Motivational PrEP cascade math
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TABLE 1. Overall Progression Through Each Stage of the Motivational PrEP Cascade
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Relative to Previous M
Each stage contains onl
ajor Stage†
y those men who met the criteria for the prior stage.
Additional Ratios of Interest
Denominator is different for each ratio, refer to column title; each value is listed below in italics and references the original n at that stage or sub-stage.
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Stagen
% of prev major stage
Interpretation% lost
% of sample
% of HIV-/active (1a)
% of HIV-/active/cand (1)
% of willing (2a)
% of willing & self-ID'd (2)
% of indending (3b)
% of spoken to prvd (4a)
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995887636419301173107
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All: HIV-negative gay and bisexual men (GBM)
995100.0%100.0112.2156.4237.5330.6575.1929.9
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Stage 1: Objective identification63663.9%
HIV- GBM (all) who are HIV-/active (1a) AND candidates (1b)
36.163.971.7100.0151.8211.3367.6594.4
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Stage 1a: HIV-negative and sexually active with men
88789.1%HIV- GBM (all) who are HIV-/active (1a)10.989.1100.0139.5211.7294.7512.7829.0
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Stage 1b: PrEP candidate using modified CDC criteria
64264.5%HIV- GBM (all) who are candidates (1b)35.564.572.4100.9153.2213.3371.1600.0
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Stage 2: PrEP contemplation30147.3%
obj candidates (1) who are willing (2a) AND self-ID'd (2b)
33.730.333.947.371.8100.0174.0281.3
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Stage 2a: willing to take PrEP41965.9%obj candidates (1) who are willing (2a)21.842.147.265.9100.0139.2242.2391.6
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Stage 2b: self-identified as PrEP candidate34654.4%obj candidates (1) who are self-ID'd (2b)29.134.839.054.482.6115.0200.0323.4
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Stage 3: PrEParation15250.5%
contemplating (2) who have provider (3a) AND intend (3b)
15.015.317.123.936.350.587.9142.1
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Stage 3a: has potential PrEP provider24481.1%contemplating (2) who have provider (3a)5.724.527.538.458.281.1141.0228.0
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Stage 3b: intending to take PrEP17357.5%contemplating (2) who intend (3b)12.917.419.527.241.357.5100.0161.7
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Stage 4: PrEP action and initiation8253.9%
prepared (3) who spoke to provd (4a) AND prescribed (4b)
7.08.29.212.919.627.247.476.6
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Stage 4a: spoken to a medical provider about PrEP10770.4%prepared (3) who spoke to a provider (4a)4.510.812.116.825.535.561.8100.0
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Stage 4b: currently prescribed PrEP8253.9%prepared (3) who were prescribed (4b)7.08.29.212.919.627.247.476.6
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Stage 5: PrEP maintenance and adherence5870.7%
acted/initiated (4) who maintain (5a) AND test (5b)
2.45.86.59.113.819.333.554.2
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Stage 5a: maintaining 4+ doses per week8097.6%acted/initiated (4) who maintain 4+ doses/wk (5a)0.28.09.012.619.126.646.274.8
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Stage 5b: returning for quarterly testing5972.0%acted/initiated (4) who return for quarterly testing (5b)2.35.96.79.314.119.634.155.1
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^only 47.3% of candidates were willing and self-ID'd†Participants must meet criteria for both sub-stages in order to reach the full stage, hence the lower numbers who achieve the higher-order stage than each sub-stage.red = most % lost/
most opportunity
^only 6.5% of HIV-/sexually active GBM ultimately used and adhered to PrEP^only 9.1% of HIV-/sexually active GBM who were candidates ultimately used and adhered to PrEP^only 50.5% of willing/self-ID'd had a potential provider and intended to take PrEP^only 76.6% who spoke to provider ended up getting a prescription
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^only 70% of prescriptions led to 4+/wk + qtrly tests^52.7% of HIV-/active candidates STOP the cascade because they are NOT WILLING (OR) do NOT REALIZE they are candidates^81.1% of willing/self-ID'd had potential provider^only 54.2% who spoke to provider then adhered (maintained 4+ doses/week and returned to quarterly testing)
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^45.6% of HIV-/active candidates STOP the cascade because they do NOT REALIZE they are candidates^only 57.5 of willing/self-ID'd intended to take PrEP
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Source: Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States (2017)
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Sample: One Thousand Strong is a longitudinal study prospectively following a national cohort of HIV-negative GBM for 3 years
(details in Grov C, Cain D, Whitfield TH, et al. Recruiting a US National sample of HIV-negative gay and bisexual men to complete at-home self-administered HIV/STI testing and surveys: challenges and opportunities. Sex Res Social Policy. 2016;13:1–21.)
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