Challenges remain in progressing PrEP interest to uptake among young black MSM
SEATTLE —Despite a high level of interest in pre-exposure prophylaxis, or PrEP, among young black men who have sex with men, researchers reported that PrEP uptake was “suboptimal” in this population, even after addressing barriers limiting its use.
Charlotte-Paige Rolle, MD, MPH, of Emory University, said during a presentation at the Conference on Retroviruses and Opportunistic Infections (CROI) that young black men who have sex with men (YBMSM) account for the highest number of new HIV infections among gay and bisexual men in the United States. Therefore, it is an “ethical obligation” to ensure that this population has access to quality HIV prevention tools, including PrEP, she said.
Rolle, along with Carlos del Rio, MD, FIDSA, professor of medicine at Emory University School of Medicine, and colleagues, assessed PrEP interest, uptake and adherence in YBMSM who were offered PrEP through an optional HIV prevention program. They recruited participants aged 16 to 29 years through Facebook and Grinder and at clubs, sex clubs and community events in the metro-Atlanta region.
“This is a real-life community sample of what happens when you offer YBMSM at high risk PrEP,” Rolle said.
The participants were offered comprehensive HIV–risk reduction counseling, condoms, lubricant and daily oral PrEP. They were also shown a brief educational video (whatisprep.org) on PrEP. Those interested in PrEP were scheduled for an initiation visit. The costs of clinician visits and PrEP monitoring were covered by the study; the drug was obtained through the participants’ health insurance and/or manufacturer assistance.
The analysis included 184 YBMSM eligible for PrEP (median age, 24 years). Just 53% of participants were familiar with PrEP, according to Rolle. Of the eligible MSM, 18 (10%) were not interested in PrEP and 50 (27%) wanted to discuss PrEP at the next visit. Overall, 116 men (63%) were interested in taking PrEP; however, more than half (54%) did not attend an initiation visit despite several scheduled attempts among a substantial proportion. Sixty-three interested men (46%) initiated PrEP, but 11 (17%) discontinued its use. As a result, only 52 men (83%), or 28% of the original cohort, are currently enrolled in the PreP program.
Older age, identifying as homosexual, recent condomless anal intercourse and prior PrEP awareness were all positively associated with PrEP uptake; however, the only factor significantly associated with uptake was reported STI in the prior year (n = 46; unadjusted PR = 1.50; 95% CI, 1.002-2.25), with nearly half of men who reported an STI initiating PrEP (n = 21). Another crucial factor related to PrEP uptake was support from family, partners and the community, according to Rolle.
To date, five HIV seroconversions occurred during 95.3 person-years of follow-up, yielding an annual incidence rate of 5.3% (95% CI, 1.9-11.6). Three seroconversions occurred in men who initiated PrEP, but were not taking it at the time of diagnosis.
The median duration between the baseline and an initiation visit among men interested in PrEP was 16 weeks.
“Notably, PrEP initiation visits are offered at least weekly in our study; however, a small part of this delay may be related to the fact that we were unable to consistently offer same-day PrEP initiation visits,” Rolle said.
Meanwhile, the median duration between an initiation visit and starting PrEP therapy was 4 weeks.
“In our sample, PrEP uptake was suboptimal, despite the amelioration of important structural barriers such as the need for health care access, and there does seem to be some sort of critical barrier between PrEP interest and uptake,” Rolle concluded. “Additional research is needed to fully understand these and other factors that mediate PrEP uptake and adherence among YBMSM. We need to focus our efforts on developing interventions to improve progression from willingness to uptake as this group continues to experience disproportionately, and quite frankly unacceptably, high HIV incidence.”
According to del Rio, studying behavior will be key moving forward with this research.
“Just because something is good for you and someone is telling you that it is good for you is not going to make you do it,” he told Infectious Disease News. “We need to understand what drives people and what the challenges are. We need to focus not just on PrEP, but really understand this whole issue of how to change behavior.” – by Stephanie Viguers
Rolle CP, et al. Abstract 90. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 13-16, 2017; Seattle.
Disclosure: del Rio reports no relevant financial disclosures. Infectious Disease News was unable to confirm Rolle’s relevant financial disclosures at the time of publication.