender women. Cult Health Sex. 2021; 24(8):1033-1046. DOI: 10.1080/13691058.2021.1909142. View

11.

Tordoff D, Barbee L, Khosropour C, Hughes J, Golden M . Derivation and Validation of an HIV Risk Prediction Score Among Gay, Bisexual, and Other Men Who Have Sex With Men to Inform PrEP Initiation in an STD Clinic Setting. J Acquir Immune Defic Syndr. 2020; 85(3):263-271. DOI: 10.1097/QAI.0000000000002438. View

12.

Beymer M, Weiss R, Sugar C, Bourque L, Gee G, Morisky D . Are Centers for Disease Control and Prevention Guidelines for Preexposure Prophylaxis Specific Enough? Formulation of a Personalized HIV Risk Score for Pre-Exposure Prophylaxis Initiation. Sex Transm Dis. 2016; 44(1):48-56. PMC: 5145736. DOI: 10.1097/OLQ.0000000000000535. View

13.

Wilton J, Mishra S, Tan D . Considerations for Using the HIRI-MSM Screening Tool to Identify MSM Who Would Benefit Most From PrEP. J Acquir Immune Defic Syndr. 2017; 76(2):e58-e61. DOI: 10.1097/QAI.0000000000001472. View

14.

Owens D, Davidson K, Krist A, Barry M, Cabana M, Caughey A . Preexposure Prophylaxis for the Prevention of HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019; 321(22):2203-2213. DOI: 10.1001/jama.2019.6390. View

15.

Smith D, Pals S, Herbst J, Shinde S, Carey J . Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2012; 60(4):421-7. DOI: 10.1097/QAI.0b013e318256b2f6. View

16.

Menza T, Hughes J, Celum C, Golden M . Prediction of HIV acquisition among men who have sex with men. Sex Transm Dis. 2009; 36(9):547-55. PMC: 2753675. DOI: 10.1097/OLQ.0b013e3181a9cc41. View

17.

Vaccher S, Grulich A, Haire B, Conway D, Poynten I, Ooi C . Validation of participant eligibility for pre-exposure prophylaxis: Baseline data from the PRELUDE demonstration project. PLoS One. 2017; 12(9):e0185398. PMC: 5614574. DOI: 10.1371/journal.pone.0185398. View