Correlates of linkage to HIV preexposure prophylaxis among HIV-testing clients

Charlene A. Flash, Oluwatobi O. Adegboyega, Xiaoying Yu, Carmen Avalos, Syundai Johnson, Kenneth H. Mayer, Thomas P. Giordano

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: Publicly funded HIV-testing sites can identify HIV preexposure prophylaxis (PrEP) candidates and provide PrEP linkage. Setting: Harris Health System's HIV clinic, HIV-testing program, and HIV-prevention program (HPP) in Houston, TX, a high HIVincidence city. Methods: A prospective assessment of individuals aged 18 years and older recruited from walk-in HIV testing from December 2013 to April 2015 included risk assessment, HIV testing, and self-administered survey, with follow-up surveys at 6 and 12 months and medical record review. Results: The mean age of our sample (n = 300) was 38.3 6 11.7 years. Men constituted 63.1% of the sample and 53.7% were black non-Hispanic, 26.3% Hispanic, and 14.7% white non-Hispanic. Most were uninsured (63.5%). Only 27% always used condoms, although 67% perceived personal HIV risk. Of 300 participants, 64 (21.3%) linked to PrEP care and 49 (16.3%) took PrEP. In multivariable analysis, compared with heterosexual men, women [adjusted OR (aOR) 4.1, 95% CI: 1.5 to 11.1] and MSM (aOR 10.2, 95% CI: 3.4 to 31.0) were more likely to attend HPP and to take PrEP (aOR 3.0, 95% CI: 1.6 to 15.1 and 3.0, 95% CI: 1.1 to 8.3, respectively). Serodiscordance and PrEP interest correlated with program attendance (aOR 14.0, 95% CI: 6.1 to 32.3 and aOR 6.7, 95% CI: 1.8 to 25.4) and taking PrEP (aOR 13.1, 95% CI: 5.2 to 32.8 and 14.4, 95% CI: 1.8 to 166.9), respectively. Conclusions: Preexposure prophylaxis interest, being female or MSM, and serodiscordance correlated with PrEP linkage. Safety-net health systems can facilitate PrEP access in marginalized populations, but the PrEP initiation rates remain low.

Original languageEnglish (US)
Pages (from-to)365-372
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number4
StatePublished - 2018


  • HIV prevention
  • HIV testing
  • Linkage to care
  • PrEP
  • Pre-exposure prophylaxis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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