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Pre-Exposure Prophylaxis Care Continuum, Barriers, and Facilitators among Black Men Who Have Sex with Men in the United States: A Systematic Review and Meta-Analysis

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Abstract

Pre-exposure prophylaxis (PrEP) represents a viable HIV prevention tool for black men who have sex with men (BMSM). However, aggregated evidence regarding the presentations and determinants of the PrEP continuum (e.g., awareness, willingness, intention, uptake and adherence) remains absent to empirically inform future intervention efforts. We meta-analytically summarized the prevalence and qualitatively synthesized key barriers/facilitators of the stages of the PrEP continuum among a pooled sample of 42,870 BMSM aggregated from 56 published studies. Our random-effect models indicated a pooled prevalence of PrEP awareness (50.8%, 95% CI: 43.6–58.0%, willingness/intention (58.2%, 95% CI: 52.0–68.1%) and uptake (15.5%, 95% CI: 12.8–18.2%). Qualitative summary revealed that perception of HIV risk, intersectional/PrEP-related stigma and medical mistrust were among the most quoted factors that influence PrEP use. BMSM remain underrepresented in key stages of the PrEP continuum. Futures interventions are continuously needed to target multilevel barriers/facilitators to enhance the PrEP continuum among BMSM.

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  1. Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, BOX 420644, Rochester, NY, 14642, USA

    Savanah Russ & Yu Liu

  2. School of Nursing, University of Rochester Medical Center, Rochester, NY, USA

    Chen Zhang

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Russ, S., Zhang, C. & Liu, Y. Pre-Exposure Prophylaxis Care Continuum, Barriers, and Facilitators among Black Men Who Have Sex with Men in the United States: A Systematic Review and Meta-Analysis. AIDS Behav 25, 2278–2288 (2021). https://doi.org/10.1007/s10461-020-03156-x

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