Examining the Role of Autonomy Support, Goal Setting, and Care Coordination Quality on HIV PrEP Adherence in Black Men Who Have Sex with Men: HPTN 073


Donte T. Boyd, College of Social Work, The Ohio State University, Columbus, Ohio, USA.
LaRon E. Nelson, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.
Mandy J. Hill, Department of Emergency Medicine, University of Texas Health Sciences Center at Houston, McGovern Medical School, Houston, Texas, USA.
Darren Whitfield, School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA.
S Raquel Ramos, Yale School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.
Samuel Akyirem, Yale School of Nursing, New Haven, Connecticut, USA.
Lynda Emel, Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Leo Wilton, State University of New York at Binghamton, Binghamton, New York, USA.
Lisa Hightow-Weidman, Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA.
Steve Shoptaw, Division of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Manya Magnus, Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
Kenneth H. Mayer, Fenway Health, The Fenway Institute, Boston, Massachusetts, USA.
Estelle Piwowar-Manning, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore Maryland, USA.
Stephaun E. Wallace, Vaccine and Infectious Disease Division, Fred Hutch, Seattle, Washington, USA.
Sheldon D. Fields, Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA.
Darrell P. Wheeler, State University of New York, New Paltz, New Paltz, New York, USA.

Document Type

Journal Article

Publication Date



AIDS patient care and STDs








Black MSM; HIV prevention; PrEP adherence; autonomy support


Autonomy support is a concept that is derived from self-determination theory. Autonomy refers to the freedom to act as one chooses. The current study aimed to examine if autonomy support was associated with dried blood spot validated pre-exposure prophylaxis (PrEP) adherence, and whether the association was mediated by PrEP adherence goal setting and progress toward PrEP adherence goals. Our sample was drawn from Black men who have sex with men (MSM) from across three cities (Chapel Hill, NC; Los Angeles, CA; and Washington, DC) in the United States between February 2013 and September 2014. We used logistic regression to evaluate associations between study variables and path analysis to test mediation effects. Participants were, on average, 28 [standard deviation () = 1.12] years old and 25% were unemployed. We found that MSM who experienced high autonomy support were more likely to adhere to PrEP [odds ratio (OR) = 1.17; 95% confidence interval: 1.00-1.38]. MSM who set PrEP adherence goals were more likely to adhere to PrEP. Moreover, MSM who reported making progress toward their goals were also more likely to adhere to PrEP. Finally, client perception of coordination quality enhanced the magnitude of the association between goal setting and goal progress and the effect size of goal progress on PrEP adherence. Autonomy support, goal setting, goal monitoring/evaluation, and care coordination quality influenced PrEP adherence among Black MSM. Our findings indicate that while it is important to set goals for PrEP adherence, goal setting may need to be accompanied by progress monitoring to achieve the maximal effect.