Impact of geographic mobility on pre-exposure prophylaxis and HIV care outcomes

HIV continues to be a major public health concern for men who have sex with men in the U.S. Men who have sex with men who have high mobility are a key group susceptible to HIV acquisition and transmission. They are more likely to receive delayed HIV diagnoses and to be uninsured/underinsured, in addition to facing obstacles to care. For example, they face diminished proximity to pre-exposure prophylaxis and HIV service navigation services and reduced access to properly tailored pre-exposure prophylaxis and HIV care, creating an increasingly invisible HIV burden. Geographic mobility has been shown to enhance HIV susceptibility and adversely impact HIV care and treatment in people living with HIV, yet there is limited data on how geographic mobility impacts pre-exposure prophylaxis and HIV care outcomes among men who have sex with men who have high mobility in the U.S. Further, geographic mobility may lead to positive outcomes, as people may travel for better access to HIV prevention and care services, or move toward better support networks or away from negative beliefs about HIV and pre-exposure prophylaxis in their communities. To address the knowledge gap regarding the impact of geographic mobility for men who have sex with men who are mobile on pre-exposure prophylaxis and HIV care outcomes and to inform future interventions, the Specific Aims for this exploratory proposal are: Aim 1: To characterize patterns of geographic mobility in the past 3 years, including destinations, temporality (including duration, frequency, or seasonality), purpose, and level of planning over travel among 40 men who have sex with men not living with HIV (on/not on pre-exposure prophylaxis) and 40 living with HIV (on/not on antiretroviral therapy) in New York City using qualitative in-depth interviews and mobility maps. Aim 2: To determine how past-year geographic mobility impacts pre-exposure prophylaxis care outcomes (initiation/adherence, retention and persistence in care) and HIV care outcomes (antiretroviral therapy initiation/adherence, retention in care, and viral suppression) longitudinally over 12 months. We will ensure a range of men who have sex with men experiences are included, by purposive sampling by: living with and without HIV and mobility history (i.e., locations, recency). Our approach is innovative, as it examines the impact of geographic mobility on pre-exposure prophylaxis and HIV care outcomes among men who have sex with men who have been affected by HIV, applies mobility maps in a novel way, and has potential to inform future design of interventions to improve pre-exposure prophylaxis and HIV care outcomes in this population.