Monitoring HIV pre-exposure prophylaxis use among men who have sex with men in Washington State: findings from an internet-based survey.

BACKGROUND: Many state and local health departments now promote and support the use of HIV pre-exposure prophylaxis (PrEP), yet monitoring use of the intervention at the population level remains challenging.

METHODS: We report the results of an online survey designed to measure PrEP use among men who have sex with men (MSM) in Washington State. Data on the proportion of men with indications for PrEP based on state guidelines and levels of awareness, interest, and use of PrEP are presented for 1,080 cisgender male respondents who completed the survey between January 1 and February 28, 2017. We conducted bivariate and multivariable logistic regression to identify factors associated with current PrEP use. To examine patterns of discontinuation, we conducted Cox Proportional Hazards regression and fit a Kaplan Meier curve to reported data on time on PrEP.

RESULTS: Eighty percent of respondents had heard of PrEP, 19% reported current use, and 36% of men who had never used PrEP wanted to start taking it. Among MSM for whom state guidelines recommend PrEP, 31% were taking it. In multivariable analysis, current PrEP use was associated with older age, higher education, and meeting indications for PrEP use. Our data suggest that 20% of PrEP users discontinue within 12 months, and men with lower educational attainment were more likely to discontinue.

CONCLUSIONS: Despite high levels of use, there is significant unmet need for PrEP in Washington. Our experience indicates that internet surveys are feasible and informative for monitoring PrEP use in MSM.