(PS6-58) Validation of the PrEP Use Self-Efficacy (PrEP-USE) Scale among Sexual Minority Men in the United States

Sexual minority men (SMM) face high rates of HIV including nearly 70% of the 30,000 new HIV cases documented in the United States (U.S.) in 2022. Self-efficacy is integral to SMM’s adherence to biomedical tools for HIV prevention such as pre-exposure prophylaxis (PrEP). Key factors associated with PrEP self-efficacy among SMM include adhering to a medication routine, confidence in overcoming perceived challenges, and self-confidence in remaining engaged in the PrEP-care continuum. Although existing measures assessing PrEP self-efficacy focus on these factors individually, few studies have assessed them holistically. Therefore, this study addressed this gap by validating the PrEP Use Self-Efficacy (PrEP-USE) scale via a multidimensional approach in the context of the PrEP continuum of care.
PrEP prescribed SMM (N=300) currently facing at least one psychosocial syndemic problem (e.g., depression, anxiety, substance use, childhood sexual abuse, etc.) were recruited to participate in a RCT to test the efficacy of a stepped-care PrEP adherence intervention. SMM responded to measures assessing PrEP-use self-efficacy, which were developed by the current study team. Additional measures assessed PrEP adherence and other PrEP-related variables, including attitudes, stigma, and both subjective (disclosing PrEP use) and descriptive (how they perceive their community’s acceptance of PrEP) norms. Authors conducted exploratory factor analysis (EFA) to examine the structure of the PrEP-USE measure. Regression models examined PrEP-related correlates of adherence, while Pearson’s correlations assessed the PrEP-USE scale’s construct validity by linking it to outcome measures.
EFA fit indices (χ² (25) = 25.98, p = 0.409), CFI (0.999), and RMSEA (0.011) indicated acceptable model fit, and factor loadings, along with Cronbach's alphas, which demonstrated good internal consistency for the scale. The factors identified represent three distinct domains of PrEP use self-efficacy: “Challenges” captured psychological and situational barriers, “Management” reflected engagement with PrEP-related medical appointments, and “Routine” represented adherence consistency. The Challenges factor was associated with PrEP adherence (b = 1.09, p < 0.01) and correlated with all PrEP-related variables (p < 0.01) while the Routine factor was associated with PrEP adherence (b= 2.42, p < 0.001) and only correlated with PrEP attitudes (p < 0.01). The Management factor was correlated with all the PrEP-related variables (p < 0.01), but not general PrEP adherence.
The PrEP use scale identified routine adherence and overcoming psychological/situational barriers as factors associated with PrEP adherence. Therefore, cognitive-behavioral interventions may improve HIV prevention efforts among SMM by addressing modifiable factors such as PrEP self-efficacy. Specifically, incorporating problem-solving techniques may help address barriers faced by SMM with lower self-efficacy in taking PrEP as prescribed. This measure not only identifies different dimensions of confidence in PrEP use, but it could also inform development and implementation of tailored prevention strategies to improve both PrEP self-efficacy and adherence.