High Interest in a Long-Acting Injectable Formulation of Pre-Exposure Prophylaxis for HIV in Young Men Who Have Sex with Men in NYC: A P18 Cohort Substudy

Abstract

ObjectiveIn the context of continued high rates of condomless anal intercourse and HIV-1 infection, young men who have sex with men (YMSM) need additional effective and desirable HIV prevention tools. This study reports on the willingness of a racially-ethnically diverse cohort of YMSM to use a new biomedical prevention approach, a long-acting injectable pre-exposure prophylaxis (LAI-PrEP) agent.MethodsA cross-sectional study conducted between June-August 2013 recruited participants from an ongoing cohort study of YMSM in NYC. Participants included 197 YMSM, of whom 72.6% (n = 143) identified as men of color. Two outcomes were measured through computer-assisted self-interviews: 1) willingness to use long-acting injectable PrEP and 2) preference for route of administration of PrEP. In addition, concerns about perceived impacts of PrEP on health and risk behavior, access to health services, and stigma were investigated.ResultsOver 80% (n = 159/197, p<0.001) of participants stated they would be willing to use LAI-PrEP. With regards to preference for mode of delivery 79.2% (n = 156/197, p<0.001) stated they would prefer an injection administered every three months over a daily pill or neither one.ConclusionsThis study is the first to explore acceptability of LAI-PrEP in the US. A significant majority of participants expressed willingness to use LAI and the majority preferred LAI-PrEP. LAI-PrEP holds great promise in that it could circumvent the adherence challenges associated with daily dosing, especially if nested within appropriate psycho-behavioral support. Medical providers whose patients include YMSM at high risk for HIV infection should note the positive attitudes toward PrEP, and specifically LAI-PrEP.

Antiretroviral pre-exposure prophylaxis preferences among men who have sex with men in Vietnam: results from a nationwide cross-sectional survey

“…Although there is a large body of literature concerning acceptability of daily oral PrEP globally, considerably less research has considered acceptability of newer alternative modalities of PrEP delivery. 16,18,21,23,32–34 Previous studies in the United States 35 , Thailand 25 , and Peru 18,36 have demonstrated acceptability of rectal microbicides for HIV prevention among MSM. The results of the current study indicate that PrEP implementation programs in Vietnam may benefit from offering a variety of PrEP modalities, should they be shown to be effective.…”

“…14,15 Among MSM, drug levels consistent with taking FTC/TDF four or more times per week have been shown to be highly effective in protecting .against HIV. 13 Recently, there has been increasing interest in alternative modalities of PrEP delivery, including long-acting injectable PrEP 16 and rectal microbicides, delivered as gels. 17,18 Long-acting injectables are being developed with a once-quarterly injection schedule that has been shown in macaques to maintain suitable drug levels for protection against HIV.…”

“…For example, long acting injectables may have benefits in terms of adherence, by eliminating the need to remember to take a pill everyday. 16 Rectal microbicidal gels could be associated with increased adherence because of the frequent use of lubricants during anal intercourse. However, although the acceptability of daily oral PrEP has been established in multiple settings 20–23 , there are relatively fewer studies assessing acceptability of long-acting injectables 16 and rectal microbicides.…”

“…16 Rectal microbicidal gels could be associated with increased adherence because of the frequent use of lubricants during anal intercourse. However, although the acceptability of daily oral PrEP has been established in multiple settings 20–23 , there are relatively fewer studies assessing acceptability of long-acting injectables 16 and rectal microbicides. 18,24–27 Ultimately, it is likely that different PrEP modalities will be suitable for different individuals, and that a suite of options may allow for maximum population level benefit.…”

HIV Risk Behaviors, Perceptions, and Testing and Preexposure Prophylaxis (PrEP) Awareness/Use in Grindr-Using Men Who Have Sex With Men in Atlanta, Georgia

“…For example, in a sample of 197 young MSM in New York City, 79.2% favored a long-acting injectable form of PrEP every 3 months over a daily pill (Meyers et al, 2014). Additionally, recent clinical trials in the United Kingdom (McCormack et al, 2015) and France (Molina et al, 2015) noted that both daily and intermittent dosing of the medication were effective in reducing the incidence of HIV, compared to placebo groups.…”