Dissertations and Theses
Date of Degree
9-22-2023
Document Type
Dissertation
Degree Name
Doctor of Philosophy (Ph.D.)
Department
Community Health and Social Sciences
Advisor(s)
Christian Grov
Committee Members
Sarit Golub
Asa Radix
Nicholas Grosskopf
Subject Categories
Community Health and Preventive Medicine | Public Health
Keywords
PrEP, Community Health, HIV prevention, Biomedical prevention, HIV, EHE
Abstract
The implementation of preexposure prophylaxis (PrEP) in the United States has fallen short of meeting both 2020 and projected 2030 milestones, with less than one-third of those who would benefit most from PrEP choosing to initiate it. High discontinuation rates and persistently elevated HIV incidence underscore the need for improvement. However, opportunities exist to enhance PrEP uptake, supported by a growing pipeline of PrEP innovations. To achieve this, effective implementation of available tools to combat HIV and the inclusion of all communities as stakeholders are essential. One such tool is event-driven (ED) PrEP, also known as PrEP 2-1-1, which is an on-demand, reduced-pill approach for using TDF-formulation PrEP. While successfully implemented in other countries and introduced in the US since 2021, limited knowledge exists regarding the response of PrEP candidates to ED PrEP, and discussions on implementation and rollout efforts have not emerged. Furthermore, ensuring equity requires visibility and inclusion of all stakeholders in HIV prevention, including transgender men and other masculine individuals who have sex with men (TMSM), a community historically overlooked in prevention efforts. To that end, this dissertation seeks to explore opportunities to improve rates of PrEP use and the overall spectrum of HIV prevention in the United States. Using three different datasets and a variety of data analysis methods, we explored ways to expand and improve the rollout of event-driven PrEP, which was recently added to new US national PrEP guidelines. Additionally, we explored the uptake of PrEP among a community that has been left out of HIV prevention efforts: transgender men who have sex with men. The findings of these analyses are discussed, and implications for current national HIV prevention efforts are put forward.
Recommended Citation
Carneiro, Pedro B., "Exploring opportunities to expand and improve PrEP uptake in vulnerable US communities." (2023). CUNY Academic Works.
https://academicworks.cuny.edu/sph_etds/102