@article{Karakosta:2026:10.1111/hiv.70222,
author = {Karakosta, A and Nicholls, EJ and Coukan, F and Nugent, D and Reeves, I and Waters, L and Fidler, S and Burga, ER and Fox, J and Uriel, A and Nicholls, J and Mackintosh, C and Tariq, S and Burns, F and for, CASCADE Collaboration},
doi = {10.1111/hiv.70222},
journal = {HIV Med},
title = {Missed opportunities to prevent HIV acquisition with pre-exposure prophylaxis: A mixed methods study of people with recently acquired HIV in the United Kingdom.},
url = {http://dx.doi.org/10.1111/hiv.70222},
year = {2026}
}

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TY  - JOUR
AB  - OBJECTIVES: To explore missed opportunities for PrEP use among people with recently acquired HIV in the United Kingdom. METHODS: Data were derived from CASCADE, an international, longitudinal, mixed-methods study of adults (≥16 years) with recently acquired HIV (≤12 months). Individuals were recruited from nine UK clinics (08/2022-09/2024) to self-complete a questionnaire; a subset participated in semi-structured interviews (SSIs). RESULTS: 46 questionnaires were completed (39 cisgender men and 7 women, including 2 transgender women) and 11 SSIs (1 cisgender woman). Among men, 22 perceived HIV risk before diagnosis; 21 had ≥5 sexual partners and 17 reported group sex in the 3 months before diagnosis. Thirty (29 men and 1 woman) reported sexualized drug use. Twenty men had ever used PrEP; seven of them had not used it in the 6 months prior to diagnosis. No women had ever used PrEP. Most gay, bisexual and other men who have sex with men (GBMSM) were aware of PrEP; however, risk perception, social meanings of PrEP and concerns about side effects hindered utilization. Among five men using event-based dosing (EBD), three described difficulty predicting sexual activity that led to missed or mistimed pre-/post-sex doses - while others were reluctant to take daily PrEP. For women, the biggest barrier was lack of awareness. CONCLUSIONS: PrEP barriers vary by population. For GBMSM, addressing barriers to uptake/adherence (e.g., EBD challenges) are key, highlighting the potential benefit of long-acting injectables. However, awareness of PrEP remains a key challenge for women to achieve equity in prevention.
AU  - Karakosta,A
AU  - Nicholls,EJ
AU  - Coukan,F
AU  - Nugent,D
AU  - Reeves,I
AU  - Waters,L
AU  - Fidler,S
AU  - Burga,ER
AU  - Fox,J
AU  - Uriel,A
AU  - Nicholls,J
AU  - Mackintosh,C
AU  - Tariq,S
AU  - Burns,F
AU  - for,CASCADE Collaboration
DO  - 10.1111/hiv.70222
PY  - 2026///
TI  - Missed opportunities to prevent HIV acquisition with pre-exposure prophylaxis: A mixed methods study of people with recently acquired HIV in the United Kingdom.
T2  - HIV Med
UR  - http://dx.doi.org/10.1111/hiv.70222
UR  - https://www.ncbi.nlm.nih.gov/pubmed/41856044
ER  - 

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