‘Substantial misinformation’ affects PrEP uptake among American MSM
The majority of urban American men who have sex with men, or MSM, who are at risk for HIV do not use pre-exposure prophylaxis treatment, or PrEP — suggesting a need for more interventions that increase awareness and uptake of PrEP in this group, according to findings from CROI 2020.
“The four-city study found that PrEP is still underutilized by high-risk men who have sex with men [MSM] and that there is substantial misinformation, including perceptions that the medications have more side effects than they actually do,” Kenneth H. Mayer, MD, medical research director at Fenway Health and co-director of The Fenway Institute and professor of medicine at Harvard Medical School, told Healio.
Mayer and colleagues examined data from the HPTN 078 study, which included HIV screening for 1,305 MSM in Boston, Baltimore, Atlanta and Birmingham in 2018. The current analysis included HIV-negative MSM from those same cities who met CDC risk criteria for HIV. The researchers reviewed patient-reported sociodemographic information, behavioral risk factors and attitudes about PrEP for all participants. Plasma tenofovir concentrations were measured for participants who noted that they used PrEP in the past 12 months. Univariate and multivariable models were used to examine the factors that correlated with knowledge of PrEP, use of PrEP in the past 12 months and the presence of protective plasma tenofovir concentrations (>40 ng/mL).
Out of 382 HIV-negative MSM, 267 (70%) met CDC risk criteria for PrEP. Of these 267 patients, 21% were aged 18 to 24 and 39% were aged 25 to 35 years. Black and Latinx individuals comprised 42% and 17%, respectively, of this PrEP risk group; 37% of people in this group had a high school or less level of education. A total of 21% of the PrEP risk group did not have health insurance, 87% reported an annual income of less than $30,000 and 72.5% said they had heard of PrEP. Of those who had heard of PrEP, 23.1% noted they had used it in the past year; among those who indicated they had used PrEP, 57.6% had protective blood concentrations.
“It is important to create welcoming environments so gay and other men who have sex with men feel comfortable discussing their risks, and it is key that clinicians feel knowledgeable to educate their patients about the real-world considerations regarding PrEP,” Mayer said. “The low rate of PrEP uptake [in this study] has been seen in similar studies, but these data are very recent, which suggests that there has not been much of a change in recent years.”
In multivariable models, factors related to prior knowledge of PrEP included younger age (P = .001), being white (P < .001) and having more than a high school education (P = .001). Correlates for having used PrEP included being employed (P = .025), living in Baltimore (P = .012), having health insurance (P = .040), self-perceived HIV risk (P < .001) and not being concerned about side effects (P = .023).
“The other major reasons for decreased PrEP use related to economic challenges, which was surprising, since there are many drug assistance programs,” Mayer said. “This suggests that many men have not been able to adequately navigate our challenging health care system to access needed medication.”– by Eamon Dreisbach
Mayer KH, et al. Abstract 995. Presented at: Conference on Retroviruses and Opportunistic Infections; March 8-11, 2020; Boston.
Disclosure: Mayer reports no relevant financial disclosures.