Association Between HIV PrEP Indications and Use in a National Sexual Network Study of US Men Who Have Sex with Men

Overview

Journal J Int AIDS Soc

Specialty Infectious Diseases

Date 2021 Oct 4

PMID 34605174

Citations 9

Authors

Kevin M Weiss

Pragati Prasad

Travis Sanchez

Steven M Goodreau

Samuel M Jenness

Affiliations

Soon will be listed here.

Abstract

Introduction: HIV pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. United States Public Health Service (USPHS) clinical practice guidelines define biobehavioral indications for initiation. To assess guideline implementation, it is critical to quantify PrEP nonusers who are indicated and PrEP users who are not indicated. We sought to estimate current PrEP use among US men who have sex with men (MSM), characterize whether their PrEP use aligned with their current indications for PrEP, and assess whether the association between PrEP indications and PrEP use differed by demography or geography.

Methods: Using data from a US web-based sexual network study of MSM between 2017 and 2019, we measured PrEP usage and assessed whether respondents met indications for PrEP. Log-binomial regression was used to estimate the relationship between PrEP indications and PrEP use, with adjustment for geography, age and race/ethnicity.

Results: Of 3508 sexually active, HIV-negative MSM, 34% met indications for PrEP. The proportion with current PrEP use was 32% among MSM meeting indications and 11% among those without indications. Nearly 40% of those currently using PrEP did not meet indications for PrEP, and 68% of MSM with indications for PrEP were not currently using PrEP. After adjusting for geography and demographics, MSM with PrEP indications were about three times as likely to be currently using PrEP. This association varied slightly, but not significantly, by geographic region, age and race/ethnicity.

Conclusions: Indications for PrEP strongly predicted current PrEP use among US MSM. However, we identified substantial misalignment between indications and use in both directions (indicated MSM who were not benefitting from PrEP, and MSM taking PrEP while not presently being indicated). PrEP underuse by those at greatest risk for HIV acquisition may limit the projected impact of PrEP implementation, despite reported increases in PrEP provision. This calls for further implementation efforts to improve PrEP delivery to those most in need during periods of elevated sexual risk and to close the gap between indications and uptake.

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References

Pleuhs B, Quinn K, Walsh J, Petroll A, John S . Health Care Provider Barriers to HIV Pre-Exposure Prophylaxis in the United States: A Systematic Review. AIDS Patient Care STDS. 2020; 34(3):111-123. PMC: 7087402. DOI: 10.1089/apc.2019.0189. View

Siegler A, Bratcher A, Weiss K, Mouhanna F, Ahlschlager L, Sullivan P . Location location location: an exploration of disparities in access to publicly listed pre-exposure prophylaxis clinics in the United States. Ann Epidemiol. 2018; 28(12):858-864. PMC: 6261794. DOI: 10.1016/j.annepidem.2018.05.006. View

Sullivan P, Khosropour C, Luisi N, Amsden M, Coggia T, Wingood G . Bias in online recruitment and retention of racial and ethnic minority men who have sex with men. J Med Internet Res. 2011; 13(2):e38. PMC: 3221372. DOI: 10.2196/jmir.1797. View

Huang Y, Zhu W, Smith D, Harris N, Hoover K . HIV Preexposure Prophylaxis, by Race and Ethnicity - United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018; 67(41):1147-1150. PMC: 6193685. DOI: 10.15585/mmwr.mm6741a3. View

Jenness S, Goodreau S, Rosenberg E, Beylerian E, Hoover K, Smith D . Impact of the Centers for Disease Control's HIV Preexposure Prophylaxis Guidelines for Men Who Have Sex With Men in the United States. J Infect Dis. 2016; 214(12):1800-1807. PMC: 5142082. DOI: 10.1093/infdis/jiw223. View

Antoni G, Tremblay C, Delaugerre C, Charreau I, Cua E, Castro D . On-demand pre-exposure prophylaxis with tenofovir disoproxil fumarate plus emtricitabine among men who have sex with men with less frequent sexual intercourse: a post-hoc analysis of the ANRS IPERGAY trial. Lancet HIV. 2019; 7(2):e113-e120. DOI: 10.1016/S2352-3018(19)30341-8. View

Hoots B, Finlayson T, Nerlander L, Paz-Bailey G . Willingness to Take, Use of, and Indications for Pre-exposure Prophylaxis Among Men Who Have Sex With Men-20 US Cities, 2014. Clin Infect Dis. 2016; 63(5):672-7. PMC: 5009903. DOI: 10.1093/cid/ciw367. View

Hoth A, Shafer C, Dillon D, Mayer R, Walton G, Ohl M . Iowa TelePrEP: A Public-Health-Partnered Telehealth Model for Human Immunodeficiency Virus Preexposure Prophylaxis Delivery in a Rural State. Sex Transm Dis. 2019; 46(8):507-512. DOI: 10.1097/OLQ.0000000000001017. View

Zlotorzynska M, Sullivan P, Sanchez T . The Annual American Men's Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: 2016 Key Indicators Report. JMIR Public Health Surveill. 2019; 5(1):e11313. PMC: 6401665. DOI: 10.2196/11313. View

10.

Owens C, Hubach R, Williams D, Voorheis E, Lester J, Reece M . Facilitators and Barriers of Pre-exposure Prophylaxis (PrEP) Uptake Among Rural Men who have Sex with Men Living in the Midwestern U.S. Arch Sex Behav. 2020; 49(6):2179-2191. DOI: 10.1007/s10508-020-01654-6. View

11.

Volk J, Marcus J, Phengrasamy T, Blechinger D, Nguyen D, Follansbee S . No New HIV Infections With Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting. Clin Infect Dis. 2015; 61(10):1601-3. PMC: 4809999. DOI: 10.1093/cid/civ778. View

12.

Grant R, Lama J, Anderson P, McMahan V, Liu A, Vargas L . Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010; 363(27):2587-99. PMC: 3079639. DOI: 10.1056/NEJMoa1011205. View

13.

Pyra M, Rusie L, Keglovitz Baker K, Baker A, Ridgway J, Schneider J . Correlations of HIV Preexposure Prophylaxis Indications and Uptake, Chicago, Illinois, 2015-2018. Am J Public Health. 2020; 110(3):370-377. PMC: 7002954. DOI: 10.2105/AJPH.2019.305469. View

14.

Smith D, Sullivan P, Cadwell B, Waller L, Siddiqi A, Mera-Giler R . Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012-2016. Clin Infect Dis. 2020; 71(12):3144-3151. PMC: 7819523. DOI: 10.1093/cid/ciz1229. View

15.

Lockard A, Rosenberg E, Sullivan P, Kelley C, Serota D, Rolle C . Contrasting Self-Perceived Need and Guideline-Based Indication for HIV Pre-Exposure Prophylaxis Among Young, Black Men Who Have Sex with Men Offered Pre-Exposure Prophylaxis in Atlanta, Georgia. AIDS Patient Care STDS. 2019; 33(3):112-119. PMC: 6442270. DOI: 10.1089/apc.2018.0135. View

16.

Golub S, Fikslin R, Goldberg M, Pena S, Radix A . Predictors of PrEP Uptake Among Patients with Equivalent Access. AIDS Behav. 2019; 23(7):1917-1924. PMC: 6571035. DOI: 10.1007/s10461-018-2376-y. View

17.

Fauci A, Redfield R, Sigounas G, Weahkee M, Giroir B . Ending the HIV Epidemic: A Plan for the United States. JAMA. 2019; 321(9):844-845. DOI: 10.1001/jama.2019.1343. View

18.

Molina J, Charreau I, Spire B, Cotte L, Chas J, Capitant C . Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men: an observational cohort study. Lancet HIV. 2017; 4(9):e402-e410. DOI: 10.1016/S2352-3018(17)30089-9. View

19.

Smith D, Van Handel M, Grey J . Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018; 28(12):850-857.e9. DOI: 10.1016/j.annepidem.2018.05.003. View

20.

Sanchez T, Zlotorzynska M, Craig Sineath R, Kahle E, Tregear S, Sullivan P . National Trends in Sexual Behavior, Substance Use and HIV Testing Among United States Men Who have Sex with Men Recruited Online, 2013 Through 2017. AIDS Behav. 2018; 22(8):2413-2425. DOI: 10.1007/s10461-018-2168-4. View