Introduction
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 init...