Recent HIV Risk Behavior and Partnership Type Predict HIV Pre-Exposure Prophylaxis Adherence in Men Who Have Sex with Men

Abstract

Men who have sex with men (MSM) reporting higher HIV risk behavior over time are often more adherent to pre-exposure prophylaxis (PrEP), but it is unclear if recent risk behavior and partnership type affect long-term PrEP adherence. HIV-negative MSM and transgender women completing the 48-week randomized study TAPIR (Daily Text Messages to Support Adherence to PrEP in At-Risk for HIV Individuals) were included. At baseline and weeks 24 and 48, a modified Calculated Risk (mCalcR) Score estimated the likelihood of HIV seroconversion over 1 year based on reported condomless anal sex acts in the last month and current sexually transmitted infection. mCalcR scores were categorized as low, moderate, and high/very high risk. Partnership type was classified as no partner/single HIV-negative partner (no/single-), single HIV-positive partner (sin-gle+), or multiple partners of any serostatus (multi) in the past 3 months. PrEP adherence was measured by intracellular tenofovir-diphosphate (TFV-DP) levels. Among 313 individuals, there was no difference in mCalcR category from baseline to week 48. There was a significant change in partnership type, with no/single partnerships increasing from 0.5% to 9%. Participants with moderate and high/very risk had higher TFV-DP levels than the low-risk group. No/single participants had lower TFV-DP levels than those reporting single+ or multi. Although there was a shift toward lower-risk partnerships, HIV risk category remained stable over time. Individuals with riskier behaviors and partnerships had higher PrEP drug levels, suggesting continued motivation for and adherence to PrEP.

Randomized Trial of Individualized Texting for Adherence Building (iTAB) Plus Motivational Interviewing for PrEP Adherence in Transgender Individuals: The iM-PrEPT Study

“…Our previous work has found that those with higher HIV risk behaviors have better adherence. 25 This could account for some of the somewhat lower adherence seen in this study, but there may be many other contributing factors for transgender individuals to adherence that need to be further analyzed. The MI intervention was delivered through phone by 1 coordinator to all study sites to be cost-effective and to ensure fidelity.…”

The Potential of Telecommunication Technology to Address Racial/Ethnic Disparities in HIV PrEP Awareness, Uptake, Adherence, and Persistence in Care: A Review

“…Results from each primary study are summarized in Table 1 [ 17 – 31 ]. Findings from four additional secondary analyses of the Moore et al primary study [ 17 , 18 , 22 , 27 , 28 ] are summarized in Table 1 . Two studies [ 19 , 20 ] (20%) used e-health platforms and focused on patient awareness and acceptability of PrEP, three studies [ 23 , 29 , 31 ] (30%) used telehealth and focused on uptake, adherence and persistence in PrEP, and five studies [ 21 , 24 – 27 ] (50%) were mHealth primarily focused on adherence to PrEP.…”

“…30% reported a decrease in barriers. Participants self-reported mean PrEP adherence rates of 91% through daily entries in the mSMART app Moore et al (2017) [ 27 ] Adherence to PrEP Urban N = 398 Asian = 12 (6.2%); Black = 52 (13.1%); White = 295 (74.1%); Multiple = 24 (6.0%); Other = 7 (1.8%) Hispanic Ethnicity = 119 (29.9%) Cisgender men, transgender women MSM Adults: ≥ 18 years No The text messaging intervention did not significantly improve adequate adherence (≥ 719 fmol/punch) compared to the SOC (72.0% vs 69.2%; p = 0.58), but did improve near-perfect adherence (≥ 1246 fmol/ punch) a secondary outcome, through week 48 (33.5% vs 24.8%, p = 0.06) Secondary analysis studies • Blumenthal et al (2019) [ 17 ]—Analysis found the correlation between self-report measures of adherence were significant associated with quantifiable biomarker collected • Blumenthal et al (2019) [ 18 ]—Study calculated modified calculated risk scores to estimate likelihood of HIV seroconversion based on self -reported risk behaviors. Analysis found participants with moderate or high-risk behaviors had higher PrEP adherence levels compared to lower risk groups • Hoenigl et al (2018) [ 22 ]—No statistical difference was found in PrEP adherence among substance users compared to non substance users • Pasipanodya et al (2018) [ 28 ]—growth mixture modeling to identify 4 trajectories of text-reported adherence.…”

“…• Blumenthal et al (2019) [ 18 ]—Study calculated modified calculated risk scores to estimate likelihood of HIV seroconversion based on self -reported risk behaviors. Analysis found participants with moderate or high-risk behaviors had higher PrEP adherence levels compared to lower risk groups…”