PrEP Beyond the Clinic: Evaluation of a Home-Based PrEP Follow-Up System Among a Cohort of Predominantly Black and Latino Men who Have Sex with Men in South Florida.

Abstract

Background: PrEP is highly effective for HIV prevention, but structural and logistical barriers, such as stigma, transportation, and time required for appointment can limit PrEP continuation. Home-based (HB) PrEP systems may alleviate these barriers, promoting greater adherence and persistence in PrEP care.

Methods: PrEP clients were recruited from a sexual health clinic program in South Florida. Participants received self-collection kits for urine, rectal, pharyngeal, and blood specimens by mail combined with remote assessments replacing three quarterly in-person visits. Data on demographic characteristics, PrEP follow-up preferences, and completion rates were collected. Bivariate and logistic regression analyses identified factors influencing HB PrEP adoption and completion.

Results: Of 225 clients approached 160 (71.1%) were screened with 60 (37.5%) opting for HB PrEP. In logistical regression analysis, Black Non-Hispanic/Latino race/ethnicity and any comfort level other than "very comfortable" for specimen collection were independent negative predictors of HB PrEP election (OR 0.11; 95%CI 0.02-0.67; p=0.02 and OR 0.12-0.25; 95% CI 0.02-0.89; p=0.01-0.04 respectively). HB PrEP completion rates were 48.3%, 16.7%, and 15% for the first, second, and third follow-up. Despite initial preference for HB PrEP, most participants returned to in-clinic care citing discomfort with self-collection, logistical challenges, convenience, and reliability concerns.

Conclusion: HB PrEP shows potential for improving PrEP maintenance but faces challenges in equitable uptake and persistence. Addressing logistical issues, enhancing specimen collection ease, and providing robust support systems are crucial for broader adoption and sustained PrEP care. Integrating flexible follow-up options may better accommodate the diverse needs of priority populations.