Pre-exposure Prophylaxis Uptake and Discontinuation Among Young Black Men Who Have Sex With Men in Atlanta, Georgia: A Prospective Cohort Study

Abstract

Background Human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has great potential to reduce HIV incidence among young black men who have sex with men (YBMSM); however, initiation and persistence for this group remain low. We sought to understand the patterns and predictors of PrEP uptake and discontinuation among YBMSM in Atlanta, Georgia. Methods PrEP was offered to all participants in a prospective cohort of YBMSM aged 18–29 years not living with HIV. Time to PrEP uptake, first discontinuation, and final discontinuation were assessed using the Kaplan-Meier method. Cox proportional hazard models were used to identify predictors of uptake and discontinuation. Results After 440 person-years of follow-up, 44% of YBMSM initiated PrEP through the study after a median of 122 days. Of PrEP initiators, 69% had a first discontinuation and 40% had a final discontinuation during the study period. The median time to first PrEP discontinuation was 159 days. Factors associated with PrEP uptake included higher self-efficacy, sexually transmitted infection (STI), and condomless anal intercourse. Factors associated with discontinuation included younger age, cannabis use, STI, and fewer sex partners. HIV incidence was 5.23/100 person-years (95% confidence interval [CI], 3.40–7.23), with a lower rate among those who started PrEP (incidence rate ratio, 0.39; 95% CI, .16–.92). Conclusions Persistent PrEP coverage in this cohort of YBMSM was suboptimal, and discontinuations were common despite additional support services available through the study. Interventions to support PrEP uptake and persistence, especially for younger and substance-using YBMSM, are necessary to achieve full PrEP effectiveness. Clinical Trials Registration NCT02503618.

National trends in HIV pre‐exposure prophylaxis awareness, willingness and use among United States men who have sex with men recruited online, 2013 through 2017

“…However, unless that misclassification was differential by year, our conclusions about the trends and direction of changes in our outcomes should be valid. We did not collect data on PrEP persistence, which is a critical threat to the population‐level impact of PrEP on averting new HIV infections . The proportion of our respondents who were PrEP‐eligible was 51%, whereas CDC estimates that about 25% of MSM overall are PrEP‐eligible .…”

Lack of health insurance is associated with delays in PrEP initiation among young black men who have sex with men in Atlanta, US: a longitudinal cohort study

“…All uninsured participants pursued access to PrEP through the MAP. Other covariates identified in previous analyses as contributing to PrEP uptake and/or persistence including cannabis use, STIs and self‐efficacy were assessed . Cannabis use was defined by a composite of self‐reported use in the prior 6 months or a positive urine drug screen.…”

“…A Cox proportional hazards model was used to estimate the adjusted association between insurance status and time to PrEP initiation. Potential confounders were chosen a priori based on hypothesized causal pathways and prior analyses from this cohort . All covariates were included in the final model.…”

Highly synergistic drug combination prevents vaginal HIV infection in humanized mice

“…Pre-exposure prophylaxis (PrEP) against HIV-1 using an oral regimen of the antiretroviral (ARV) agents tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has been initiated in numerous countries around the world 5 , but discontinuation is high in multiple populations [6][7][8][9] . The future success of HIV-1 PrEP depends on a broad range of product choices being available to end-users.…”