PrEP Uptake among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi

Background: Among people at risk for HIV in the United States (US), Black people of all gender identities and sexual orientations have disproportionately high rates of new HIV infection but low uptake of pre-exposure prophylaxis (PrEP), especially in the Southern United States. There is limited research evaluating factors associated with PrEP uptake especially among Black communities. Setting and MethodsThe Open Arms Clinic in Jackson, Mississippi is the largest provider of PrEP in the state with the 6th highest rate of HIV diagnosis in the US. Open Arms systematically documented PrEP eligibility and uptake (i.e., agreed undergo a clinical evaluation for PrEP) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP uptake among those eligible based on clinic criteria using bivariate and multivariate log binomial regression. A person-based analysis was conducted using chi-square tests to compare individuals who ever vs. never accepted an offer for PrEP. ResultsAmong 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of these encounters (526 unique individuals). Eligible patients were mostly ages 25 and older (61.5%), identified as Black (73.1%), and cisgender men who have sex with men (MSM) (63.5%). Individuals accepted a PrEP offer at 58% of encounters; 65.8% of individuals ever accepted an offer. Encounters with individuals that identified as transgender/non-binary were least likely to accept a PrEP offer. Encounters with individuals who reported having sex partners living with HIV or unknown HIV status were more likely to accept PrEP offer. There was no significant difference in accepting an offer by age or race. ConclusionsPrEP uptake in this clinic was suboptimal despite standardized methodical evaluation of eligibility. Our findings signify a critical need to enhance PrEP delivery in this region and enhance PrEP education for key groups such as transgender/non-binary individuals.