Open AccessPre‐exposure prophylaxis initiation and adherence among Black men who have sex with men ( MSM ) in three US cities: results from the HPTN 073 study
Author(s) -
Wheeler Darrell P,
Fields Sheldon D,
Beauchamp Geetha,
Chen Ying Q,
Emel Lynda M,
HightowWeidman Lisa,
HucksOrtiz Christopher,
Kuo Irene,
Lucas Jonathan,
Magnus Manya,
Mayer Kenneth H,
Nelson LaRon E,
Hendrix Craig W,
PiwowarManning Estelle,
Shoptaw Steven,
Watkins Phaedrea,
Watson C Chauncey,
Wilton Leo
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25223
Subject(s) - medicine , men who have sex with men , pre exposure prophylaxis , confidence interval , emtricitabine , odds ratio , demography , generalized estimating equation , human immunodeficiency virus (hiv) , casual , anal intercourse , family medicine , antiretroviral therapy , viral load , syphilis , statistics , materials science , mathematics , sociology , composite material
Randomized clinical trials have demonstrated the efficacy of antiretroviral pre‐exposure prophylaxis (Pr EP ) in preventing HIV acquisition among men who have sex with men ( MSM ). However, limited research has examined initiation and adherence to Pr EP among Black MSM ( BMSM ) in the United States ( US ) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 ( HPTN 073) study aimed to examine Pr EP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client‐centered care coordination (C4) model. Methods The HPTN 073 study enrolled and followed 226 HIV ‐uninfected Black MSM in three US cities (Los Angeles, CA ; Washington DC ; and Chapel Hill, NC ) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir ( FTC / TDF ) Pr EP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results Of the 226 men enrolled, 178 participants initiated Pr EP (79%), and of these 64% demonstrated Pr EP utilization at week 26 (mid‐point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV ‐infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of Pr EP initiation (adjusted odds ratio ( OR ) 4.4, 95% confidence interval ( CI ) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 –6.37), perception of having enough money ( OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking Pr EP before sex ( OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of Pr EP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated Pr EP , compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate Pr EP ( p = 0.18). Conclusions Results suggest a high level of Pr EP initiation among at‐risk Black MSM , a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect Pr EP initiation and adherence, and of additional research on the ultimate benefit of Pr EP in HIV prevention among Black MSM .