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To the Editors:
Many thanks to Dr. Clement et al for their interest in our brief report, which highlighted the disparate uptake of HIV preexposure prophylaxis (PrEP) by populations that are most affected by the HIV epidemic, in particular black men who have sex with men (MSM) in the United States Deep South. In our brief report, it was emphasized that community-based support systems, as well as, targeted messaging, and novel strategies may be necessary to increase uptake of HIV preexposure prophylaxis (PrEP) in this high-risk population. As evident by our primary referral source, most patients in our cohort were referred by a sexual partner (34%) or health care provider (21%), and not by a community-based organization (8%). This likely contributed to our initial HIV preexposure prophylaxis (PrEP) cohort demographics, with under-representation of black MSM.
The authors of this letter provide proof of concept that partnerships with community-based organizations can be extremely successful as a referral source for black patients, whereas relying on self-referrals and/or PCP referrals may not result in patient demographics reflective of the current epidemic. We are similarly relying on strong partnerships with community agencies and local health departments to leverage existing relationships within the community to increase uptake of PrEP among black MSM in our Southern state. Moreover, we are actively working with clinical, community, and public health partners across the state to provide awareness, education, and technical assistance in developing and implementing PrEP service delivery programs in traditional clinical settings, as well as alternative community-based venues. Qualitative studies we have conducted with black MSM have suggested that novel, nontraditional venues for PrEP delivery may be preferable and enhance the uptake of this biomedical prevention tool (Elopre, unpublished data, 2017). We feel that there is an urgent need for more public health and implementation science research to identify best practices for targeted outreach to increase uptake of PrEP among those in greatest need to prevent further amplification of HIV health disparities, which are particularly magnified in the Deep South among black MSM.
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