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PrEP Interest, Uptake and Adherence among Young Men Who Have Sex with Men (YMSM) in the United States
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Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
Sybil Hosek1, Jaime Martinez1, Kristine Santos2, Christopher Balthazar1, Pedro Serrano1, Kelly Bojan2, Megha Mehrotra2, Robert Grant2 and the Adolescent Trials Network (ATN) for HIV/AIDS Interventions3
1John Stroger Hospital of Cook County, Chicago, IL; 2Ruth M. Rothstein CORE Center, Chicago, IL; 3Gladstone Institute; 4University of Alabama at Birmingham, Birmingham, AL
Program Abstract-
Background: Young men who have sex with men, particularly racial minority YMSM, are the only group in the
United States whose HIV infection rates continue to increase. Pre-exposure prophylaxis (PrEP), which has been
shown to reduce the risk of HIV acquisition, may be an ideal prevention method for these young men.
Data on interest in open label PrEP use among MSM from the iPrEx trial have been presented, yet YMSM in the
United States were not included in those analyses. Understanding the interest, uptake, and adherence to PrEP
among U.S. YMSM is critical for designing PrEP implementation programs domestically.
Methodology: All 68 YMSM previously enrolled in ATN 082, a randomized pilot trial of PrEP feasibility and
acceptability, were eligible to enroll in the open label extension of the iPrEx trial (iPrEx OLE). All HIV-uninfected
participants were offered daily PrEP (TDF/FTC) along with a comprehensive package of HIV/STI testing and
integrated risk reduction/adherence counseling. All participants taking PrEP were tested for tenofovir levels via plasma.
Participants completed detailed computer assisted self-interviews on reasons for study participation, knowledge of
PrEP efficacy, PrEP adherence and sexual behavior. We compared rates of self-reported adherence, tenofovir
drug levels, and sexual risk behavior between the ATN 082 and iPrEx OLE.
Results: Forty-six YMSM (68% of total eligible; mean age 21; 52% Black, 37% Latino) enrolled in iPrEx OLE.
Of those, 69.6% chose to take PrEP. The most common reasons for study participation were to help fight the HIV
epidemic (74%), to get tested for HIV (59%) and to protect against HIV (59%). Tenofovir detection during the first
12 weeks of iPrEX OLE was 58.3% - up from 45% during the same timeframe of ATN 082. Self-reported adherence
(64.8%) was consistent with tenofovir detection. Most common reasons for missing doses were not having pills with
them (28%), schedule changes (24%) and forgetting (22%). Perceptions of PrEP efficacy increased significantly
(p<.001) across study visits, while number of recent sex partners and episodes of unprotected anal receptive sex
decreased. Participants reported multiple social benefits from study participation and 70% stated they would take
PrEP in the future if available.
Conclusions: When offered open label access to an efficacious product, the majority ATN 082 participants chose to
enroll in iPrEx OLE and take PrEP. While adherence among this challenging population was not optimal, it improved from
ATN 082 and was consistent with self-report. YMSM may find both medical and social benefits to participation in
PrEP programs as well as develop skills to improve adherence and decrease sexual risk behavior.
YMSM appear interested and willing to take PrEP now that efficacy has been established.
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