Inaccurate HIV risk perception by men who have sex with men (MSM) is a barrier to HIV prevention. Providing information about objective HIV risk could improve preexposure prophylaxis (PrEP) uptake.
PrEP Accessibility Research & Evaluation 2 (PrEPARE2) was a randomized controlled trial of MSM to determine if an objective risk score affects future PrEP uptake. Participants completed a baseline survey to assess demographics, risk behaviors and HIV self-perceived risk (SPR). The survey generated a calculated HIV risk score (CalcR), estimating HIV risk based on reported condomless anal intercourse and sexually transmitted infections, and was provided to individuals in the intervention arm. Participants were contacted 8 weeks later to determine if they initiated PrEP.
Of 171 participants (median age 32; 37% Hispanic or Non-Hispanic Black; median 5 sexual partners in past 6 months), 81% had heard of PrEP, and 57% thought they were good PrEP candidates. SPR had poor agreement with CalcR (kappa=0.176) with 38% underestimating their HIV risk. At week 8, only 14 of 135 participants had initiated PrEP with no difference between arms (CalcR 11%, control 10%, p>0.99). The most common reason for not starting PrEP was low HIV risk perception. There was a relative decrease in SPR over time (p=0.06) but no difference between arms (p=0.29).
Providing an objective HIV risk score alone did not increase PrEP uptake. HIV testing performed at testing sites may be a crucial time to correct misperceptions about risk and initiate same-day PrEP given enthusiasm for PrEP on testing day to facilitate greater uptake.