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CROI 2016: Tailored Support Encourages Black Gay Men to Stay on PrEP

Providing culturally tailored counseling and support programs for black men who have sex with men can increase their likelihood of maintaining adherence to pre-exposure prophylaxis (PrEP) for HIV prevention, helping to address a key public health gap in the U.S., according to findings from the HPTN 073 study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2016)last month in Boston.

Black gay and bisexual men -- especially young men -- are the group with the highest rate of new HIV infections in the U.S. Though they make up less than 1% of the U.S. population, they accounted for more than 20% of all new infections in 2013.

Clinical trials and demonstration projects have shown that PrEP using daily Truvada (tenofovir/emtricitabine) can reduce the risk of infection by more than 90%. But some studies have also found that black gay men are less likely than white gay men to start and stay on PrEP.

HPTN 073, conducted by the HIV Prevention Trials Network and funded by the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse, is one of the first studies to evaluate PrEP for black men who have sex with men (MSM). The study enrolled more than 200 HIV-negative men at sites in 3 cities: Chapel Hill, NC; Los Angeles; and Washington, DC.

The study recruited 226 black MSM, of whom 209 (92%) completed 12 month of follow-up; 40% were under 25 years of age. Over a quarter were unemployed or on disability, a third had been incarcerated, 25% had a high school education or less, nearly half had an annual income under $20,000, and 31% did not have health insurance.

Nearly three-quarters identified as gay and 20% as bisexual. About one-third reported having a male primary partner (only 3 had female primary partners) and 73% said they had casual male partners; the median number of male sex partners in the past 3 months was 3.

All participants were offered once-daily oral Truvada along with client-centered care coordination or "C4," a counseling approach to support PrEP use which combined service referral, linkage, and follow-up to assist the men in addressing unmet psychosocial needs including substance use, homelessness, mental health and medical issues, and intimate partner violence.

Participants were followed for 12 months. Men who agreed to take PrEP attended a median of 6 "C4" sessions (range 3-8), while men who declined PrEP attended a median of 4 sessions (range 2-6).

Results

• A majority of study participants (178 or 79%) accepted PrEP, usually starting it soon after enrollment.
• All but 1 of the men (96%) who had an HIV-positive primary partner and 86% of those who had casual partners who were HIV-positive or of unknown status accepted PrEP.
• Cumulative PrEP uptake was highest in Chapel Hill (nearly 90%), followed by Washington, DC (nearly 80%), and Los Angeles (around 65%).
• More than two-thirds (68%) remained on PrEP at 26 weeks.
• Self-reported adherence of at least 50% of doses was 85% at 4 weeks, 81% at 26 weeks, and 86% at 52 weeks.
• Adherence of at least 90% was reported by 67%, 62%, and 67% at the respective time points.
• At the study's midpoint, about 70% of participants who accepted PrEP had protective drug levels in their plasma, according to a NIAID news release.
• 5 new HIV infections occurred among the 178 men who accepted PrEP, for an incidence of 2.9% (95% CI 0.9-6.8); in comparison, the incidence was 7.7% among the much smaller number of men who declined PrEP (95% CI 6.0-22.5).
• However, in 2 of these cases the men reported stopping PrEP at 50 and 272 days prior to seroconversion.

"Providing theory-based culturally tailored programs for black MSM can potentially increase their ability to establish and maintain adherence and prevent HIV in this highly impacted group," the researchers concluded. "HPTN 073 demonstrated high uptake of PrEP in black MSM utilizing a novel coordinated counseling model that was highly acceptable, and led to data that could support a reduced rate of HIV infection for black MSM on PrEP."

3/23/16

Reference

DP Wheeler, S Fields, LE Nelson, et al. HPTN 073: PrEP Uptake and Use by Black Men Who Have Sex With Men. Conference on Retroviruses and Opportunistic Infections. Boston, February 22-25, 2016. Abstract 883LB.

Other Source

National Institute of Allergy and Infectious Diseases. NIH-Funded Study Finds Critical Population Adheres to PrEP with Coordinated Care. NIAID News. February 24, 2016.