Young Men Who Have Sex with Men at High Risk for HIV, Bangkok MSM Cohort Study, Thailand 2006–2014

Thienkrua, Warunee; Griensven, Frits van; Mock, Philip A.; Dunne, Eileen F.; Raengsakulrach, Boonyos; Wimonsate, Wipas; Howteerakul, Nopporn; Ungsedhapand, Chaiwat; Chiwarakorn, Anupong; Holtz, Timothy H.

doi:10.1007/s10461-017-1963-7

Cited by 43 publications

(31 citation statements)

References 41 publications

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“…Adolescents and young men who have sex with men (YMSM) and young transgender women (YTGW) bear disproportionate burdens of HIV globally [1‐4]. In Thailand, the HIV incidence among YMSM/YTGW has been consistently high, reported at 4 to 11 per 100 person years [3‐7], similar to the United States where an estimated 14% of TGW are living with HIV (US CDC 2019) and over a third of all new HIV infections are in YMSM [8,9]. The Thai epidemic among YMSM and YTGW is perpetuated by low rates of HIV test uptake, poor HIV knowledge and rates of condom use below 50% [10,11].…”

Section: Introductionmentioning

confidence: 99%

Youth‐friendly services and a mobile phone application to promote adherence to pre‐exposure prophylaxis among adolescent men who have sex with men and transgender women at‐risk for HIV in Thailand: a randomized control trial

et al. 2020

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Introduction Strategies are needed to curb the increasing HIV incidence in young men who have sex with men (YMSM) and transgender women (YTGW) worldwide. We assessed the impact of youth‐friendly services (YFS) and a mobile phone application (app) on adherence to pre‐exposure prophylaxis (PrEP) in YMSM and YTGW in Thailand. Methods A randomized control trial was conducted in YMSM and YTGW aged 15 to 19 years. Participants were provided daily oral tenofovir disoproxil fumerate/emtricitabine (TDF/FTC), condoms and randomized to receive either YFS or YFS plus a PrEP app (YFS + APP), whose features included self‐assessment of HIV acquisition risk, point rewards and reminders for PrEP and clinic appointments. Clinic visits occurred at zero, one, three and six months and telephone contact at two, four and five months. HIV testing was performed at every clinic visit. PrEP adherence was evaluated with intracellular tenofovir diphosphate (TFV‐DP) concentrations in dried blood spot (DBS) samples at months 3 and 6. The primary endpoint assessed was “PrEP adherence” defined as TFV‐DP DBS concentrations ≥700 fmol/punch (equivalent to ≥4 doses of TDF/week). Results Between March 2018 and June 2019, 489 adolescents were screened at three centres in Bangkok. Twenty‐seven (6%) adolescents tested positive for HIV and 200 (41%) adolescents participated in the study. Of these, 147 were YMSM (74%) and 53 YTGW (26%). At baseline, median age was 18 years (IQR 17 to 19), 66% reported inconsistent condom use in the past month. Sexually transmitted infection prevalence was 23%. Retention at six months was 73%. In the YFS + APP arm, median app use duration was three months (IQR 1 to 5). PrEP adherence at month 3 was 51% in YFS and 54% in YFS + APP (p‐value 0.64) and at month 6 was 44% in YFS and 49% in YFS + APP (p‐value 0.54). No HIV seroconversions occurred during 75 person years of follow‐up. Conclusions Youth‐friendly PrEP services enabled good adherence among half of adolescent PrEP users. However, the mobile phone application tested did not provide additional PrEP adherence benefit in this randomized trial. Adolescent risk behaviours are dynamic and require adaptive programmes that focus on “prevention‐effective adherence.”

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Section: Introductionmentioning

confidence: 99%

Youth‐friendly services and a mobile phone application to promote adherence to pre‐exposure prophylaxis among adolescent men who have sex with men and transgender women at‐risk for HIV in Thailand: a randomized control trial

et al. 2020

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“…Nevertheless, OA was successfully (but of unknown reliability) applied to YMSM in Amsterdam, The Netherlands in 1997 [ 20 ], in Bangkok, Thailand from 2003 to 2007 [ 21 ], in six cities in China in 2010 [ 22 ] and in adjusted fashion to YMSM across the continental United States and Puerto Rico in 2013 [ 23 ]. To assess the reliability of OA to estimate recent HIV incidence in YMSM compared to conventional prospective cohort study serology, we applied both methods in parallel against YMSM 18 to 21 and 18 to 24 years old enrolled in the Bangkok men who have sex with men cohort study (BMCS) [ 24 – 26 ]. As part of the BMCS, behavioral and serological data were collected simultaneously in the context of high HIV incidence in YMSM between 2006 and 2014, providing a robust number of existing and new HIV infections to evaluate agreement between the two methods.…”

Section: Introductionmentioning

confidence: 99%

Estimating recent HIV incidence among young men who have sex with men: Reinvigorating, validating and implementing Osmond's algorithm for behavioral imputation

et al. 2018

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HIV incidence information is essential for epidemic monitoring and evaluating preventive interventions. However, reliable HIV incidence data is difficult to obtain, especially among marginalized populations, such as young men who have sex with men (YMSM). Here we evaluate the reliability of an alternative HIV incidence assessment method, behavioral imputation, as compared to serologically estimated HIV incidence. Recent HIV incidence among YMSM (aged 18 to 21 and 18 to 24 years) enrolled in a cohort study in Bangkok from 2006 to 2014 was estimated using two mid-point methods for seroconversion: 1) between age of first anal intercourse and first HIV-positive test (without previous HIV-negative test) (behavioral imputation) and 2) between the date of last negative and first positive HIV test (serological estimation). Serologically estimated HIV incidence was taken as the “gold standard” to evaluate between-method agreement. At baseline, 314 YMSM age 18 to 21 years accumulated 674 person-years (PY) of follow-up since first anal intercourse. Considering that 50 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.4 per 100 PY. Of the remaining 264 HIV-negative men, 54 seroconverted for HIV infection during the study, accumulating 724 PY of follow-up and a serologically estimated HIV incidence of 7.5 per 100 PY. At baseline, 712 YMSM age 18 to 24 years (including 18 to 21-year-old men analyzed above) accumulated 2143 PY of follow-up since first anal intercourse. Considering that 151 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.0 per 100 PY. Of the remaining 561 HIV-negative men, 125 seroconverted for HIV infection during the study, accumulating 1700 PY of follow-up and a serologically estimated HIV incidence of 7.4 per 100 PY. Behavioral imputation and serological estimation are in good agreement when estimating recent HIV incidence in YMSM.

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“…MSM aged 18-24 years had a fourfold higher incidence of HIV-1 acquisition, compared with men older than 34 years. Elsewhere, in a Bangkok cohort, young MSM (aged < 21 years) had an increased risk for HIV-1 acquisition [29,30].…”

Section: Discussionmentioning

confidence: 99%

An Empiric Risk Score to Guide PrEP Targeting Among MSM in Coastal Kenya

et al. 2018

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Men who have sex with men (MSM), who have heterogeneous HIV-acquisition risks are not specifically targeted in Kenyan pre-exposure prophylaxis (PrEP) guidelines. We used data from an open cohort, which followed 753 initially HIV-negative MSM participants for more than 1378.5 person-years, to develop an empiric risk score for targeting PrEP delivery. Independent predictors of incident HIV-1 infection in this cohort were an age of 18-24 years, having only male sex partners, having receptive anal intercourse, having any unprotected sex, and having group sex. Poisson model coefficients were used to assign a numeric score to each statistically significant predictor. A risk score of ≥ 1 corresponded to an HIV-1 incidence of ≥ 2.2 [95% confidence interval (CI) 1.2-4.1] and identified 81.3% of the cohort participants as being at high risk for HIV-1 acquisition. The area under the receiver operating characteristic curve was 0.76 (95% CI 0.71-0.80). This empiric risk score may help Kenyan health care providers to assess HIV-1 acquisition risk and encourage PrEP uptake by high-risk MSM.

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Young Men Who Have Sex with Men at High Risk for HIV, Bangkok MSM Cohort Study, Thailand 2006–2014

Cited by 43 publications

References 41 publications

Youth‐friendly services and a mobile phone application to promote adherence to pre‐exposure prophylaxis among adolescent men who have sex with men and transgender women at‐risk for HIV in Thailand: a randomized control trial

Youth‐friendly services and a mobile phone application to promote adherence to pre‐exposure prophylaxis among adolescent men who have sex with men and transgender women at‐risk for HIV in Thailand: a randomized control trial

Estimating recent HIV incidence among young men who have sex with men: Reinvigorating, validating and implementing Osmond's algorithm for behavioral imputation

An Empiric Risk Score to Guide PrEP Targeting Among MSM in Coastal Kenya

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