BOSTON — A coordinated counseling method geared toward black men who have sex with men improved pre-exposure prophylaxis adherence and could help reduce disparities in HIV prevention, according to data presented at CROI 2016.
Protocol chair for the HPTN 073 study, Darrell P. Wheeler, PhD, MPH, dean and professor of the School of Social Welfare, State University of New York at Albany, and colleagues assessed the efficacy of a client-centered care coordination (C4) counseling approach offering PrEP use among black men who have sex with men – a population representing 0.4% of the U.S. population, but 20% of new infections in 2013. The researchers offered C4 sessions plus once-daily Truvada (emtricitabine/tenofovir disoproxil fumarate, Gilead Sciences; FTC/TDF) to 226 HIV-negative black MSM from Washington, D.C., Los Angeles, and Chapel Hill, North Carolina. The C4 sessions were coordinated by a biomedical interventionist, a team member with expertise in human, social and/or behavioral sciences and a community member, all of whom contributed to a better understanding of critical issues in a participants’ life that may impact PrEP acceptance and utilization, such as unemployment, a lack of education and incarceration, Wheeler said during a press conference.
Darrell P. Wheeler
“This was really important because we believe that paying attention to the men early on helped us to develop an intervention package that attracted men, encouraged them to accept and take PrEP and then helped them to sustain on PrEP,” he said. “The pill, while available, was not going to be the panacea or the bullet if you didn’t tend to the other issues.”
After 12 months of follow-up, 92% of men were retained in the study. Seventy-nine percent of all participants accepted PrEP, including 96% of participants who had a primary partner with HIV (n = 24), and 86% of participants who reported having casual partners with unknown HIV status (n = 120). Those who accepted PrEP participated in a median of six C4 sessions vs. a median of four sessions for those who declined PrEP.
At 26 weeks, 68% of participants were still receiving PrEP, and 78% reported between 50% and 90% adherence.
Differences in HIV incidence were noted for men accepting PrEP, with five infections per 172 person-years (PY) among participants who accepted PrEP (incidence rate = 2.9%; 95% CI, 0.9-6.8) vs. three infections per 39 PY among participants who declined PrEP (incidence rate = 7.7%; 95%CI, 1.6-22.5). Two infections occurring in participants who accepted PrEP had discontinued the regimen at 50 days and 272 days before seroconversion.
“The conclusion here is that C4 is a culturally anchored intervention and has demonstrated a degree of efficacy for recruiting, attracting and supporting men’s PrEP utilization,” Wheeler said. “We’ll be gathering and reporting on much more information about factors that facilitated adherence for this group of men who are disproportionately impacted by the epidemic here in the U.S.” – by Stephanie Viguers
Wheeler DP, et al. Abstract 883LB. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.
Disclosure: Wheeler reports no relevant financial disclosures.