Threefold Increase in PrEP Uptake Over Time with High Adherence Among Young Men Who Have Sex With Men in Chicago

Morgan, Ethan; Moran, Kevin; Ryan, Daniel T.; Mustanski, Brian; Newcomb, Michael E.

doi:10.1007/s10461-018-2122-5

Cited by 48 publications

(31 citation statements)

References 27 publications

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“…These data represent the largest published sample ever used to evaluate the PrEP continuum among MSM in the United States and include data from MSM in rural areas and smaller cities (critical because the use of many prevention services is lower among rural MSM ), and men recruited through non‐sex‐seeking online venues. Our data extend the findings of the NHBS , and previous online studies recruited exclusively from online sex‐seeking websites or in specific US cities . Although these data are from a convenience sample and therefore have limited external generalizability, it is critical to triangulate data on PrEP use from multiple sources, in light of their limitations.…”

Section: Discussionsupporting

confidence: 59%

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

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is a key HIV prevention technology, and is a pillar of a comprehensive HIV prevention approach for men who have sex with men (MSM). Because there have been no national data to characterize trends in the PrEP continuum in the United States, overall and for key demographic groups of MSM, we aimed to describe the extent to which PrEP awareness, willingness and use changed over time, overall and for specific groups of MSM critical for HIV prevention (e.g. Black and Hispanic MSM, younger MSM, MSM in rural areas and MSM without health coverage). Methods The American Men's Internet Survey (AMIS) is an annual survey of US MSM conducted in the United States among MSM aged ≥15 years since 2013. We analysed data on trends in elements of the PrEP continuum (awareness, willingness and use of PrEP) in a sample of 37,476 HIV‐negative/unknown status MSM from December 2013 through November 2017. We evaluated trends in continuum steps overall and among demographic subgroups using Poisson models with Generalized Estimating Equations. For 2017 data, we used logistic regression to compare the prevalence of PrEP use among demographic groups. Results Overall, 51.4% (n = 19,244) of AMIS respondents were PrEP‐eligible across study years. Between 2013 and 2017, PrEP awareness increased from 47.4% to 80.6% willingness to use PrEP increased from 43.9% to 59.5% and PrEP use in the past 12 months increased from 1.7% to 19.9%. In 2017, use of PrEP was lower for men who were younger, lived outside of urban areas, and lacked health insurance; PrEP use was not different among Black, Hispanic and white MSM. Conclusions Our data show progress in use of PrEP among US MSM, but also reveal mismatches between PrEP use and epidemic need. We call for additional support of PrEP initiation, especially among young, non‐urban and uninsured MSM. Black and Hispanic MSM report levels of PrEP use no different from white MSM, but given higher HIV incidence for Black and Hispanic MSM, parity in use is not sufficient for epidemic control or health equity.

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Section: Discussionsupporting

confidence: 59%

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

et al. 2020

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“…With respect to the uptake rate of PrEP in our study, our findings are consistent with results documented in other settings in which PrEP uptake ranged between 60% and 93% [22][23][24] among MSM reporting condomless RAI [23] or condomless anal sex [25]. Although we did not find significant differences in PrEP eligibility at baseline compared to the end of the follow-up period in our study, four men became eligible during follow-up, highlighting the importance of period reassessments of HIV risk.…”

Section: Discussionsupporting

confidence: 91%

Assessment of PrEP eligibility and uptake among at-risk MSM participating in a HIV-1 vaccine feasibility cohort in coastal Kenya

Wahome

Graham

Thiong'o³

et al. 2019

Preprint

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Introduction Pre-exposure prophylaxis (PrEP) is provided free of costs to a broad range of at-risk populations in Kenya, including men who have sex with men (MSM), but anal intercourse is not an eligibility criterion. We set out to determine PrEP eligibility, uptake and predictors of PrEP uptake among MSM enrolled in an HIV-1 vaccine feasibility cohort in coastal Kenya. Methods We compared the number of MSM identified as eligible for PrEP from June - December 2017 by Kenyan Ministry of Health (MoH) criteria, which do not include reported anal intercourse, to those identified as eligible by a published MSM cohort-derived HIV-1 risk score (CDHRS). We determined PrEP uptake and assessed factors associated with PrEP uptake at first offer among eligible MSM followed up monthly for HIV-1 testing, risk assessment, and risk reduction counselling. Results Out of 167 MSM assessed for PrEP eligibility, 118 (70.7%) were identified by both MoH and CDHRS eligibility criteria. However, the CDHRS identified 33 (19.8%) more cohort MSM for PrEP eligibility than the MoH criteria, of whom the majority (24 or 72.7%) reported receptive anal intercourse (RAI). Of the 162 MSM eligible for PrEP, 113 (69.7%) accepted PrEP at first offer. Acceptance of PrEP was higher for men reporting RAI (adjusted prevalence ratio [aPR], 1.4; 95% confidence interval [CI], 1.0–1.9), having paid for sex (aPR, 1.3; 95% CI, 1.1–1.6) and group sex (aPR, 1.4; 95% CI, 1.1–1.8), after adjustment for sociodemographic factors. Conclusions Assessing PrEP eligibility using a CDHRS identified 20% more at-risk MSM for PrEP initiation than when Kenyan MoH criteria were used. Approximately 70% of eligible men accepted PrEP at first offer, suggesting that PrEP is acceptable among at-risk MSM. MSM reporting RAI, group sex, or paying for sex were more likely to accept PrEP, reinforcing the importance of an informed discussion of HIV-1 risk during PrEP counselling.

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“…We previously identified lack of health insurance as a risk factor for acquiring HIV infection among black MSM in Atlanta , and those who choose to initiate PrEP have a higher prevalence of sexual risk behaviours . Thus, our finding that PrEP‐interested YBMSM without insurance have the longest delays between receipt of a PrEP prescription and PrEP initiation is especially concerning.…”

Section: Resultsmentioning

confidence: 73%

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

et al. 2019

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Introduction Delays between receiving a PrEP prescription and taking a first dose increase the risk of HIV infection. This is especially relevant in populations with high HIV incidence, such as young black men who have sex with men (YBMSM) in the United States. Additionally, YBMSM have relatively low levels of health insurance. We investigated whether lack of health insurance and reliance on PrEP funding through the manufacturer assistance programme (MAP) leads to delays in initiation of PrEP. Methods HIV‐negative YBMSM were offered PrEP as part of a prospective cohort. Enrolment began in June 2015 with follow‐up through February 2019. Interested participants attended a PrEP clinician visit and received a prescription. Those with health insurance received a copay assistance card; those without insurance accessed PrEP using the MAP. The primary outcome was the days between prescription and initiation. The effect of insurance status on this delay was modelled using a Cox proportional hazards model. Results and Discussion The median delay between receipt of a PrEP prescription and taking a first dose was 12 days (IQR 3 to 32). Compared to uninsured participants, the adjusted hazard ratio for PrEP initiation for those with insurance was 2.72 (95% CI 1.82 to 4.06). The adjusted median time to initiation for insured participants was 5 days versus 21 days for those without insurance (p < 0.0001). Older age and STI diagnosis were also associated with faster PrEP initiation. Despite equivalent access to PrEP provided by the study, YBMSM without insurance had longer delays in initiation after receipt of a prescription. Overall, the observed delay in PrEP initiation increases the chances of HIV infection and the possibility of PrEP initiation after undetected seroconversion. Conclusions The extended time period between PrEP prescription and taking a first dose increases the risk of HIV transmission. Younger YBMSM and those without health insurance had longer delays in PrEP initiation. Immediate PrEP initiation programmes could decrease the likelihood of this occurrence and mitigate the disparity in initiation between those with and without health insurance. Clinical Trial Number: NCT02503618.

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Threefold Increase in PrEP Uptake Over Time with High Adherence Among Young Men Who Have Sex With Men in Chicago

Cited by 48 publications

References 27 publications

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

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

Assessment of PrEP eligibility and uptake among at-risk MSM participating in a HIV-1 vaccine feasibility cohort in coastal Kenya

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

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