Exploring the HIV continuum of care among young black MSM

Abstract

BackgroundHIV disproportionately impacts young, black men who have sex with men (YBMSM) who experience disparities across the HIV care continuum. A more nuanced understanding of facilitators and barriers to engagement in care, missed visits, antiretroviral uptake, adherence and viral suppression could improve care and intervention design.MethodsA randomized controlled trial of an online intervention, healthMpowerment, enrolled 465 YBMSM (18–30 years); 193 identified as HIV-positive. Bivariable and multivariable analyses of baseline data explored predictors of: engagement in care, missed visits, antiretroviral uptake, self-reported adherence, and viral suppression.ResultsMean age was 24.9 years; most identified as gay (71.0%) and were receiving HIV care (89.1%). Among those in care, 52.1% reported no missed visits in the past 12 months, 41 (24.6%) reported one missed visit, and 39 (23.4%) reported two or more. Having insurance (prevalence odds ratio [POR] 4.5; 95% CI: 1.3, 15.8) and provider self-efficacy (POR 20.1; 95% CI: 6.1, 64.1) were associated with being in care. Those with a college degree (POR 9.1; 95% CI: 1.9, 45.2) and no recent marijuana (POR 2.6; 95% CI: 1.2, 5.6) or methamphetamine use (POR 5.4; 95% CI: 1.0, 28.5) were less likely to miss visits. Most (n = 153, 84.1%) had been prescribed antiretroviral therapy. A majority of participants (70.8%) reported ≥90% adherence; those with depressive symptoms had 4.7 times the odds of reporting adherence <90% (95% CI: 1.65, 13.37). Of participants who reported viral load testing in the past six months, 65% (n = 102) reported an undetectable viral load. Disclosure to sex partners was associated with viral suppression (POR 6.0; 95% CI: 1.6, 22.4).ConclusionsMulti-level facilitators and barriers to engagement across the continuum of care were identified in this sample of YBMSM. Understanding the distinct needs of YBMSM at each stage of the continuum and addressing them through tailored approaches is critical for long term success in care.

Pre‐exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study

“…Along with behavioural interventions , early HIV diagnosis and linkage to care and treatment , use of antiretroviral drugs as pre‐exposure prophylaxis (PrEP) is critical for the prevention of HIV acquisition . Clinical studies have demonstrated the efficacy of oral daily PrEP along with counselling in preventing HIV acquisition in MSM .…”

The Association Between Marijuana Use and HIV Continuum of Care Outcomes: a Systematic Review

“…There were no significant associations between marijuana use and ARV uptake, self-reported adherence, or viral suppression [35]. …”

Mind the Gap: HIV Prevention Among Young Black Men Who Have Sex with Men

“…However, studies have often focused on subgroups defined by age or race/ethnicity and rarely the intersection of these subgroups where YBMSM populations are positioned [14]. Further delineations of adolescent (13)(14)(15)(16)(17) and young adult (18)(19)(20)(21)(22)(23)(24) YBMSM communities are rarer still. Nevertheless, several factors described in existing studies may be important considerations for YBMSM.…”

“…The efficacy of TasP and U=U depends on an intact and robust HIV care continuum including early diagnosis, care linkage, engagement, and sustained viral suppression among people living with HIV. However, YBMSM living with HIV are often less likely to be diagnosed, engaged in care, or virally suppressed compared with other age and race/ethnicity subgroups [21][22][23][24]. Several studies have examined barriers and facilitators of treatment engagement, adherence, and viral suppression in this population [21,[25][26][27][28].…”