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Aryal A, A Leibowitz A, Comulada WS, Rotheram-Borus MJ, Bolan R, Ocasio MA, Swendeman D. PrEP Use and HIV Incidence Among Youth At-Risk for HIV Infection in Los Angeles and New Orleans: Findings From ATN 149. J Acquir Immune Defic Syndr 2023; 94:220-226. [PMID: 37643417 DOI: 10.1097/qai.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Expanding HIV pre-exposure prophylaxis (PrEP) use is key to goals for lowering new HIV infections in the U.S. by 90% between 2022 and 2030. Unfortunately, youth aged 16-24 have the lowest PrEP use of any age group and the highest HIV incidence rates. METHODS To examine the relationship between HIV seroconversion and PrEP uptake, adherence, and continuity, we used survival analysis and multivariable logistic regression on data of 895 youth at-risk for HIV infection enrolled in Adolescent Trials Network for HIV Medicine protocol 149 in Los Angeles and New Orleans, assessed at 4-month intervals over 24 months. RESULTS The sample was diverse in race/ethnicity (40% Black, 28% Latine, 20% White). Most participants (79%) were cis-gender gay/bisexual male but also included 7% transgender female and 14% trans masculine and nonbinary youth. Self-reported weekly PrEP adherence was high (98%). Twenty-seven participants acquired HIV during the study. HIV incidence among PrEP users (3.12 per 100 person year [PY]) was higher than those who never used PrEP (2.53/100 PY). The seroconversion incidence was highest among PrEP users with discontinuous use (3.36/100 PY). If oral PrEP users were adherent using 2-monthly long-acting injectables, our estimate suggests 2.06 infections per 100 PY could be averted. CONCLUSIONS Discontinuous use of PrEP may increase risk of HIV acquisition among youth at higher risk for HIV infection and indications for PrEP. Thus, to realize the promise of PrEP in reducing new HIV infections, reducing clinical burdens for PrEP continuation are warranted.
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Affiliation(s)
- Anu Aryal
- Fielding School of Public Health, University of California, Los Angeles, CA
| | - Arleen A Leibowitz
- Luskin School of Public Affairs, University of California, Los Angeles, CA
| | - Warren Scott Comulada
- Fielding School of Public Health, University of California, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | | | | | - Manuel A Ocasio
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA
| | - Dallas Swendeman
- Fielding School of Public Health, University of California, Los Angeles, CA
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
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McLean J, Bartram L, Zucker J, LaSota E, Carnevale C, Richards P, Perez E, Mori K, Mgbako O, Olender S, Cohall A, Gordon P, Sobieszczyk M. Back2PrEP: Rates of Bacterial Sexually Transmitted Infection Diagnosis Among Individuals Returning to HIV Pre-Exposure Prophylaxis Care: A Retrospective Review of a New York City Comprehensive HIV Prevention Program. AIDS Patient Care STDS 2022; 36:458-461. [PMID: 36383140 PMCID: PMC9805874 DOI: 10.1089/apc.2022.0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) effectively reduces new HIV diagnoses. High rates of incident bacterial sexually transmitted infections (STIs) have been observed in patients eligible for and adherent to PrEP. Observational studies generally report low long-term retention in PrEP care. Limited data exist on the rates of bacterial STI diagnosis upon re-engagement with PrEP services. We conducted a retrospective chart review within the HIV prevention program of an urban academic medical center in New York City. Eligible patients started PrEP from 2015 to 2019, then resumed PrEP services after a gap in care of at least 180 days. Demographic, clinical, and laboratory data were used to characterize the patient population and rates of bacterial STI diagnosis at re-engagement. In total, 286 patients were identified, with 316 qualifying re-engagement visits. Twenty-nine percent of patients had continued PrEP during the care gap, and 30% reported discontinuing medication due to a perceived change in risk. A new STI was diagnosed at 19% of re-engagement visits. There was no statistically significant difference in rates of new STI between individuals returning on or off PrEP, nor between those with perceived lower risk and those without. Individuals who fall out of PrEP services and subsequently re-engage remain at high risk of bacterial STI during the gap in care, regardless of whether PrEP medication is continued or the patient perceives themselves to be at lower HIV acquisition risk. Providers should strongly encourage patients discontinuing PrEP to remain engaged in sexual health services. Alternatives to clinic-based PrEP care must still include regular bacterial STI screening.
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Affiliation(s)
- Jacob McLean
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Logan Bartram
- Division of Infectious Diseases, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jason Zucker
- Divisions of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Elijah LaSota
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Caroline Carnevale
- HIV Prevention Program, New York Presbyterian/Columbia University Irving Medical Center Hospital Comprehensive Health Program, New York City, New York, USA
| | - Paul Richards
- HIV Prevention Program, New York Presbyterian/Columbia University Irving Medical Center Hospital Comprehensive Health Program, New York City, New York, USA
| | - Edward Perez
- HIV Prevention Program, New York Presbyterian/Columbia University Irving Medical Center Hospital Comprehensive Health Program, New York City, New York, USA
| | - Kanako Mori
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Ofole Mgbako
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU Langone Health, New York City, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Alwyn Cohall
- Sociomedical Sciences, Population and Family Health, and Pediatrics, Mailman School of Public Health and Columbia University Medical Center, New York City, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York City, New York, USA
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Rotsaert A, Reyniers T, Vanhamel J, Van Landeghem E, Vanbaelen T, Van Mieghem H, Nöstlinger C, Laga M, Vuylsteke B. Putting 2-1-1 into Practice: PrEP Users’ Knowledge of Effectively Starting and Stopping Oral PrEP Use. AIDS Behav 2022; 27:1793-1799. [PMID: 36399253 DOI: 10.1007/s10461-022-03911-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Abstract
Starting and stopping oral HIV pre-exposure prophylaxis (PrEP) in a way that compromises its effectiveness should be avoided. Between September 2020 and June 2021, we assessed self-perceived and actual knowledge of effectively starting and stopping oral PrEP through an online survey among 206 PrEP users assigned male at birth in Belgium. We examined associations between incorrect start-and-stop knowledge and socio-demographics, sexual behaviour and PrEP use, using bi- and multi-variable logistic regression. The majority of men (84.9%) perceived their start-and-stop knowledge as 'very good', but only 62.1% of all men correctly indicated how to effectively start and stop with PrEP. Using PrEP daily [adjusted OR 2.12, 95% CI (1.06-4.28), p = 0.034] was significantly associated with incorrect start-and-stop knowledge. To enable PrEP users to effectively use PrEP, they need to be better informed about how to start and stop use, irrespective of the dosing regimen.
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Thomas B, Piron P, de La Rochebrochard E, Segouin C, Troude P. Is HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men Effective in a Real-World Setting? Experience with One-On-One Counseling and Support in a Sexual Health Center in Paris, 2018-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114295. [PMID: 36361171 PMCID: PMC9656100 DOI: 10.3390/ijerph192114295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 06/04/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective but depends on patients' care engagement, which is often mediocre and poorly measured in real-world settings. This study aimed to assess the effectiveness of a PrEP program in a sexual health center that included accompanying measures to improve engagement. A retrospective observational study was conducted. All men who have sex with men (MSM) who initiated PrEP for the first time between 1 August 2018 and 30 June 2019 in the Fernand-Widal sexual health center, Paris, France, were included. Among the 125 MSM who initiated PrEP, the median age was 33 and most had only male partners. At initiation, 58% were considered at very high risk of HIV infection, mainly due to a history of post-exposure prophylaxis. During the first year, patients attended a median of three visits (Q1-Q3, 2-4). At 12 months, 96% (95% CI, 92.6 to 99.4) had a successful PrEP course, assessed by a novel metric. These results highlight the possibility of achieving a high PrEP success ratio among MSM in a real-world setting. The accompanying measures and one-on-one counseling by a trained counselor could explain the effectiveness of this PrEP program.
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Affiliation(s)
- Bérenger Thomas
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
| | - Prescillia Piron
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
- Free Sexual Health Center, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
| | - Elise de La Rochebrochard
- Institut National d’Etudes Démographiques (INED), 93300 Aubervilliers, France
- CESP U1018, Inserm, UVSQ, Université Paris-Saclay, 94800 Villejuif, France
| | - Christophe Segouin
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
- Free Sexual Health Center, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
| | - Pénélope Troude
- Department of Public Health, University Hospital Lariboisière-Fernand-Widal, AP-HP, 75010 Paris, France
- Institut National d’Etudes Démographiques (INED), 93300 Aubervilliers, France
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