Facilitators for retaining men who have sex with men in pre-exposure prophylaxis care in real world clinic settings within the United States.

BACKGROUND: Pre-exposure prophylaxis (PrEP) can significantly reduce HIV acquisition especially among communities with high HIV prevalence, including men who have sex with men (MSM). Much research has been finding suboptimal PrEP persistence; however, few studies examine factors that enhance PrEP persistence in real-world settings. METHODS: We interviewed 33 patients who identified as MSM at three different PrEP clinics in three regions of the U.S. (Northeast, South, Midwest). Participants were eligible if they took PrEP and had been retained in care for a minimum of 6 months. Interviews explored social, structural, clinic-level and behavioral factors that influencing PrEP persistence. RESULTS: Through thematic analysis we identified the following factors as promoting PrEP persistence: (1) navigation to reduce out-of-pocket costs of PrEP (structural), (2) social norms that support PrEP use (social), (3) access to LGBTQ + affirming medical providers (clinical), (4) medication as part of a daily routine (behavioral), and (5) facilitation of sexual health agency (belief). DISCUSSION: In this sample, persistence in PrEP care was associated with structural and social supports as well as a high level of perceived internal control over protecting their health by taking PrEP. Patients might benefit from increased access, LGBTQ + affirming medical providers, and communications that emphasize PrEP can promote sexual health.

Sugar transport by intestine. Escape of galactose from preloaded mucosa of hamster jejunum.

Everted hamster jejunum was loaded with D-galactose and then escape into an initially galactose-free mucosal solution was followed. Mucosal anaerobiosis greatly increased the rate of escape, an effect which might have been caused by inhibiting reuptake from the unstirred layer and/or by augmenting the ease of unidirectional efflux across the brush border membrane. The former effect was expected because of our previous results from influx studies, and the main object here was to find out if the ease of efflux is affected by anaerobiosis. With phlorizin present in the mucosal solution during escape, information about unidirectional efflux was obtainable. We estimated that 10(-4) M phlorizin inhibited the ease of efflux via the phlorizin-sensitive pathway by about 65%. Apparently the reason why mucosal phlorizin accelerates escape of sugar from loaded mucosa, an effect which has been reported previously by others, is that it inhibits unidirectional efflux less effectively than it inhibits reuptake from the unstirred layer. Residual efflux via the phlorizin-sensitive pathway was markedly increased by mucosal anaerobiosis. This increase did not require an elevation of intracellular Na+ concentration. These results, together with those of our previous study, show that mucosal anaerobiosis abolishes uphill transport of galactose across the brush border of hamster jejunum by inhibiting unidirectional influx and by increasing the ease of unidirectional efflux. Neither of these effects requires a rise in intracellular Na+ concentration.