Behavioral Changes Following Uptake of HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in a Clinical Setting (original) (raw)
Related papers
High Interest in Pre-exposure Prophylaxis Among Men Who Have Sex with Men at Risk for HIV-Infection
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Background: Preexposure prophylaxis (PrEP) is the first biomedical intervention with proven efficacy to reduce HIV acquisition in men who have sex with men (MSM) and transgender women. Little is known about levels of interest and characteristics of individuals who elect to take PrEP in real-world clinical settings. Methods: The US PrEP Demonstration Project is a prospective open-label cohort study assessing PrEP delivery in municipal sexually transmitted disease clinics in San Francisco and Miami and a community health center in Washington, DC. HIV-uninfected MSM and transgender women seeking sexual health services at participating clinics were assessed for eligibility and offered up to 48 weeks of emtricitabine/tenofovir for PrEP. Predictors of enrollment were assessed using a multivariable Poisson regression model, and characteristics of enrolled participants are described. Results: Of 1069 clients assessed for participation, 921 were potentially eligible and 557 (60.5%) enrolled. In multivariable analyses, participants from Miami (adjusted Relative Risk [aRR]: 1.53; 95% confidence interval [CI]: 1.33 to 1.75) or DC (aRR: 1.33; 95% CI: 1.2 to 1.47), those who were self-referred (aRR: 1.48; 95% CI: 1.32 to 1.66), those with previous PrEP awareness (aRR: 1.56; 95% CI: 1.05 to 2.33), and those reporting .1 episode of anal sex with an HIV-infected partner in the last 12 months (aRR: 1.20; 95% CI: 1.09 to 1.33) were more likely to enroll. Almost all (98%) enrolled participants were MSM, and at baseline, 63.5% reported condomless receptive anal sex in the previous 3 months. Conclusions: Interest in PrEP is high among a diverse population of MSM at risk for HIV infection when offered in sexually transmitted disease and community health clinics.
Aids and Behavior, 2017
In a community-based clinic serving men who have sex with men (MSM) in San Francisco, California, this study characterized key steps of the PrEP cascade and identified correlates of retention in care. In total, 344 patients were evaluated for PrEP. Three-fourths (78%) of those who sought PrEP services initiated PrEP. The overall cumulative incidence of discontinuing PrEP at 13 months was 38%. Men with a sexually transmitted infection (STI) were 44% less likely to be retained (adjusted hazard ratio [aHR] 0.56, 95% confidence interval [0.33-0.95]). Comprehensive retention efforts for men with STIs are crucial to optimize the benefits of PrEP.
Challenges for HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men in the United States
Pre-exposure prophylaxis (PrEP) to prevent HIV infection with anti-retroviral (ARV) medications was found to be partially efficacious among men who have sex with men (MSM) [1] and heterosexuals . Other studies have provided information about potential uptake of PrEP among MSM, including factors associated with use and sharing of HIV medications before [4] and after [5] ARV efficacy was known. In a study of high-risk, substance-using MSM in four United States cities conducted prior to the release of efficacy trial results, black and Latino (versus white) MSM were more willing to use a less effective PrEP product in order to avoid condom use [6]; further, high-risk MSM with less education reported more non-prescribed, pre-efficacy ARV use (by HIV-negative men) and sharing of ARVs with sex partners (by HIV-positive men) to prevent HIV infection . In an Internet study of US MSM immediately following release of the efficacy trial results among MSM, black and Latino (versus white) MSM were more willing to use PrEP after efficacy was known .
Journal of the International AIDS Society, 2016
Despite the efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV transmission, few studies have evaluated PrEP use and retention in care outcomes in real-world settings outside of clinical trials. Data were collected from PrEP clinical care programmes in three mid-size US cities: Providence, Rhode Island (RI); Jackson, Mississippi (MS); and St. Louis, Missouri (MO). We assessed the demographic and social characteristics of patients prescribed PrEP and documented their insurance and copayment experiences. We assessed retention in PrEP care at three and six months. Multivariate analyses were used to predict retention in care among men who have sex with men (MSM). HIV acquisition among the cohort was also assessed. A total of 267 (RI: 117; MS: 88; MO: 62) patients were prescribed PrEP; 81% filled prescriptions (RI: 73%; MS: 82%; MO: 94%; p<0.001). Patients in MS and MO were more commonly African American than in RI (72% and 26% vs. 7%, respectively), but less frequently Lat...
AIDS and behavior, 2016
The Food and Drug Administration approved pre-exposure prophylaxis (PrEP) to prevent HIV infection, and the Centers for Disease Control and Prevention has presented PrEP as a prevention option for groups at high risk such as men who have sex with men (MSM). Intervention data provide some information on how PrEP affects sexual behavior of MSM in trials, open label extensions, or clinics. However, it is unclear whether sexual risk and preventive behavioral patterns are changing in the population as a whole as PrEP becomes more widely available, whether due to PrEP use or other factors. We examined trends in PrEP use, numbers of condomless anal sex partners, consistent condom use, and seroadaptive strategies in San Francisco-a city which has actively promoted PrEP-using data from National HIV Behavioral Surveillance (NHBS). NHBS recruited 1211, 383, 373, and 268 HIV-negative MSM in 2004, 2008, 2011, and 2014, respectively. PrEP use increased from zero in 2004, 2008, and 2011 to 9.6 % i...
ProQuest Dissertations Publishing, 2020
Risky sexual behaviors (e.g., engaging in condomless sex) are a leading cause of disease (e.g., sexually transmitted infections) and burden on people and families in the United States and across the globe. The United States has a longstanding history of pathologizing human anatomy and sex through negative messaging, resulting in the stigmatizing of sexual behaviors, sexually transmitted infections, and homosexual behaviors. Discussions between men who have sex with men and their primary care doctors regarding the promotion of sexual health are lacking, despite research showing men are engaging in condomless anal sex within this population. Recent medical and pharmacological advances have been approved to help slow the rate of HIV infection. However, some research suggests this has led to an increase in risky sexual behaviors and condomless sex among men who have sex with men population. Most patients believe it should be their primary care physician who talks to them about issues concerning sexual health and disease prevention; however, many primary care physicians lack a comprehensive knowledge of sex or may not have the necessary time to discuss each patient’s sexual practices and how to reduce risky sexual behaviors. As such, this study seeks to identify variables that are associated with lower stages of change (i.e., due to inconsistent condom use), as well as variables that are correlated with either taking PrEP or being HIV positive. This study found the factors that may suggest lower SOC, and thus increased risk for STIs/HIV, include: being monogamous, having a higher income, having a history of a STI diagnosis, having a HIV positive diagnosis, or already taking PrEP. Being HIV positive is being associated with increased age, higher levels of education, and receiving sexual education from a primary care physician. Taking PrEP is being associated with living in the coastal United States or abroad, higher incomes, having a history of a diagnosis for a sexually transmitted infection, and receiving sexual education from a primary care physician. While these findings suggest individuals are talking to their primary care doctors about sexual health, consistent condom use is found to be low. As such, the findings in this study make a case for the integration of behavioral health professionals (e.g., psychologists) into primary care physicians’ offices to provide interventions to patients regarding risky sexual behaviors.
Journal of Men's Health, 2020
Background and objective Pre-exposure prophylaxis (PrEP) uptake has been suboptimal. Sexually transmitted disease (STD) clinics provide important opportunities to scale PrEP uptake. Material and methods To inform the development of a brief intervention to enhance PrEP uptake in STD clinics, we conducted 32 qualitative interviews to explore barriers and facilitators of PrEP uptake among PrEP eligible, PrEP naïve, and men who have sex with men (MSM) presenting for STD screening services. We also solicited input for intervention components to enhance PrEP uptake at STD clinics. Results Most participants’ self-perceived HIV risks were low despite reporting unprotected anal intercourse. Many were reluctant to take any medications, expressed apprehension about perceived side effects of PrEP, and were unaware of how to obtain PrEP. Participants recommended that interventions focusing on enhancing PrEP uptake in STD clinics should include: culturally tailored educational materials about PrE...
Journal of Clinical Nursing, 2018
Background-Pre-exposure prophylaxis (PrEP) for HIV has been available since 2012. Even so, PrEP has not been widely accepted among healthcare providers and MSM some of whom are convinced that PrEP decreases condom use, and increases sexually transmitted infections (STIs). Design-A systematic review of the state of the evidence regarding the association of PrEP with condom use, STI incidence and change in sexual risk behaviors in MSM. A structured search of databases resulted in 142 potential citations, but only ten publications met inclusion criteria and underwent data abstraction and critical appraisal. Methods-An adapted Cochrane Collaboration domain based assessment tool was used to critically appraise the methodological components of each quantitative study, and the Mixed Methods Appraisal Tool (MMAT) was used to critically appraise qualitative and mixed-methods studies. Results-Condom use in MSM utilizing PrEP is influenced by multiple factors. Studies indicate rates of STIs in treatment and placebo groups were high. PrEP did not significantly change STI rates between baseline and follow-up. Reporting of sexual risk improved when questionnaires were completed in private by clients. Our review found that PrEP may provide an opportunity for MSM to access sexual health care, testing, treatment and counselling services. We did not find any conclusive evidence that PrEP users increase sexual risk behaviors. Conclusion-The perception among healthcare providers that PrEP leads to increased sexual risk behaviors has yet to be confirmed. In order to provide effective sexual health services, clinicians need to be knowledgeable about PrEP as an HIV prevention tool.
The Lancet Public Health, 2020
Background Since October, 2017 (and until October, 2020), pre-exposure prophylaxis (PrEP) has only been available in England, UK, through the PrEP Impact Trial, by purchasing it from some genitourinary medicine clinics, or via online sources. Here we report changes from 2013 to 2018 in PrEP and postexposure prophylaxis (PEP) awareness and use among HIV-negative gay, bisexual, and other men who have sex with men (MSM) and assess predictors of PrEP initiation. Methods In the prospective cohort study Attitudes to, and Understanding of Risk of Acquisition of HIV 2 (AURAH2), MSM were recruited from three sexual health clinics in England: two in London and one in Brighton, UK. Men were eligible if they were aged 18 years or older and HIV-negative or of unknown HIV status. Participants self-completed a baseline paper questionnaire at one of the three clinics between July 30, 2013, and April 30, 2016, and were subsequently able to complete 4-monthly and annual online questionnaires, which were available between March 1, 2015, and March 31, 2018, and collected information on sociodemographics, health and wellbeing, HIV status, and sexual behaviours. PrEP and PEP use in the previous 12 months was obtained at baseline and in annual questionnaires. We assessed trends over calendar time in 3-month periods from first enrolment to the end of the study period (July-December, 2013, was counted as one period) in use of PrEP and PEP using generalised estimating equation logistic models. We used age-adjusted Poisson models to assess factors associated with PrEP initiation among participants who reported never having used PrEP at baseline. Findings 1162 men completed a baseline questionnaire, among whom the mean age was 34 years (SD 10•4), and of those with available data, 942 (82%) of 1150 were white, 1076 (94%) of 1150 were gay, and 857 (74%) of 1159 were university educated. 622 (54%) of 1162 men completed at least one follow-up online questionnaire, of whom 483 (78%) completed at least one annual questionnaire. Overall, PrEP use in the past year increased from 0% (none of 28 respondents) in July to December, 2013, to 43% (23 of 53) in January to March, 2018. The corresponding increase in PrEP use among men who reported condomless sex with two or more partners was from 0% (none of 13 respondents) to 78% (21 of 27). PEP use peaked in April to June, 2016, at 28% (41 of 147 respondents), but decreased thereafter to 8% (four of 53) in January to March, 2018. Among 460 men who had never used PrEP at baseline, predictors of initiating PrEP included age 40-44 years (incidence rate ratio [IRR] 4•25, 95% CI 1•14-15•79) and 45 years and older (3•59, 1•08-11•97) versus younger than 25 years; and after adjustment for age, recent HIV test (5•17, 1•89-14•08), condomless sex (5•01, 2•16-11•63), condomless sex with two or more partners (5•43, 2•99-9•86), group sex (1•69, 1•01-2•84), and non-injection chemsex-related drugs use (2•86, 1•67-4•91) in the past 3 months, PEP use (4•69, 2•83-7•79) in the past 12 months, and calendar year (
Health services research, 2017
To evaluate the impact of an HIV pre-exposure prophylaxis (PrEP) education intervention on PrEP awareness and use among men who have sex with men (MSM) attending a sexually transmitted diseases (STD) clinic. Men who have sex with men STD clinic patients. We estimated a difference-in-differences linear regression model, comparing MSM whose first visit to the clinic was before ("control") or after ("treatment") intervention implementation and controlling for patient. We used self-reported data on PrEP awareness and use from STD clinic intake forms. Pre-exposure prophylaxis awareness between first and second clinic visits increased 27.2 percentage points (pp) in the treatment group, relative to 13.7 pp in the control group. Similarly, PrEP use increased 7.1 pp in the treatment group versus 2.4 pp in the control group. Based on adjusted estimates, the PrEP intervention increased PrEP awareness by 24 pp (p < .01) and PrEP use by 5 pp (p = .01), increases of 63 perc...