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Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.

BackgroundAmong 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.

The updated 2023–24 COVID-19 vaccine was available in the United States beginning September 2023. Our objective was to identify reasons for decisions related to vaccination of children in the household. In December 2023, adults in Oregon and Washington were asked whether they or their household children had received the 2023–24 COVID-19 vaccination. Adults with unvaccinated children were asked about intentions to vaccinate and to rank the top three reasons for their decision. Vaccine concordance between adults and household children was assessed. Among 1067 adult participants, 33 % (n = 352) of adults reported at least one unvaccinated household child: 23 % intended to vaccinate and 10 % did not intend to vaccinate. Among 243 adults who intended to vaccinate, 73 % selected “if there is more severe illness in my school or community”, as a primary reason; the highest ranked reason among those not intending to vaccinate was the belief that their child would not become severely ill (66 %). 78 % of adults made the same vaccine decisions for themselves and their children. Participant's perception of their child's individual risk from SARS-CoV-2 infection was the primary consideration impacting vaccine uptake and intent for 2023–24 COVID-19 vaccine.