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Vega-Ramirez H, Guillen-Diaz-Barriga C, Luz PM, Torres TS. Perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities: a systematic review. BMC Infect Dis 2024; 24:574. [PMID: 38858666 PMCID: PMC11163805 DOI: 10.1186/s12879-024-09456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
We conducted a systematic review to explore the relationship between perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities. We included 39 studies divided into (i) correlations or associations, (ii) models using sexual HIV exposure as the outcome, and (iii) models using perceived risk for HIV acquisition as the outcome. The sample size range was from 55 to 16,667 participants, primarily cisgender men who have sex with men (73.3%) and White (51.3%). Sexual HIV exposure and perceived risk for HIV acquisition assessments and recall time frames across studies differed markedly. Most of studies (84.6%) found significant correlations, comparisons, or associations between different levels of perceived risk for HIV acquisition and high sexual HIV exposure. In addition, 51.3% of studies reported other variables associated with high sexual HIV exposure (i.e., misuse of substances or alcohol) or with high perceived risk for HIV acquisition (i.e., younger age). In conclusion, the association between perceived risk for HIV acquisition and sexual HIV exposure has shown to be consistent. However, the assessment for perceived risk for HIV acquisition should include more components of perception (i.e., an affective component), or for sexual HIV exposure should consider the different estimated sexual per-acts probability of acquiring HIV.
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Affiliation(s)
- Hamid Vega-Ramirez
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico.
| | - Centli Guillen-Diaz-Barriga
- Division of Graduate Studies and Research, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
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Dietrich JJ, Ahmed N, Webb EL, Tshabalala G, Hornschuh S, Mulaudzi M, Atujuna M, Stranix‐Chibanda L, Nematadzira T, Ssemata AS, Muhumuza R, Seeley J, Bekker L, Weiss HA, Martinson N, Fox J. A multi-country cross-sectional study to assess predictors of daily versus on-demand oral pre-exposure prophylaxis in youth from South Africa, Uganda and Zimbabwe. J Int AIDS Soc 2022; 25:e25975. [PMID: 36002910 PMCID: PMC9402915 DOI: 10.1002/jia2.25975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa (SSA) carries the burden of the HIV epidemic, especially among adolescents and young people (AYP). Little is known about pre-exposure prophylaxis (PrEP) uptake and preferences among AYP in SSA. We describe preferences for daily and on-demand PrEP among AYP in South Africa, Uganda and Zimbabwe. METHODS A cross-sectional survey was conducted in 2019 among 13- to 24-year olds, capturing socio-demographics, HIV risk behaviours and preferences for daily or on-demand PrEP. Logistic regression models were used to estimate odds ratios, adjusting for site, sex and age. RESULTS AND DISCUSSION A total of 1330 participants from Cape Town (n = 239), Johannesburg (n = 200), Entebbe (n = 491) and Chitungwiza (n = 400) were enrolled; 673 (51%) were male, and the median age was 19 years (interquartile range 17-22 years). Of 1287 participants expressing a preference, 60% indicated a preference for on-demand PrEP with differences by site (p < 0.001), sex (p < 0.001) and age group (p = 0.003). On-demand PrEP was most preferred in Entebbe (75%), among males (65%) versus females (54%) and in older participants (62% in 18- to 24-year-olds vs. 47% in 13- to 15-year-olds). After adjusting for site, sex and age group, preference for on-demand PrEP decreased as sex frequency over the past month increased (p-trend = 0.004) and varied with the number of partners in the last 6 months, being least popular among those reporting four or more partners (p = 0.02). Participants knowing further in advance that they were likely to have sex were more likely to prefer on-demand PrEP (p-trend = 0.02). Participants having a larger age gap with their most recent partner and participants whose last partner was a transactional sex partner or client were both less likely to prefer on-demand compared to daily PrEP (p = 0.05 and p = 0.09, respectively). Participants who knew their most recent partner was living with HIV or who did not know the HIV status of their most recent partner were less likely to prefer on-demand PrEP (p = 0.05). CONCLUSIONS Our data show that AYP in four SSA communities prefer on-demand over daily PrEP options, with differences seen by site, age and sex. PrEP demand creation needs to be reviewed, optimized and tailored to socio-demographic differences and designed in conjunction with AYP.
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Affiliation(s)
- Janan Janine Dietrich
- Perinatal HIV Research Unit (PHRU)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Health Systems Research Unit, South African Medical Research Council, BellvilleSouth Africa and African Social Sciences Unit of Research and Evaluation (ASSURE)Wits Health ConsortiumUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nadia Ahmed
- Mortimer Market CentreCentral North West London NHS TrustLondonUnited Kingdom
| | - Emily L. Webb
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Gugulethu Tshabalala
- Perinatal HIV Research Unit (PHRU)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit (PHRU)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Mamakiri Mulaudzi
- Perinatal HIV Research Unit (PHRU)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Lynda Stranix‐Chibanda
- Clinical Trials Research CentreUniversity of ZimbabweHarareZimbabwe
- Child and Adolescent Health UnitFaculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
| | | | - Andrew Sentoogo Ssemata
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research UnitEntebbeUganda
| | - Richard Muhumuza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research UnitEntebbeUganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research UnitEntebbeUganda
- Global Health and Development DepartmentLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | - Helen A. Weiss
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Neil Martinson
- Perinatal HIV Research Unit (PHRU)Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Julie Fox
- Guys and St Thomas’ NHS Trust/King's College LondonLondonUnited Kingdom
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Truong HHM, Fatch R, McFarland W, Grasso M, Raymond HF, Holt M, Steward WT. Destination-Specific and Home Environment Condom Norms Influence Sexual Behavior During Travel. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:245-255. [PMID: 35647868 PMCID: PMC10654111 DOI: 10.1521/aeap.2022.34.3.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Travelers may adapt HIV risk-reduction practices based on perceived destination-specific norms. We examined the association between perceived condom norms and condomless anal sex (CAS) during international and domestic travel and in the home environment among men who have sex with men. Men who traveled internationally in the past 12 months were recruited by respondent-driven sampling (N = 501). Not knowing destination-specific condom norms was significantly associated with less CAS during international travel and in the home environment but not during domestic travel. Perceiving home environment condom norms to expect use of condoms was significantly associated with less CAS during domestic but not international travel. Men were less likely to engage in CAS during international travel when destination-specific condom norms were unknown. Unfamiliarity with the environment and culture may influence some men to refrain from higher-risk behaviors. During domestic travel, some men appeared to apply home environment condom norms, which may be erroneous in some situations and pose an HIV risk.
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Affiliation(s)
| | | | - Willi McFarland
- University of California San Francisco
- California Department of Public Health
| | | | | | - Martin Holt
- University of New South Wales, Sydney, Australia
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Feasibility of Short-Term PrEP Uptake for Men Who Have Sex With Men With Episodic Periods of Increased HIV Risk. J Acquir Immune Defic Syndr 2021; 84:508-513. [PMID: 32692109 DOI: 10.1097/qai.0000000000002382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate is efficacious in reducing HIV acquisition. For some gay, bisexual, and other men who have sex with men (MSM), daily ongoing PrEP may be unsuitable for use as a long-term prevention strategy because of episodic risk, cost issues, or concerns about the biological consequences of medication. SETTING This study evaluated the feasibility of short-term, fixed-interval episodic PrEP (Epi-PrEP) for use among vacationing MSM. We describe the feasibility of implementing a clinic-based Epi-PrEP pilot program for 48 MSM who reported occasional condomless sex and anticipated a defined high-risk time. METHODS This was a nonrandomized naturalistic study of an observational clinical intervention. The primary outcome assessed was adherence, as measured by self-report and plasma tenofovir levels. RESULTS Of 54 MSM who enrolled in the study, 48 completed the 3-month visit. The majority (93.7%) had tenofovir concentrations consistent with daily use on returning from vacation. Almost 3/4 reported condomless sex during vacation, and about 1/3 reported recreational drug use. During the 3-month follow-up, 1 participant had become HIV-infected because of a lapse in continued access to the PrEP after study. Although adverse events were common, none were serious. More than 70% of participants indicated an interest in daily ongoing PrEP use. CONCLUSIONS Epi-PrEP was well tolerated by at risk MSM in this study, with high levels of medication adherence. Many participants felt the experience of initiating PrEP while on vacation could be a means for transition to long-term PrEP use.
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Zhang J, Xu J, Wang H, Huang X, Chen Y, Wang H, Chu Z, Hu Q, He X, Li Y, Zhang L, Hu Z, Bao R, Li S, Li H, Ding H, Jiang Y, Geng W, Sylvia S, Shang H. Preference for daily versus on-demand pre-exposure prophylaxis for HIV and correlates among men who have sex with men: the China Real-world Oral PrEP Demonstration study. J Int AIDS Soc 2021; 24:e25667. [PMID: 33586841 PMCID: PMC7883476 DOI: 10.1002/jia2.25667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/09/2021] [Accepted: 01/13/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION This study explores the preference for daily versus on-demand pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in developing countries when both regimens are available. METHODS From 11 December 2018 to 19 October 2019, we recruited MSM for an open-label real-world PrEP demonstration study in four major cities in China. Subjects selected their preferred PrEP (oral tenofovir/emtricitabine) regimen (daily vs. on-demand) at recruitment and underwent on-site screening before initiation of PrEP. We used logistic regression to assess preference for daily PrEP and correlates. RESULTS Of 1933 recruited MSM, the median age was 29 years, 7.6% was currently married to or living with a female; the median number of male sexual partners was four and 6.1% had used post-exposure prophylaxis (PEP) in the previous six months. HIV infection risk was subjectively determined as very high (>75%) in 7.0% of subjects, high (50% to 75%) in 13.3%, moderate (25% to 49%) in 31.5% and low or none (0% to 24%) in 48.1%. On average, participants preferred on-demand PrEP over daily PrEP (1104 (57.1%) versus 829 (42.9%)) at recruitment. In multivariable analysis, currently being married to or living with a female was associated with 14.6 percentage points lower preference for daily PrEP (marginal effect = -0.146 [95% CI: -0.230, -0.062], p = 0.001); whereas the number of male sexual partners (marginal effect = 0.003 [95% CI: 0.000, 0.005], p = 0.034) and a subjective assessment of being very high risk of HIV infection (vs. low and no risk, marginal effect size = 0.105 [95% CI: 0.012, 0.198], p = 0.027) were associated with increased preference for daily versus on-demand PrEP. Among the 1933 potential participants, 721 (37.3%) did not attend the subsequent on-site screening. Lower-income, lower education level, lower subjective expected risk of HIV infection risk and younger age positively correlated with the absence of on-site screening. CONCLUSIONS MSM in China prefer both daily and on-demand PrEP when both regimens are provided free. Social structural factors and subjective risk of HIV infection have significant impacts on PrEP preference and use. The upcoming national PrEP guideline should consider incorporating both regimens and the correlates to help implement PrEP in China.
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Massud I, Ruone S, Zlotorzynska M, Haaland R, Mills P, Cong ME, Kelley K, Johnson R, Holder A, Dinh C, Khalil G, Pan Y, Kelley CF, Sanchez T, Heneine W, García-Lerma JG. Single oral dose for HIV pre or post-exposure prophylaxis: user desirability and biological efficacy in macaques. EBioMedicine 2020; 58:102894. [PMID: 32707451 PMCID: PMC7381488 DOI: 10.1016/j.ebiom.2020.102894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Daily oral pre- or post-exposure prophylaxis (PrEP or PEP) is highly effective in preventing HIV infection. However, many people find it challenging to adhere to a daily oral regimen. Chemoprophylaxis with single oral doses of antiretroviral drugs taken before or after sex may better adapt to changing or unanticipated sexual practices and be a desirable alternative to daily PrEP or PEP. We investigated willingness to use a single oral pill before or after sex among men who have sex with men (MSM) and assessed the biological efficacy of a potent antiretroviral combination containing elvitegravir (EVG), emtricitabine (FTC), and tenofovir alafenamide (TAF). METHODS Data on willingness to use single-dose PrEP or PEP were obtained from the 2017 cycle of the American Men's Internet Survey (AMIS), an annual online behavioral surveillance survey of MSM in the United States. Antiretroviral drug levels were measured in humans and macaques to define drug distribution in rectal tissue and identify clinically relevant doses for macaque modeling studies. The biological efficacy of a single dose of FTC/TAF/EVG as PrEP or PEP was investigated using a repeat-challenge macaque model of rectal HIV infection. FINDINGS Through pharmacokinetic assessment in humans and macaques we found that EVG penetrates and concentrates in rectal tissues supporting its addition to FTC/TAF to boost and extend chemoprophylactic activity. Efficacy estimates for a single oral dose given to macaques 4h before or 2h after SHIV exposure was 91•7%[35•7%-98•9%] and 100%, respectively, compared to 80•1%[13•9%-95•4%] and 64•6%[-19•4%-89•5%] when single doses were given 6 and 24h post challenge, respectively. A two-dose regimen at 24h and 48h after exposure was also protective [77•1%[1•7%-94•7%]. INTERPRETATION Informed by user willingness, human and macaque pharmacokinetic data, and preclinical efficacy we show that single-dose prophylaxis before or after sex is a promising HIV prevention strategy. Carefully designed clinical trials are needed to determine if any of these strategies will be effective in humans. FUNDING Funded by CDC intramural funds, CDC contract HCVJCG2-2016-03948 (to CFK), and a grant from the MAC AIDS Fund and by the National Institutes of Health [P30AI050409] - the Emory Center for AIDS Research (to MZ and TS).
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Affiliation(s)
- Ivana Massud
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Susan Ruone
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Maria Zlotorzynska
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Richard Haaland
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Patrick Mills
- Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mian-Er Cong
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Kristen Kelley
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Ryan Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Angela Holder
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Chuong Dinh
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - George Khalil
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Yi Pan
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Travis Sanchez
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Walid Heneine
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States
| | - J Gerardo García-Lerma
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States.
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Haberer JE, Mugo N, Baeten JM, Pyra M, Bukusi E, Bekker LG. PrEP as a Lifestyle and Investment for Adolescent Girls and Young Women in Sub-Saharan Africa. J Int Assoc Provid AIDS Care 2020; 18:2325958219831011. [PMID: 30776954 PMCID: PMC6748528 DOI: 10.1177/2325958219831011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Adolescent girls and young women (AGYW) are highly affected by the HIV epidemic, yet standard approaches to pre-exposure prophylaxis (PrEP) delivery will not meet their needs. This commentary highlights key characteristics of AGYW related to PrEP use and delivery, including typical neurocognitive development, lack of experience with sustained medication use, and the social and connected nature of AGYW’s lives. We then suggest ways for programs to embrace these characteristics, such as presenting PrEP as a lifestyle choice and not a biomedical tool, making access to PrEP simple and easy, and recognizing the many influences AGYW face in taking PrEP. We also suggest ways for programs to identify AGYW at the highest risk of HIV acquisition. Adolescent girls and young women have an important role to play in ending the HIV epidemic and they deserve considerable, tailored investment.
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Affiliation(s)
- Jessica E Haberer
- 1 Massachusetts General Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Nelly Mugo
- 3 Kenya Medical Research Institute, Thika, Kenya.,4 University of Washington, Seattle, WA, USA
| | | | - Maria Pyra
- 4 University of Washington, Seattle, WA, USA
| | - Elizabeth Bukusi
- 4 University of Washington, Seattle, WA, USA.,5 Kenya Medical Research Institute, Kisumu, Kenya
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Rao DW, Carr J, Naismith K, Hood JE, Hughes JP, Morris M, Goodreau SM, Rosenberg ES, Golden MR. Monitoring HIV Preexposure Prophylaxis Use Among Men Who Have Sex With Men in Washington State: Findings From an Internet-Based Survey. Sex Transm Dis 2019; 46:221-228. [PMID: 30870322 PMCID: PMC7687921 DOI: 10.1097/olq.0000000000000965] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Many state and local health departments now promote and support the use of HIV preexposure prophylaxis (PrEP), yet monitoring use of the intervention at the population level remains challenging. METHODS We report the results of an online survey designed to measure PrEP use among men who have sex with men (MSM) in Washington State. Data on the proportion of men with indications for PrEP based on state guidelines and levels of awareness, interest, and use of PrEP are presented for 1080 cisgender male respondents who completed the survey between January 1 and February 28, 2017. We conducted bivariate and multivariable logistic regression to identify factors associated with current PrEP use. To examine patterns of discontinuation, we conducted Cox proportional hazards regression and fit a Kaplan-Meier curve to reported data on time on PrEP. RESULTS Eighty percent of respondents had heard of PrEP, 19% reported current use, and 36% of men who had never used PrEP wanted to start taking it. Among MSM for whom state guidelines recommend PrEP, 31% were taking it. In multivariable analysis, current PrEP use was associated with older age, higher education, and meeting indications for PrEP use. Our data suggest that 20% of PrEP users discontinue within 12 months, and men with lower educational attainment were more likely to discontinue. CONCLUSIONS Despite high levels of use, there is significant unmet need for PrEP in Washington. Our experience indicates that Internet surveys are feasible and informative for monitoring PrEP use in MSM.
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Affiliation(s)
- Darcy White Rao
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Jason Carr
- Infectious Disease Assessment Unit, Disease Control and Health Statistics, Washington State Department of Health, Olympia, Washington, USA
| | - Kelly Naismith
- Infectious Disease Assessment Unit, Disease Control and Health Statistics, Washington State Department of Health, Olympia, Washington, USA
| | - Julia E. Hood
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Martina Morris
- Department of Statistics, University of Washington, Seattle, Washington, USA
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Steven M. Goodreau
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY
| | - Matthew R. Golden
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, Washington, USA
- Center for AIDS and STD, University of Washington, Seattle, Washington, USA
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Patel RR, Crane JS, López J, Chan PA, Liu AY, Tooba R, James AS. Pre-exposure prophylaxis for HIV prevention preferences among young adult African American men who have sex with men. PLoS One 2018; 13:e0209484. [PMID: 30592756 PMCID: PMC6310267 DOI: 10.1371/journal.pone.0209484] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/06/2018] [Indexed: 11/18/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infections among men who have sex with men (MSM). PrEP uptake and adherence remain low and product preferences are unknown, especially among young African American MSM who are most at-risk. We conducted 26 qualitative interviews from 2014-2016 among young adult HIV-negative African American MSM regarding PrEP product preferences in Missouri. While the pill and injectable were most liked of all modalities, about a quarter preferred rectal products or patches. Most participants preferred a long-acting injectable (LAI) to daily oral pills due to better medication adherence and a dislike for taking pills. Many participants preferred daily oral pills to on-demand oral PrEP due to the inability to predict sex and the perception that insufficient time or medication would not achieve HIV protection with on-demand. A fear of needles and the perception that there would not be therapeutic levels for a long duration were concerns with injectable PrEP. Study findings highlight the need for a range of prevention options for African American MSM and can inform PrEP product development as well as dissemination and implementation efforts.
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Affiliation(s)
- Rupa R. Patel
- Division of Infectious Diseases, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - John S. Crane
- Division of Infectious Diseases, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Julia López
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Philip A. Chan
- Division of Infectious Diseases, Brown University, Providence, Rhode Island, United States of America
| | - Albert Y. Liu
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Rubabin Tooba
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Aimee S. James
- Division of Public Health Sciences, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Dubov A, Altice FL, Fraenkel L. An Information-Motivation-Behavioral Skills Model of PrEP Uptake. AIDS Behav 2018; 22:3603-3616. [PMID: 29557540 DOI: 10.1007/s10461-018-2095-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP uptake remains low among at-risk populations. The 2015 CDC report estimates that about 1.2 million people in the US have indications for PrEP. However, only 49,158 or 4% of the targeted population are currently using PrEP. Efforts to optimize uptake of PrEP may be facilitated by the development of a comprehensive theoretical framework which can be used to understand reasons for poor uptake and to develop interventions to maximize PrEP uptake and adherence. This article reviews research on correlates of PrEP uptake and presents findings organized within an Information-Motivation-Behavioral Skills (IMB) model framework. In the context of PrEP uptake, the IMB model asserts that to the extent that at-risk groups are well-informed about PrEP, motivated to act on their knowledge, and have necessary behavioral skills to seek out and initiate PrEP regimen, they will successfully overcome obstacles to initiate and adhere to PrEP. The article proposes an adaptation the IMB model for PrEP uptake, provides empirical support for the adapted IMB model extracted from related research, and discusses its application in PrEP uptake interventions.
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Buchbinder SP. Maximizing the Benefits of HIV Preexposure Prophylaxis. TOPICS IN ANTIVIRAL MEDICINE 2018; 25:138-142. [PMID: 29689539 PMCID: PMC5935218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Preexposure prophylaxis (PrEP) with tenofovir/emtricitabine (slash indicates coformulation) is highly effective in preventing new HIV infections. PrEP efficacy is strongly associated with adherence. In clinical trials, PrEP has been more effective in men who have sex with men and HIV-serodiscordant heterosexual couples than in women, likely reflecting pharmacokinetic differences between levels of tenofovir disoproxil fumarate in vaginal and rectal tissues, and poorer adherence in studies in women. Current guidelines recommend daily PrEP for men and women; however, PrEP taken at least 4 days per week for men may be as effective as daily PrEP, and women must take PrEP 6 to 7 days per week to maximize efficacy. Data are accumulating on the effectiveness of pericoital PrEP for men who have sex with men, but it is not yet recommended in the United States. PrEP is underprescribed for younger individuals, black individuals, and Hispanic and Latino individuals. This article summarizes a presentation by Susan P. Buchbinder, MD, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in Chicago, Illinois, in May 2017.
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Vaccher SJ, Gianacas C, Templeton DJ, Poynten IM, Haire BG, Ooi C, Foster R, McNulty A, Grulich AE, Zablotska IB. Baseline Preferences for Daily, Event-Driven, or Periodic HIV Pre-Exposure Prophylaxis among Gay and Bisexual Men in the PRELUDE Demonstration Project. Front Public Health 2017; 5:341. [PMID: 29326917 PMCID: PMC5736869 DOI: 10.3389/fpubh.2017.00341] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The effectiveness of daily pre-exposure prophylaxis (PrEP) is well established. However, there has been increasing interest in non-daily dosing schedules among gay and bisexual men (GBM). This paper explores preferences for PrEP dosing schedules among GBM at baseline in the PRELUDE demonstration project. MATERIALS AND METHODS Individuals at high-risk of HIV were enrolled in a free PrEP demonstration project in New South Wales, Australia, between November 2014 and April 2016. At baseline, they completed an online survey containing detailed behavioural, demographic, and attitudinal questions, including their ideal way to take PrEP: daily (one pill taken every day), event-driven (pills taken only around specific risk events), or periodic (daily dosing during periods of increased risk). RESULTS Overall, 315 GBM (98% of study sample) provided a preferred PrEP dosing schedule at baseline. One-third of GBM expressed a preference for non-daily PrEP dosing: 20% for event-driven PrEP, and 14% for periodic PrEP. Individuals with a trade/vocational qualification were more likely to prefer periodic to daily PrEP [adjusted odds ratio (aOR) = 4.58, 95% confidence intervals (95% CI): (1.68, 12.49)], compared to individuals whose highest level of education was high school. Having an HIV-positive main regular partner was associated with strong preference for daily, compared to event-driven PrEP [aOR = 0.20, 95% CI: (0.04, 0.87)]. Participants who rated themselves better at taking medications were more likely to prefer daily over periodic PrEP [aOR = 0.39, 95% CI: (0.20, 0.76)]. DISCUSSION Individuals' preferences for PrEP schedules are associated with demographic and behavioural factors that may impact on their ability to access health services and information about PrEP and patterns of HIV risk. At the time of data collection, there were limited data available about the efficacy of non-daily PrEP schedules, and clinicians only recommended daily PrEP to study participants. Further research investigating how behaviours and PrEP preferences change correspondingly over time is needed. TRIAL REGISTRATION ClinicalTrials.gov NCT02206555. Registered 28 July 2014.
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Affiliation(s)
| | | | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- RPA Sexual Health, Sydney Local Health District and Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Catriona Ooi
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Rosalind Foster
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Clinic 16 Northern Sydney Sexual Health, Royal North Shore Community Health Centre, St Leonards, NSW, Australia
| | - Anna McNulty
- Sydney Sexual Health Centre, Sydney, NSW, Australia
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
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Goedel WC, Halkitis PN, Greene RE, Duncan DT. Correlates of Awareness of and Willingness to Use Pre-exposure Prophylaxis (PrEP) in Gay, Bisexual, and Other Men Who Have Sex with Men Who Use Geosocial-Networking Smartphone Applications in New York City. AIDS Behav 2016; 20:1435-42. [PMID: 26966013 DOI: 10.1007/s10461-016-1353-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Geosocial-networking smartphone applications are commonly used by gay, bisexual, and other men who have sex with men (MSM) to meet sexual partners. The purpose of the current study was to evaluate awareness of and willingness to use pre-exposure prophylaxis (PrEP) among MSM who use geosocial-networking smartphone applications residing in New York City. Recruitment utilizing broadcast advertisements on a popular smartphone application for MSM yielded a sample of 152 HIV-uninfected MSM. Multivariable models were used to assess demographic and behavioral correlates of awareness of and willingness to use PrEP. Most participants (85.5 %) had heard about PrEP but few (9.2 %) reported current use. Unwillingness to use PrEP was associated with concerns about side effects (PR = 0.303; 95 % CI 0.130, 0.708; p = 0.006). Given that more than half (57.6 %) of participants were willing to use PrEP, future research is needed to elucidate both individual and structural barriers to PrEP use among MSM.
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Affiliation(s)
- William C Goedel
- Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY, 10016, USA.
- College of Global Public Health, New York University, New York, NY, USA.
- Department of Sociology, College of Arts and Science, New York University, New York, NY, USA.
| | - Perry N Halkitis
- Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY, 10016, USA
- College of Global Public Health, New York University, New York, NY, USA
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY, USA
- Population Center, College of Arts and Science, New York University, New York, NY, USA
- Center for Health, Identity, Behavior, and Prevention Studies, College of Global Public Health, New York University, New York, NY, USA
| | - Richard E Greene
- Center for Health, Identity, Behavior, and Prevention Studies, College of Global Public Health, New York University, New York, NY, USA
- Department of Medicine, School of Medicine, New York University, New York, NY, USA
| | - Dustin T Duncan
- Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY, 10016, USA
- College of Global Public Health, New York University, New York, NY, USA
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, NY, USA
- Population Center, College of Arts and Science, New York University, New York, NY, USA
- Center for Health, Identity, Behavior, and Prevention Studies, College of Global Public Health, New York University, New York, NY, USA
- Center for Data Science, New York University, New York, NY, USA
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Hall EW, Heneine W, Sanchez T, Sineath RC, Sullivan P. Preexposure Prophylaxis Modality Preferences Among Men Who Have Sex With Men and Use Social Media in the United States. J Med Internet Res 2016; 18:e111. [PMID: 27199100 PMCID: PMC4909393 DOI: 10.2196/jmir.5713] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023] Open
Abstract
Background Preexposure prophylaxis (PrEP) is available as a daily pill for preventing infection with the human immunodeficiency virus (HIV). Innovative methods of administering PrEP systemically or topically are being discussed and developed. Objective The objective of our study was to assess attitudes toward different experimental modalities of PrEP administration. Methods From April to July 2015, we recruited 1106 HIV-negative men who have sex with men through online social media advertisements and surveyed them about their likelihood of using different PrEP modalities. Participants responded to 5-point Likert-scale items indicating how likely they were to use each of the following PrEP modalities: a daily oral pill, on-demand pills, periodic injection, penile gel (either before or after intercourse), rectal gel (before/after), and rectal suppository (before/after). We used Wilcoxon signed rank tests to determine whether the stated likelihood of using any modality differed from daily oral PrEP. Related items were combined to assess differences in likelihood of use based on tissue or time of administration. Participants also ranked their interest in using each modality, and we used the modified Borda count method to determine consensual rankings. Results Most participants indicated they would be somewhat likely or very likely to use PrEP as an on-demand pill (685/1105, 61.99%), daily oral pill (528/1036, 50.97%), injection (575/1091, 52.70%), or penile gel (438/755, 58.01% before intercourse; 408/751, 54.33% after). The stated likelihoods of using on-demand pills (median score 4) and of using a penile gel before intercourse (median 4) were both higher than that of using a daily oral pill (median 4, P<.001 and P=.001, respectively). Compared with a daily oral pill, participants reported a significantly lower likelihood of using any of the 4 rectal modalities (Wilcoxon signed rank test, all P<.001). On 10-point Likert scales created by combining application methods, the reported likelihood of using a penile gel (median 7) was higher than that of using a rectal gel (median 6, P<.001), which was higher than the likelihood of using a rectal suppository (median 6, P<.001). The modified Borda count ranked on-demand pills as the most preferred modality. There was no difference in likelihood of use of PrEP (gel or suppository) before or after intercourse. Conclusions Participants typically prefer systemic PrEP and are less likely to use a modality that is administered rectally. Although most of these modalities are seen as favorable or neutral, attitudes may change as information about efficacy and application becomes available. Further data on modality preference across risk groups will better inform PrEP development.
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Affiliation(s)
- Eric William Hall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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Goedel WC, Halkitis PN, Greene RE, Hickson DA, Duncan DT. HIV Risk Behaviors, Perceptions, and Testing and Preexposure Prophylaxis (PrEP) Awareness/Use in Grindr-Using Men Who Have Sex With Men in Atlanta, Georgia. J Assoc Nurses AIDS Care 2016; 27:133-42. [PMID: 26708834 PMCID: PMC5453651 DOI: 10.1016/j.jana.2015.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Abstract
Geosocial-networking smartphone applications such as Grindr can help men who have sex with men (MSM) meet sexual partners. Given the high incidence of HIV in the Deep South, the purpose of our study was to assess HIV risk and preexposure prophylaxis (PrEP) awareness and use in a sample of HIV-uninfected, Grindr-using MSM residing in Atlanta, Georgia (n = 84). Most (n = 71; 84.6%) reported being somewhat or very concerned about becoming HIV infected. Most (n = 74; 88.1%) had been tested for HIV in their lifetimes. About three fourths (n = 65; 77.4%) were aware of PrEP, but only 11.9% currently used the medication. HIV continues to disproportionately impact MSM and represents a significant source of concern. As the number of new infections continues to rise, it is important to decrease risks associated with acquisition and transmission of HIV by increasing rates of HIV testing and the use of biobehavioral interventions such as PrEP.
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Affiliation(s)
- William C. Goedel
- Undergraduate student at the New York University College of Global Public Health, New York, New York, USA
| | - Perry N. Halkitis
- Associate Dean for Academic Affairs, New York University College of Global Public Health, New York, New York, USA
| | - Richard E. Greene
- Director of Gender and Health Education, New York University School of Medicine, New York, New York, USA
| | - DeMarc A. Hickson
- Director of Planning and Development, My Brother’s Keeper, Inc., Jackson, Mississippi, USA
| | - Dustin T. Duncan
- Assistant Professor, New York University School of Medicine, Department of Population Health, New York, New York, USA
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