Determinants of HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) living in rural areas of the United States: A scoping review framed by the PrEP care continuum

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-01-08 DOI:10.1111/jrh.12916

Andrew M. O'Neil MPH, Randolph D. Hubach PhD, MPH, Christopher Owens PhD, MPH, Jennifer L. Walsh PhD, Katherine G. Quinn PhD, Steven A. John PhD, MPH

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引用次数: 0

Abstract

Background

HIV pre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV transmission among men who have sex with men (MSM). Despite its effectiveness, PrEP uptake and adherence among MSM in the United States remain suboptimal, particularly in rural areas.

Objective

The present study presents a scoping review of the self-reported barriers and facilitators of PrEP use among MSM living in rural areas of the United States.

Design

Preferred Items for Systematic Reviews—Extension for Scoping Reviews (PRISMA-ScR) guidelines informed this review. Seven online databases were searched to identify papers published from 2012 to 2023 in English with keywords related the concepts of MSM, rural, and HIV PrEP.

Results

From an initial 340 articles, nine were selected. Awareness significantly impacts PrEP uptake in rural areas, with challenges including limited dissemination of information through mainstream channels and low perceived HIV risk among rural MSM. However, nonmainstream information sources can enhance PrEP awareness and use. Several barriers hinder rural residents from accessing PrEP, such as a lack of competent providers, geographic isolation, cost, and stigma. High PrEP care costs, lack of financial assistance for lab work, and limited telePrEP options are key challenges in retaining individuals in PrEP care.

Conclusions

Suboptimal PrEP uptake in rural areas with high HIV burden remains a concern, hindered by limited information dissemination, low perceived HIV risk, geographic isolation, nonaffirming medical providers, and expensive PrEP care. Leveraging telePrEP, co-pay assistance, 340B drug pricing, and geospatial networking apps can enhance PrEP use. Multilevel interventions are crucial to combat the HIV epidemic in rural regions.

查看原文本刊更多论文

美国农村地区男男性行为者（MSM）使用HIV暴露前预防（PrEP）的决定因素：PrEP护理连续体框架的范围审查。

背景：HIV暴露前预防（PrEP）是预防HIV在男男性行为者（MSM）中传播的一种非常有效的干预措施。尽管PrEP有效，但在美国，尤其是在农村地区，男男性接触者对PrEP的接受和坚持程度仍不理想。目的：本研究提出了一个范围审查自我报告的障碍和促进PrEP使用在生活在美国农村地区的男同性恋者。设计：系统评价首选项目-扩展范围评价（PRISMA-ScR）指南为本次评价提供了依据。在7个在线数据库中检索2012 - 2023年间发表的与MSM、农村和HIV prep概念相关的英文论文。结果：从最初的340篇论文中筛选出9篇。意识对农村地区预防措施的接受有重大影响，面临的挑战包括通过主流渠道传播信息有限以及农村男男性行为者对艾滋病毒风险的认知较低。然而，非主流信息来源可以提高PrEP的认识和使用。一些障碍阻碍农村居民获得预防措施，如缺乏合格的提供者、地理隔离、费用和耻辱。高昂的PrEP护理费用、缺乏对实验室工作的财政援助以及有限的远程PrEP选择是留住PrEP护理人员的主要挑战。结论：在艾滋病毒负担高的农村地区，由于信息传播有限、艾滋病毒风险认知低、地理隔离、医疗服务提供者不确定以及PrEP护理费用昂贵，PrEP使用率不佳仍然是一个问题。利用远程PrEP、共同支付援助、340B药品定价和地理空间网络应用程序可以提高PrEP的使用。多层干预措施对于在农村地区防治艾滋病毒流行病至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.