“ While PrEP uptake has increased dramatically over the past 5 years, there are huge disparities in rates of PrEP use by race, ethnicity, and geography, and there are still many people who could benefit from PrEP who are not accessing it,” Susanne DobleckiLewis, MD, MSPH, notes. “To reach PrEP’s full potential for HIV prevention, we need new strategies for getting this information out and for connecting people to PrEP care.”
Dr. Doblecki-Lewis considers current PrEP users “ideal” for increasing PrEP uptake because of their knowledge of this HIV prevention tool and personal experience with it.
For a study published in JAIDS, the researchers used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the distribution of HIV self-testing kits bundled with PrEP information (Test-to-PrEP kits) among egocentric friendship networks of PrEP users. Patients in the University of Miami PrEP program clinics, where the study was conducted, “are largely from communities that are underrepresented in PrEP care,” Dr. Doblecki-Lewis says.
“We serve mostly Latino MSM. By activating our clients to share information and HIV self-testing through their social networks, we have a unique opportunity to further expand the reach of PrEP. We also felt that our clients are much more likely to be credible and trusted sources of information to those in their networks.”
Reaching Critical Populations at Risk for HIV
The study enrolled 100 PrEP clients (egos) who were given Test-to-PrEP kits for dissemination. The egos described 414 alters —people in their social networks who they believed were appropriate users of the kit.
Participants were given 293 Test-to-PrEP kits. Participants successfully used 117 of these and completed the QR code-linked survey (kit users; 39.9%). Kit users primarily identified as Hispanic/Latino (73.5%), and more than half (58.1%) identified as men.
The program reached crucial at-risk populations with information on HIV testing and PrEP, Dr. Doblecki-Lewis notes. Among kit users, 16.2% had no prior HIV testing done, and 38.5% had never heard about PrEP before the program.
“This is a critical piece of information,” she says. “It’s also important to note that our clients were enthusiastic about the approach and participating. Many of the people who received the kits were interested in distributing kits, so there is some potential for additional spread of information through networks via secondary distribution.”
The study showed that “most egos expected to distribute to their friends,” Dr. DobleckiLewis notes (Table). “While many of our clients who were Latino MSM distributed kits to other Latino MSM—a key population for prevention—they were able to also distribute kits to women and other people of different demographics who could benefit from HIV testing and PrEP information.”
Expanding the Test-to-PrEP Strategy
The findings indicate that the social networks of PrEP users may be leveraged to increase HIV testing and the dissemination of PrEP information to populations that are often underserved. The study also serves as a reminder for clinicians that PrEP users are not only consumers of medical care but also a source of “unique potential based on their personal experience to engage others in their social networks and to help to spread HIV self-testing and PrEP through priority populations,” according to Dr. Doblecki-Lewis. “I would love to see PrEP programs offer HIV self-testing kits, as well as information and resources, to PrEP clients for distribution through their networks.” In future research, Dr. Doblecki-Lewis hopes to expand the Test-to-PrEP strategy further, comparing the resources required to share information and testing via this strategy with other strategies for PrEP engagement. “I’d also like to see how it works in different populations,” she says. “For example, we would like to further tailor the strategy for women who are current PrEP users.”
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