BCHS PhD student, Eli Andrade will be defending his dissertation; Community-based and Behavioral Dimensions of PrEP Engagement Among Latine Sexual Minority Men: TelePrEP Implementation, TelePrEP acceptability, and Predictors of PrEP Discontinuation

Abstract:

Latine sexual minority men (LSMM) experience persistent inequities in HIV incidence and pre-exposure prophylaxis (PrEP) engagement in the United States. Although PrEP is highly effective, barriers across individual, health system, and structural levels continue to limit its uptake and sustained use. This dissertation examined PrEP engagement among LSMM through three complementary studies focused on implementation of a community-based telehealth PrEP program, telehealth PrEP care acceptability, and longitudinal patterns of PrEP discontinuation.

The first study evaluated CBO-PrEP, a telehealth linkage program developed through a community-academic partnership using a mixed-methods approach guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and the Consolidated Framework for Implementation Research (CFIR) frameworks. Of 427 PrEP referrals generated during implementation, 96 were referred to CBO-PrEP; 60% scheduled a telehealth visit, 47% attended, and 86% of attendees received a PrEP prescription. Community trust, bilingual staff, and organizational champions facilitated implementation, whereas insurance navigation, workflow complexity, staff turnover, and communication gaps constrained reach and maintenance. The second study analyzed data from 145 surveys and 24qualitative interviews to assess acceptability of and interest in telehealth PrEP care (telePrEP) among LSMM. Among LSMM with no previous telePrEP experience, 69% endorsed interest, among those with PrEP experience 25% had used telePrEP. Reasons for telePrEP use focused on potential to reduce transportation and time-related barriers. Many participants continued to favor in-person services, preferring flexible hybrid models rather than telehealth-only approaches. The third study used longitudinal national cohort data and discrete-time survival analysis to examine PrEP initiation and discontinuation. Among 1,410 LSMM not using PrEP at baseline, 42% subsequently initiated PrEP. Approximately 20% of initiators discontinued, with the likelihood of discontinuation declining over time. Cannabis use was the only statistically significant predictor of discontinuation, and approximately half of participants with post-discontinuation follow-up later reinitiated PrEP.

These findings demonstrate that improving PrEP engagement among LSMM requires multilevel strategies that integrate flexible care delivery, trusted community partnerships, sustainable implementation infrastructure, and continued support during the early periods of PrEP use.

Eli's Committee:

James Egan, PhD (Chair), BCHS

Mary Hawk, DrPH, BCHS

Emily Dauria, PhD, BCHS

Sarah Krier, PhD, IDM

For information on how to access this defense virtually, please contact Paul Markgraf at pjm111@pitt.edu