Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study

Darrell P. Wheeler, Sheldon D. Fields, Geetha Beauchamp, Ying Q. Chen, Lynda M. Emel, Lisa Hightow-Weidman, Christopher Hucks-Ortiz, Irene Kuo, Jonathan Lucas, Manya Magnus, Kenneth H. Mayer, La Ron E. Nelson, Craig Hendrix, Estelle Piwowar-Manning, Steven Shoptaw, Phaedrea Watkins, C. Chauncey Watson, Leo Wilton

Research output: Contribution to journalArticle

Abstract

Introduction: Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model. Methods: The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results: Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 –6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). Conclusions: Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.

Original languageEnglish (US)
Article numbere25223
JournalJournal of the International AIDS Society
Volume22
Issue number2
DOIs
StatePublished - Feb 1 2019

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HIV
Confidence Intervals
Odds Ratio
Tenofovir
Pre-Exposure Prophylaxis
Los Angeles
Sex Ratio
Risk Reduction Behavior
Research
Sexual Behavior
Randomized Controlled Trials
Pharmacokinetics
Education
Incidence

Keywords

  • client-centered care coordination (C4)
  • HIV disparities
  • HIV prevention
  • MultiLevel interventions
  • PrEP adherence
  • PrEP initiation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities : results from the HPTN 073 study. / Wheeler, Darrell P.; Fields, Sheldon D.; Beauchamp, Geetha; Chen, Ying Q.; Emel, Lynda M.; Hightow-Weidman, Lisa; Hucks-Ortiz, Christopher; Kuo, Irene; Lucas, Jonathan; Magnus, Manya; Mayer, Kenneth H.; Nelson, La Ron E.; Hendrix, Craig; Piwowar-Manning, Estelle; Shoptaw, Steven; Watkins, Phaedrea; Watson, C. Chauncey; Wilton, Leo.

In: Journal of the International AIDS Society, Vol. 22, No. 2, e25223, 01.02.2019.

Research output: Contribution to journalArticle

Wheeler, DP, Fields, SD, Beauchamp, G, Chen, YQ, Emel, LM, Hightow-Weidman, L, Hucks-Ortiz, C, Kuo, I, Lucas, J, Magnus, M, Mayer, KH, Nelson, LRE, Hendrix, C, Piwowar-Manning, E, Shoptaw, S, Watkins, P, Watson, CC & Wilton, L 2019, 'Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities: results from the HPTN 073 study', Journal of the International AIDS Society, vol. 22, no. 2, e25223. https://doi.org/10.1002/jia2.25223
Wheeler, Darrell P. ; Fields, Sheldon D. ; Beauchamp, Geetha ; Chen, Ying Q. ; Emel, Lynda M. ; Hightow-Weidman, Lisa ; Hucks-Ortiz, Christopher ; Kuo, Irene ; Lucas, Jonathan ; Magnus, Manya ; Mayer, Kenneth H. ; Nelson, La Ron E. ; Hendrix, Craig ; Piwowar-Manning, Estelle ; Shoptaw, Steven ; Watkins, Phaedrea ; Watson, C. Chauncey ; Wilton, Leo. / Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities : results from the HPTN 073 study. In: Journal of the International AIDS Society. 2019 ; Vol. 22, No. 2.
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abstract = "Introduction: Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model. Methods: The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results: Of the 226 men enrolled, 178 participants initiated PrEP (79{\%}), and of these 64{\%} demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95{\%} confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95{\%} CI 1.37 –6.37), perception of having enough money (OR 3.6, 95{\%} CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95{\%} CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95{\%} CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95{\%} CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). Conclusions: Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.",
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TY - JOUR

T1 - Pre-exposure prophylaxis initiation and adherence among Black men who have sex with men (MSM) in three US cities

T2 - results from the HPTN 073 study

AU - Wheeler, Darrell P.

AU - Fields, Sheldon D.

AU - Beauchamp, Geetha

AU - Chen, Ying Q.

AU - Emel, Lynda M.

AU - Hightow-Weidman, Lisa

AU - Hucks-Ortiz, Christopher

AU - Kuo, Irene

AU - Lucas, Jonathan

AU - Magnus, Manya

AU - Mayer, Kenneth H.

AU - Nelson, La Ron E.

AU - Hendrix, Craig

AU - Piwowar-Manning, Estelle

AU - Shoptaw, Steven

AU - Watkins, Phaedrea

AU - Watson, C. Chauncey

AU - Wilton, Leo

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Introduction: Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model. Methods: The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results: Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 –6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). Conclusions: Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.

AB - Introduction: Randomized clinical trials have demonstrated the efficacy of antiretroviral pre-exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client-centered care coordination (C4) model. Methods: The HPTN 073 study enrolled and followed 226 HIV-uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results: Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid-point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV-infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 –6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). Conclusions: Results suggest a high level of PrEP initiation among at-risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.

KW - client-centered care coordination (C4)

KW - HIV disparities

KW - HIV prevention

KW - MultiLevel interventions

KW - PrEP adherence

KW - PrEP initiation

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DO - 10.1002/jia2.25223

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