Young MSM are willing and able to take PrEP at protective levels, but adherence challenges remain among men of color, those exposed to violence, and people trying to meet subsistence needs, a small study in Alameda County, California, showed.
A substantial proportion (nearly 12%) of the 257 study participants needed post-exposure prophylaxis after recent activity that put them at high risk of seroconversion, before they could start PrEP. Over time, PrEP adherence dropped off, with 87% having protective levels of the study drug in their blood at week 4 and 77% at week 48. Sixty percent of Latino and 48% of African-American participants were highly adherent at week 48, compared to 79% of white men. Similarly, 25% of those financially struggling to survive and 66% of those barely covering their necessities showed high adherence compared to 86% of those reporting a comfortable income. High adherence was defined as blood levels of the study drug indicating at least four doses a week.
Participants received routine counseling and support, in addition to clinical care, during their visits. Study authors credited this intervention with the relatively high adherence levels observed, but conceded that it was insufficient for offsetting the effect of the daily life challenges faced by some participants. "Preventing violence, counseling following exposures to violence, and supporting young men of color in meeting basic survival needs may be as important as prescriptions and laboratory tests in enhancing access and adherence to PrEP," they concluded.