A study presented as a poster at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, MA reveals that proper support can lead to high acceptance and adherence to pre-exposure prophylaxis (PrEP) among young black men who have sex with men (MSM).
Several demonstration projects have now found that adherence levels to PrEP are lower among black MSM than among their Latino or white counterparts. Moreover, several surveys have also found that awareness and acceptance of PrEP may also be lower among black MSM.
Though experts have presented theories for why this may occur, no studies have been conducted to assess whether interventions tailored to black MSM (the population with the highest rate of new HIV diagnoses in the United States) might improve PrEP uptake and adherence in this population who might benefit so much from it.
To explore just that, scientists designed a theory-based counseling intervention to offer and support PrEP use in a culturally competent manner. The HPTN 073 study is researching whether this intervention will lead to PrEP uptake and adherence among black MSM of all ages. The intervention is a client-centered care coordination (C4) that supports PrEP use and adherence, provides linkage and follow-up to address unmet psychosocial needs and provides referrals to practical services. All study participants were also offered PrEP, though they did not have to accept it to participate in the study or receive the intervention.
In all, researchers recruited 226 men for the study. The population was diverse in terms of age, with 40% being below 25 years of age, and geography, the three sites were Los Angeles, CA, Washington, DC and Chapel Hill, NC. Specific risks behaviors and rates of sexually transmitted infections during the study were not included, though having at least a moderate HIV risk was a criterion for study inclusion.
The authors report that PrEP uptake and adherence were both relatively high. Seventy-nine percent chose to start PrEP and 68% were still taking it 26 weeks later. Eighty-five percent of PrEP takers reported adherence greater than 50% at week 4 and 78% reported 50% or greater adherence at week 26. Participants could have multiple C4 counseling sessions, and those reporting PrEP use utilized an average of six, while those not taking PrEP utilized an average of four.
There were five infections among those who ever reported taking PrEP, two of whom had stopped taking PrEP quite a while before becoming infected (50 days and 272 days). There were three infections in those not taking PrEP. The rate of new infections was 62% lower among those reporting PrEP use, though the study was not designed to draw a conclusion about effectiveness. Drug blood levels are being collected and analyzed, so true adherence among those who became infected and those who didn't will be known and reported in the future.
Further details from the study are eagerly awaited, and it remains to be determined how well the C4 intervention can be taken up by clinics and organizations where black MSM may be reached, but the results are encouraging.