Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men

Hoenigl, Martin; Hassan, Adiba; Moore, David J.; Anderson, Peter L.; Corado, Katya; Dubé, Michael P.; Ellorin, Eric; Blumenthal, Jill; Morris, Sheldon R.

doi:10.1097/qai.0000000000002003

Cited by 16 publications

(11 citation statements)

References 36 publications

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“…Thus, HIV screening programs in San Diego specifically have been shown to be successful in both decreasing HIV diagnoses in the area, and terminating transmission chains where the program was marketed 4,6,15 . The low rate of 0.26% new HIV diagnoses that we observed in our ED HIV screening program may therefore be explained by the high density of free-of-charge HIV screening programs, and potentially also by increasing use of HIV pre-exposure prophylaxis in high risk individuals 19–21 .…”

Section: Discussionmentioning

confidence: 85%

Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

Hoenigl

Mathur

Blumenthal

et al. 2019

Sci Rep

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Universal HIV and HCV screening in emergency departments (ED) can reach populations who are less likely to get tested otherwise. The objective of this analysis was to evaluate universal opt-out HIV and HCV screening in two EDs in San Diego. HIV screening for persons aged 13–64 years (excluding persons known to be HIV+ or reporting HIV testing within last 12 months) was implemented using a 4th generation HIV antigen/antibody assay; HCV screening was offered to persons born between 1945 and 1965. Over a period of 16 months, 12,575 individuals were tested for HIV, resulting in 33 (0.26%) new HIV diagnoses, of whom 30 (90%) were successfully linked to care. Universal screening also identified 74 out-of-care for >12-months HIV+ individuals of whom 50 (68%) were successfully relinked to care. Over a one-month period, HCV antibody tests were conducted in 905 individuals with a seropositivity rate of 9.9% (90/905); 61 seropositives who were newly identified or never treated for HCV had HCV RNA testing, of which 31 (51%) resulted positive (3.4% of all participants, including 18 newly identified RNA positives representing 2% of all participants), and 13/31 individuals (42%) were linked to care. The rate of newly diagnosed HCV infections exceeded the rate of newly diagnosed HIV infections by >7-fold, underlining the importance of HCV screening in EDs.

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Section: Discussionmentioning

confidence: 85%

Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

Hoenigl

Mathur

Blumenthal

et al. 2019

Sci Rep

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“…Some sources report chemsex users as having relatively controlled drug use and maintaining safe sex strategies whilst under the influence of chemsex drugs (Graf, Dichtl, Deimel, Sander & Stover, 2018), or completely compartmentalising chemsex from the rest of their lives (Ahmed et al., 2016), suggesting that daily PrEP adherence around chemsex events can be achievable. A follow-up study of the TAPIR PrEP trial also found “less problematic” substance use to be a significant predictor of adequate adherence (Hoenigl, Hassan et al., 2019) and a recent study among Australian GBM has reported increased concurrent use of methamphetamines, Viagra and Truvada Ⓡ -PrEP, demonstrating how PrEP can be added alongside chemsex drug use to mitigate against HIV risk (Hammoud et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Another American GBM study found similar associations with instances of “club drug” use (including GHB and methamphetamine) being correlated with missed PrEP doses on the same day (Grov, Rendina, John, & Parsons, 2018). Conversely, the same research also suggested that on average “club drug” users were no more likely to miss PrEP doses than non “club drugs” users (Grov, Rendina, John, & Parsons, 2018), and in another study among American GBM, methamphetamine use was shown not to be associated with decreased PrEP adherence (Hoenigl et al., 2019, Hoenigl et al, 2019). Interestingly, in an IPERGAY trial substudy, GBM reporting chemsex were more likely to report correct PrEP use during their most recent sexual encounter, which authors have explained by their additional finding that participants reporting chemsex also reported having a higher risk perception (Roux et al., 2018).…”

Section: Introductionmentioning

confidence: 94%

Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

O’Halloran

Rice

White

et al. 2019

International Journal of Drug Policy

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BackgroundPre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants.MethodsThe PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(<7/7ID) in the 7 days before and/or after last condomless anal intercourse(CAI).Results1479 follow-up visit forms and 2260 monthly adherence forms from 388 participants were included in the analyses, with 38.5% visit forms reporting chemsex since last visit and 29.9% follow-up periods reporting <7/7ID. No statistically significant associations were observed between reporting <7/7ID and chemsex (aOR=1.29 [95% CI 0.90–1.87], p = 0.168). Statistically significant associations were seen between reporting <7/7ID and participants perceiving that they would miss PrEP doses during the trial, Asian ethnicity, and reporting unemployment at baseline.ConclusionsThese analyses suggest PrEP remains a feasible and effective HIV prevention method for GBM engaging in chemsex, a practise which is prevalent in this group and has been associated with increased HIV transmission risk.

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“…Meeting partners over Grindr™ or other geosocial networking apps may also facilitate serostatus disclosure, serosorting, negotiation regarding condom usage, discussion of sexual practices and user risk-assessment, therefore lowering overall risk [6,12,13]. Although Grindr may also serve as a forum to discuss HIV the use of pre-exposure prophylaxis (PrEP) [14] among Grindr™ users remains a under-explored topic [15].…”

Section: Introductionmentioning

confidence: 99%

Grindr Users Take More Risks, but Are More Open to Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis: Could This Dating App Provide a Platform for HIV Prevention Outreach?

Hoenigl

Grelotti

Skaathun

et al. 2019

Clinical Infectious Diseases

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Background Technology has changed the way men-who-have-sex-with-men (MSM) seek sex. Over 60% of MSM in the US use the internet and/or smartphone-based geospatial networking apps to find sex partners. We correlated use of the most popular app (Grindr™) with sexual risk and prevention behavior among MSM. Methods A nested cohort study was conducted between September 2018 and June 2019 among MSM receiving community-based HIV and STI screening in central San Diego. During the testing encounter, participants were surveyed for demographics, substance use, risk behavior (previous 3 months), HIV pre-exposure prophylaxis (PrEP) use, and Grindr™ usage. Participants who tested negative for HIV and who were not on PrEP were offered immediate PrEP. Results The study included 1,256 MSM, 1,090 of whom (86.8% percent) were not taking PrEP. Overall, 580/1,256 (46%) participants indicated that they used Grindr™ in the previous 7 days. Grindr™ users reported significantly higher risk behavior (greater number of male partners and condomless sex) and were more likely to test positive for chlamydia or gonorrhea (8.6% vs. 4.7% of non-users; p=0.005). Grindr™ users were also more likely to be on PrEP (18.7% vs. 8.7% of non-users; p<0.001) and had fewer newly diagnosed HIV infections (9 vs. 26 among non-users; p=0.014). Grindr™ users were also nearly twice as likely as non-users to initiate PrEP (24.6% vs. 14%; p<0.001). Conclusion Given the higher risk behavior and greater acceptance of PrEP among MSM who used Grindr™, Grindr™ may provide a useful platform to promote HIV and STI testing and increase PrEP uptake.

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Predictors of Long-Term HIV Pre-exposure Prophylaxis Adherence After Study Participation in Men Who Have Sex With Men

Cited by 16 publications

References 36 publications

Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

Universal HIV and Birth Cohort HCV Screening in San Diego Emergency Departments

Chemsex is not a barrier to self-reported daily PrEP adherence among PROUD study participants

Grindr Users Take More Risks, but Are More Open to Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis: Could This Dating App Provide a Platform for HIV Prevention Outreach?

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