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PrEP at CROI 2018 Report 2: uptake, HIV incidence; barriers/challenges
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Below are 20 PrEP reports from CROI 2018 preceded by a summary & review of selected studies emblematic of the trends in PrEP.
PrEP Uptake/Use is increased and PrEP can & does reduce HIV transmission, but uptake remains relatively low, as reported in several studies at CROI. Disparities in access are experienced by women and Blacks & latinos and injection drug users, and there are geographical disparities such as that reported in CROI: Geographic Access to PrEP Clinics among US MSM: Documenting PrEP Deserts - (04/4/18). Discontinuation after starting PrEP is a challenge and were reported in several studies at CROI and are discussed below with one study reporting a 33% discontinuation rate. In NYC use of navigation services appears to be important: "those who accepted navigation had higher referral rates". A study from Montreal reports a drop in HIV incidence associated with increased PrEP initiations, but high discontinuation and lost to follow up rates. Below are studies that reported on these issues including from Los Angeles, New York City, Atlanta, Montreal and Chicago, and the CDC, and the US PrEP Demomstration Project in 3 cities - Miami, SF & Wash DC. These studies report on TAF PrEP, Cabotegravir and on MK-8591, a new long-acting drug for treatment & PrEP:
CROI: Oral TAF/FTC PrEP Prevents Vaginal SHIV Infection in Monkeys - (03/09/18);
CROI: Cabotegravir long-acting protects macaques against repeated penile SHIV exposures (03/12/18);
CROI: Low-Dose Oral MK-8591 Protects Monkeys From Rectal SHIV Infection - (03/07/18)
PrEP Uptake (use) has expanded, But disparities in use by women & Blacks are persistently reported.
1. This study is the first to describe the magnitude and distribution of active PrEP prescriptions - Distribution of Active PrEP Prescriptions and the PrEP-to-Need Ratio, US Q2 2017 - active PrEP prescriptions was 61,000 in the second quarter of 2017; 5% of the 1.2 million persons indicated for PrEP are potentially receiving PrEP protection. Unique individuals starting HIV pre-exposure prophylaxis (PrEP) in the US since 2012 is estimated to be 140,000Females had lower levels of prescription prevalence and PrEP-to-need ratios than males across all regions and age groups. Active prescription prevalence and PrEP-to-need ratios were lower among persons aged ≤24 and ≥ 55. The lowest levels of active prescription prevalence were in the center of the country. Lowest levels of PrEP-to-need ratio were in Southern states. The Northeast region had the highest prevalence and the Midwest the lowest. States in highest quartile of the percent of the population living in poverty, percent uninsured, and percent of residents being African American had lower PrEP-to-need ratios. Females, persons ≤24, residents of the South, and residents of non-Medicaid expansion states received lower levels of prescription in comparison to epidemic need.
CROI: Distribution of Active PrEP Prescriptions and the PrEP-to-Need Ratio, US Q2 2017 - (03/07/18)
Disparities in use by women & Blacks are persistently reported. Jeness reported in a modeling study - If BMSM [black MSM] continuum parameters were equal to WMSM values, 17.7% of BMSM would be on PrEP, yielding a 47% decline in incidence. Reported by Dan Smith from CDC - CROI: By Race/ethnicity, Blacks Have Highest Number Needing PrEP in the United States, 2015 (03/28/18) - "Nationwide, 14% of White, 1% of Black, 3 % of Hispanic, and 8% of all persons estimated to have indications for PrEP use in 2015 were prescribed PrEP during the 12 months Sept 2015 -Aug 2016. Blacks comprised the highest number of persons with PrEP indications overall and among MSM and HET.
2. In NYC - "Although key priority groups (e.g., MSM with STI) demonstrated low navigation uptake, navigation effectively resulted in improved referral; these MSM should be prioritized in screening and outreach activities. Uninsured persons were less likely to be linked to a PrEP clinician (aOR, 0.65). Although MSM in key priority groups (e.g., prior STI) showed low navigation uptake, those who accepted navigation had higher referral rates.
3. Atlanta - (41%) did not return to start PrEP after screening. (39%) clients remained persistent in PrEP care. factor significantly associated with PrEP persistence was lack of health insurance (OR 2.68.
4, Chicago - PrEP use increased from 6.6% in visit one to 17.5%. (33.0%) participants discontinued PrEP.
5. US PrEP Demonstation Project in Miami, SF, Wash DC - (66.1%) of enrolled participants in the Demo Project were retained for all study visits, 127/554 (22.9%) had intermittent retention, and 61/554 (11.0%) had early loss to followup (ELTF). The prevalence of ELTF was highest at the Miami site
PreP Use & Discontinuations -
Atlanta -
We examined PrEP uptake and persistence over time among all clients seen at the FCBOH PrEP clinic between October 2015-March 2017 to describe the PrEP care cascade.
African-American men who have sex with men (MSM) have the highest HIV incidence in the US, and the majority of new infections occur in the South. HIV Pre-Exposure Prophylaxis (PrEP) is an effective HIV prevention method; however, implementation may be challenged by structural barriers such as lack of insurance and healthcare access. CDC data demonstrate that only 4.7% of Atlanta MSM have used PrEP compared to 11.3% of San Francisco MSM, suggesting these barriers may play a larger role in the South. Few studies have examined factors affecting persistence in PrEP care, and these data are urgently needed to inform the successful scale-up of PrEP delivery programs. For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. We implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA and describe early PrEP uptake and persistence estimates. The Fulton County Board of Health (FCBOH) PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines.
Between October 2015 and March 2017, 373 clients were screened for PrEP eligibility in accordance with CDC guidelines. Almost all were eligible [367/373 (98%)]; however, 151/367 (41%) did not return to start PrEP after screening. Over half [216/367 (59%)] of PrEP eligible clients attended an enrollment visit, and 201/216 (76%) received a prescription for PrEP. Of 201 clients who started PrEP, 88% were male, 65% were black, 69% were insured, 72% were men who have sex with men, 78% reported inconsistent condom use, and 80% had a prior sexually transmitted infection. As of March 2017, only 78/201 (39%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was lack of health insurance (OR 2.68, 95% CI 1.38, 5.36; Table 1). Among persistent clients who have started PrEP, there have been no HIV seroconversions thus far.
CROI: PrEP Implementation and Persistence in a County Health Department in Atlanta, GA - (03/29/18)
Chicago
- PrEP use increased from 6.6% to 17.2% among young MSM but 33% discontinued PrEP use. Understanding utilization and discontinuation of pre-exposure prophylaxis (PrEP) among young men who have sex with men (YMSM) outside trials and demonstration projects is key in order to inform interventions utilizing PrEP to slow the spread of HIV through this highly impacted population. Data came from RADAR (N = 1031), an ongoing longitudinal cohort of YMSM (aged 16-29) in Chicago. Trends in PrEP use, adherence, and discontinuation were assessed across five time points of data collection. Participants were between 16 and 29 years of age, assigned male at birth, and had a sexual encounter with a man in the previous year or identified as gay, bisexual or transgender.
RESULTS:
8.6% of HIV- participants had ever used PrEP, 6.6% in the past 6 months;
1. Those significantly more likely to have taken PrEP were:
- Older (AOR = 1.18: 95% CI: 1.07-1.30)
- Had more sexual partners (AOR = 1.07; 95% CI: 1.03-1.12)
- Participated in condomless sex (AOR = 2.95; 95% CI: 1.38-6.28)
2. Those significantly less likely to have taken PrEP were:
- Marijuana users with potentially hazardous levels of use (AOR =
0.94; 95% CI: 0.89-0.99)
3. PrEP use increased from 6.6% in visit one to 17.5% in visit three:
- Black participants 8.8% to 15.3% (p = 0.122)
- White participants 9.4% to 20.9% (p = 0.030)
- Hispanic participants 5.2% to 14.9% (p = 0.012)
- Other participants 9.3% to 25.0% (p = 0.054)
4. Of 155 (15.0%) participants currently on PrEP, 49 (31.6%) received questions related to medication adherence:
- A majority of participants were >90% adherent to medication as prescribed across visits one (27/35, 77.1%), two (40/49, 81.6%), and three (18/22, 81.8%)
- Across all visits only 8 (7.6%) reported <70% adherence
- 14 (28.6%) reported missing a dose in the past week with 10 of these (71.4%) missing only a single dose
5. Sixty-five (33.0%) participants discontinued PrEP use prior to the interview date. Primary reasons for discontinuation included:
- Trouble getting to doctor's appointments (21.5%)
- Issues related to insurance coverage or loss (20.0%)
As PrEP uptake continues to rise, more research needs to be focused on predictors of discontinuation and sexual behavior change following discontinuation.
CROI: Trends in PrEP Uptake, Adherence, and Discontinuation Among YMSM in Chicago - (04/5/18)
US PrEP Demonstation Project in Miami, SF, Wash DC.
Retention varied by site but was significantly influenced by age, race, employment status, and prior PrEP awareness. Key populations, such as black MSM and younger adults, are disproportionately lost in the first 12 weeks of PrEP care. Focused and early interventions during initial PrEP visits may enhance continuation in PrEP care.
557 HIV-uninfected men who have sex with men (MSM) and transgender women (TGW) were enrolled across three sites. Follow-up visits occurred at 4, 12, 24, 36, and 48 weeks. Dried blood spot (DBS) samples for tenofovir diphosphate levels. (TFV-DP) were collected at all scheduled follow-up visits and were analyzed on a subset of participants. Demo Project participants' patterns of retention were assigned to
one of three categories: early loss to follow-up (ELTF) within the first 12 weeks of the study, retention throughout the study, or intermittent retention.
RESULTS: Overall, 366/554 (66.1%) of enrolled participants in the Demo Project were retained for all study visits, 127/554 (22.9%) had intermittent retention, and 61/554 (11.0%) had early loss to followup (ELTF). The prevalence of ELTF was highest at the Miami site. Younger age was also associated with both ELTF and intermittent retention.
Factors associated with ELTF (but not intermittent retention) compared with full retention were:
o Black race (compared with white, non-Hispanic)
o Reporting giving/receiving money or other items for sex
o Lack of prior PrEP awareness
o Fewer known HIV-positive partners (<2 vs. >= 2)
o Being disabled or unemployed
Retention varied by site but was significantly influenced by age, race, employment status, and prior PrEP awareness. Key populations, such as black MSM and younger adults, are disproportionately lost in the first 12 weeks of PrEP care. Focused and early interventions during initial PrEP visits may enhance continuation in PrEP care.
CROI: Patterns and Correlates of Participant Retention in the U.S. PrEP Demonstration Project - (04/5/18)
LA -
Effectiveness of daily oral tenofovir/emtricitabine (TDF/FTC) as HIV pre-exposure prophylaxis (PrEP) in preventing HIV in community settings depends on uptake, continued engagement, and adherence.1,2 Previous studies of PrEP outside clinical trials have consistently reported a large proportion of those who start PrEP discontinue PrEP within six months.3-5 Determining the respective proportions of patients who discontinue PrEP due to access barriers versus reduction in HIV risk is crucial to allocating resources to support PrEP patients. The study was conducted to characterize longitudinal use of HIV pre-exposure prophylaxis (PrEP) at a Federally Qualified Health Center in Los Angeles, CA. Longitudinal analysis of patients who initiated TDF/FTC as PrEP at the Los Angeles LGBT Center between March 1, 2014 and February 28, 2017. STUDY OBJECTIVES: 1) Identify demographic and health services correlates of PrEP discontinuation. 2) Compare risk of HIV seroconversion among active and discontinued clients. At the end of the analysis period, 47% (n = 809) of patients who started PrEP were active, 37%
had discontinued, and 16% were lost to follow-up. By three months, 32% (n=572) discontinued, and 45% (n=802) discontinued by six months. Risk of seroconversion among those who discontinued PrEP was 0.95% (n=6 of 633), significantly higher compared to 0.25% (n=2 of 809) among active PrEP patients (p=0.04). A remaining 55% (n=972) continued attending PrEP follow-up appointments for at least six months. Black race/ethnicity (AOR: 1.6, 95% CI 1.0 2.5) and bisexual orientation (AOR: 1.8, 95% CI 1.2, 2.6) were associated with greater odds of discontinuation at baseline compared to white race/ethnicity or gay sexual orientation, respectively. Patients aged 18-24 were more likely to discontinue than older patients, which is concerning given increased HIV rates and lagging PrEP uptake among young people.Discontinuation by six months was associated with age, but not gender, sexual orientation, or race/ethnicity. Compared to those over 50, those between 18-24 (AOR = 2.6, 95% CI 1.6, 4.2); 25-29 (AOR = 1.9, 95% CI 1.3, 2.9), or 30-39 (AOR = 1.5, 95% CI 1.0, 2.3) had higher odds of discontinuing by six months. Future Directions: Examine reasons that patients stop attending PrEP appointments, determine the attributable fraction of access barriers, medication factors, and reduced risk; develop targeted retention and adherence support for young people.
CROI: High Discontinuation of Pre-Exposure Prophylaxis Within Six Months of Initiation- Los Amgeles - (04/5/18)
NYC - Misra and colleagues analyzed interview data on 3908 newly diagnosed persons in New York City . PrEP uptake is increasing but remains sub-optimal among groups at risk of HIV infection, for instance, black and Hispanic MSM and women. Monitoring and describing pre-diagnosis PrEP use history among persons newly diagnosed with HIV reveals gaps and missed opportunities in HIV prevention services. Disease Investigation Specialists at the NYC health department HIV Field Services Unit (FSU) routinely investigate and interview persons newly diagnosed with HIV to link them to HIV care and to elicit sex or needle sharing partners (partner services/PS) for exposure notification and HIV testing. PS investigations include assessment of PrEP use prior to HIV diagnosis. Over 22 months, 3739 (96%) of 3908 persons newly diagnosed with HIV in NYC were investigated for PS. Pre-diagnosis PrEP use was rare among newly HIV diagnosed persons investigated for PS in NYC.
Of these, 95 persons (3%) reported PrEP use prior to HIV diagnosis. Among the 81% of PrEP users whose PrEP stop date preceded their HIV diagnosis date, the median period between PrEP cessation and first HIV positive test was 5 months. The median duration of PrEP use was 3 months and the average number of pills taken per week was 7. A significantly greater proportion of PrEP users than non-users were male, transgender women, white and MSM. About 23% of PrEP users were diagnosed in the AHI, 34% were diagnosed with STIs in the past year, and 6% reported having used post-exposure prophylaxis (PEP). Condomless anal sex in the past year was reported by 77%, sex with a known HIV-positive partner by 41% and sex while drunk or high on drugs by 32%.
CROI: PrEP USE HISTORY OF PERSONS NEWLY DIAGNOSED WITH HIV: NEW YORK CITY, 2015-2017 - (04/5/18)
Montreal - We aim to measure rates of temporary and permanent PrEP discontinuations describe stop reasons and measure seroconversion rates subsequent to stops using the Actuel PrEP cohort (Montreal). Timeline: January 1, 2011 - September 1, 2017. Our cohort measured 450 consistent PrEP users (36%), 114 PrEP users (9%) who temporarily stopped and re-initiated PrEP at least once, 214 individuals who permanently discontinued PrEP (17%) and 480 individuals who have been lost to follow-up (38%) (Figure 1). HIV incidence following discontinuation was 3.9 cases per 100 PY. Among individuals who discontinued PrEP, the most commonly reported stop reasons were side effects (14%), cost of PrEP or loss of private insurance (9%), individual preference (7%), and changes in sex life, such as entry into a stable relationship with seronegative partner (13%), entry into relationship with seropositive undetectable partner (4%), breakup with seropositive partner (4%) or sexual abstinence (10%). Authors conclude: Our findings add evidence to the theory that, for some, PrEP use is a transient rather than constant HIV prevention method. However, the high rates of seroconversion following PrEP discontinuance indicate the need for clinical support which takes into consideration contextual lifestyle factors that may lead individuals to stop PrEP, while remaining at high risk for HIV infection. In turn, appropriate risk counseling for those who stop PrEP and the development of resources to reduce loss to follow-up should be implemented. In line with Montreal's Fast-Track City Initiative, the support of PrEP and other combined prevention measures remain key to ending the epidemic by 2030.
Yet in a 2nd Montreal report - This data shows a major drop in HIV incidence within the past five years. This decline, in parallel with the exponential increase in PrEP initiations, confirms the importance of ensuring PrEP is available to everyone who should need it. It is important to underline, however, this decline was already in progress and is likely attributable, at least in part, to progress towards treatment as prevention and other preventive efforts. From 2011 to 2016, HIV incidence dropped by 56%, from 2.31 to 1.03 new HIV diagnoses per 100 individuals screened annually (Table 1). From 2011 to 2016, HIV incidence dropped by 56%, from 2.31 to 1.03 new HIV diagnoses per 100 individuals screened annually (Table 1, Figure 1). Meanwhile, the number of consultations for PrEP increased exponentially and gradual increases were observed in number of PEP treatments (Table 1, Figure 1). The proportion of seropositive patients at the clinic having an undetectable viral load, reached 95% by 2016 (Table 1) Both the number of individuals screened annually and the total number of tests increased from 2011 to 2016, by 47% and 31%, respectively (Figure 2A, Table 1). This proportion of tests occurring within the context of PrEP care reached 12% in 2015 and 20% in 2016 (Figure 2B).
CROI: DECREASES IN HIV INCIDENCE IN A MONTREAL CLINIC COINCIDE WITH EXPANDING PREP USE - (04/5/18)
The national quarterly estimate of active PrEP prescriptions was 61,000 in the second quarter of 2017, a figure lower than the previous estimate of 120,000 cumulative PrEP starts. The differences in active PrEP prescriptions presented here versus cumulative PrEP starts is expected, as individuals may discontinue PrEP care. Siegler and colleagues calculated the ratio of PrEP provision to the number of new HIV infections (so-called PrEP-to-need ratio) in the United States as a method to evaluate the distribution of PrEP uptake compared among populations at greatest need. This study estimates that only 5% of the 1.2 million persons indicated for PrEP are potentially receiving PrEP protection, demonstrating a need to scale-up PrEP among all groups and in all regions. The lowest levels of active prescription prevalence were in the center of the country. Lowest levels of PrEP-to-need ratio were in Southern states. The PrEP-to-need ratio for the South that is half of the next lowest region. The prevalence of PrEP prescriptions was nearly an order of magnitude lower for women than for men. States in highest quartile of the percent of the population living in poverty, percent uninsured, and percent of residents being African American had lower PrEP-to-need ratios.
CROI: Distribution of Active PrEP Prescriptions and the PrEP-to-Need Ratio, US Q2 2017 - (03/07/18)
NYC PrEP Cascade - Better Navigation Services Engagement Appears to be Needed- New York City's public Sexual Health Clinics (SHC) reach many people at high risk for HIV acquisition. SHC staff provide on-site PrEP navigation to HIV-negative patients who meet program-specific PrEP criteria, and ensure linkage to ongoing PrEP care at referral facilities. We sought to understand intervention uptake and related patient-level factors, which are critical to improving the PrEP cascade. Of 9,948 MSM, 2,929 (29%) met PrEP criteria. PrEP priority groups were PEP use history (n=398, 13%; STI history (n=877, 30%), and High Risk partners (n=290, 10%). 1,372 of the 2,925 expressed PrEP interest (47%). . "Although key priority groups (e.g., MSM with STI) demonstrated low navigation uptake, navigation effectively resulted in improved referral; these MSM should be prioritized in screening and outreach activities. Clinics offering sexual health services are ideal PrEP implementation settings: A large number of racial minority patients were reached, and they were more likely than others to accept PrEP navigation.Overall, ∼1/3 of MSM were found to benefit fully from PrEP services". Uninsured persons were less likely to be linked to a PrEP clinician (aOR, 0.65). Although MSM in key priority groups (e.g., prior STI) showed low navigation uptake, those who accepted navigation had higher referral rates than other groups, suggesting a need for up-front engagement. Clinics offering sexual health services are ideal PrEP implementation settings, reaching racial minority populations likely to accept PrEP, and helping 1 in 5 MSM benefit from these HIV prevention services. Over a 3-month period, 1470 of 4761 MSM were PrEP priority patients: 13% PEP users, 32% with prior STI, 9% with HR partners, 46% with PrEP interest. Of those offered navigation, 62% (890/1437) accepted; prior STI and PEP patients had lowest acceptance (34-37%). 70% of acceptors (627/890) received navigation. Of MSM eligible for referral, 60% (317/526) accepted referral; 45% (143/317) linked to a PrEP provider, and 72% (103/143) were prescribed PrEP; overall 20% (103/526) of referred MSM received PrEP. Compared to MSM with PrEP interest, MSM with PEP history (OR 0.07, 95% CI 0.05-0.10), prior STI (OR 0.06, 95% CI 0.05-0.09), or HR partners (OR 0.18, 95% CI 0.11-0.28) were much less likely to accept navigation. Black (OR 1.63, 95% CI 1.15-2.30), Hispanic (OR 1.85, 95% CI 1.34-2.57) and MSM of other races (OR 1.64, 95% CI 1.08-2.49) were more likely than white MSM to accept navigation. Once navigated, MSM with STI or HR partners were twice as likely as those with PrEP interest to accept referrals; referral acceptance did not differ by other factors. Probability of linkage and prescription did not vary by patient factors. CROI: The PREP Cascade at NYC Sexual Health Clinics: Navigation is the Key to Uptake - (03/29/18)
Dawn Smith of the CDC estimated that 1,145,000 persons in the United States have an indication for taking PrEP, including 814,000 MSM, 258,000 heterosexuals, and 73,000 people who inject drugs. Compared with previous estimates, this new method of calculation increases the number of MSM who have a PrEP indication, and decreases the number of heterosexual and PWID who have a PrEP indication. Overall, 43.7% of persons with a PrEP indication are African American, 24.7% Latino, and 26.5% white. The states with the highest proportion of persons with a PrEP indication who are African American are concentrated in the South and Midwest. Overall coverage is quite low, with 14% of white persons with a PrEP indication having received PrEP in 2015 to 2016, and only 1% of African Americans and 3% of Latinos with a PrEP indication had been on PrEP.
CROI: By Race/ethnicity, Blacks Have Highest Number Needing PrEP in the United States, 2015 (03/28/18)
This is particularly troubling given data presented by Jenness and colleagues......."If BMSM continuum parameters were equal to WMSM values, 17.7% of BMSM would be on PrEP, yielding a 47% decline in incidence (HR = 0.53) and a disparity of 3.30 per 100 PYAR (a 46% decline in the disparity)"......
......"PrEP could be a promising approach to reduce overall incidence and while also lowering"disparities by race"......PrEP Could Reduce HIV Incidence Racial Disparities Among MSM but Due To Less Access & Use by Black MSM compared to White MSM this cannot occur. In this modeling study increasing PrEP use decreases HIV Incidence in Black MSM.
CROI:The PrEP Care Continuum and HIV Racial Disparities among Men Who Have Sex with Men (03/28/18)
In their model of racial disparities in HIV incidence between black and white MSM, they found that current race-specific values of PrEP uptake would be associated with a minimal diminution of HIV incidence among African Americans (7.7-5.9/100 py), but a more substantial reduction among white MSM (1.6- 0.8/100 py). Even if African American MSM achieved twice the rate of PrEP coverage as is currently seen in white MSM, HIV incidence would still be higher in African American MSM than in white MSM (1.7 vs 0.7/100 py). These data indicate that it is imperative that substantial scale-up of PrEP occur, particularly for African American and Latino populations. Here is Jeness abstract from recent publication od this paper: Background: HIV preexposure prophylaxis (PrEP) could reduce the disparities in HIV incidence among black men who have sex with men (BMSM) compared to white MSM (WMSM), but this may depend on progression through the PrEP care continuum. Methods: We expanded our network-based mathematical model of HIV transmission for MSM, which simulates PrEP based on CDC's clinical practice guidelines, to include race- stratified transitions through the PrEP continuum steps of awareness, access, prescription, adherence, and retention. Continuum parameters were estimated based on published incidence cohorts and PrEP open-label studies. Counterfactuals included a no- PrEP reference scenario, and intervention scenarios in which the BMSM continuum step parameters were modified. Results: Implementing PrEP according to the observed BMSM continuum was projected to result in 8.4% of all BMSM on PrEP at year 10, yielding a 23% decline in incidence (HR = 0.77). On an absolute scale, the racial disparity in incidence in this scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the reference scenario. If BMSM continuum parameters were equal to WMSM values, 17.7% of BMSM would be on PrEP, yielding a 47% decline in incidence (HR = 0.53) and a disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). Conclusions: PrEP could lower HIV incidence overall and reduce absolute racial disparities between BMSM and WMSM. Interventions addressing the racial gaps in the PrEP continuum will be needed to further decrease these HIV disparities. Manuscript available at bioRxiv: https://doi.org/10.1101/249540.
Injection Drug Users - Kuo and colleagues confirmed the substantial under-utilization of PrEP among injection drug users and heterosexuals at high risk, using data from the National Behavioral Surveillance System (Abstract 1030). Of people who inject drugs with a PrEP indication surveyed in 2015, only 9% had ever heard of PrEP, 1% had ever discussed PrEP with a health care practitioner, and fewer than 1% had ever received a PrEP prescription. None had ever taken PrEP. Of heterosexuals with indications for PrEP surveyed in 2016, only 13% had heard of PrEP, 3% had ever discussed PrEP with a health care practitioner, and fewer than 1% had ever received a PrEP prescription.
CROI: Assessing PrEP Needs Among Heterosexuals and People Who Inject Drugs, Washington, DC - (04/5/18)
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PrEP at CROI 2018
CROI: Oral TAF/FTC PrEP Prevents Vaginal SHIV Infection in Monkeys - (03/09/18)
CROI: Cabotegravir long-acting protects macaques against repeated penile SHIV exposures (03/12/18)
CROI: Low-Dose Oral MK-8591 Protects Monkeys From Rectal SHIV Infection - (03/07/18)
CROI: MULTIPLE DAILY DOSES OF MK-8591 AS LOW AS 0.25 MG ARE EXPECTED TO SUPPRESS HIV - (03/05/18)
CROI: Protection against repeated vaginal SHIV challenges by bNAb 3BNC117 and 10-1074 - (03/14/18)
CROI: Distribution of Active PrEP Prescriptions and the PrEP-to-Need Ratio, US Q2 2017 - (03/07/18)
CROI: By Race/ethnicity, Blacks Have Highest Number Needing PrEP in the United States, 2015 (03/28/18)
CROI: The PrEP Care Continuum and HIV Racial Disparities among Men Who Have Sex with Men (03/28/18)
CROI: Reported PrEP use among HIV-negative partners of US MSM receiving HIV medical care - (04/5/18)
CROI: Assessing PrEP Needs Among Heterosexuals and People Who Inject Drugs, Washington, DC - (04/5/18)
CROI: Disparities in PrEP Uptake Among Primary Care Patients (03/28/18)
CROI: Getting to Zero New Diagnoses in San Francisco: The Potential Role of PrEP (03/28/18)
CROI: Geographic Access to PrEP Clinics among US MSM: Documenting PrEP Deserts - (04/4/18)
CROI: PREDICTORS OF PrEP ELIGIBILITY AMONG AT-RISK WOMEN IN THE SOUTHERN UNITED STATES - (03/29/18)
CROI: HIV BIOMEDICAL PREVENTION AMONG U.S. WOMEN: KNOWLEDGE, BELIEFS, AND PRACTICES - (03/29/18)
CROI: Monitoring PrEP Use Among Washington State MSM: Results of an Internet Survey - (04/5/18)
CROI: PrEP Implementation and Persistence in a County Health Department in Atlanta, GA - (03/29/18)
CROI: HIGH SEROCONVERSION RATES FOLLOWING PrEP DISCONTINUANCE IN A MONTREAL CLINIC - (04/5/18)
CROI: DECREASES IN HIV INCIDENCE IN A MONTREAL CLINIC COINCIDE WITH EXPANDING PREP USE - (04/5/18)
CROI: PrEP USE HISTORY OF PERSONS NEWLY DIAGNOSED WITH HIV: NEW YORK CITY, 2015-2017 - (04/5/18)
CROI: The PREP Cascade at NYC Sexual Health Clinics: Navigation is the Key to Uptake - (03/29/18)
CROI: Trends in PrEP Uptake, Adherence, and Discontinuation Among YMSM in Chicago - (04/5/18)
CROI: Patterns and Correlates of Participant Retention in the U.S. PrEP Demonstration Project - (04/5/18)
CROI: High Discontinuation of Pre-Exposure Prophylaxis Within Six Months of Initiation- Los Amgeles - (04/5/18)
CROI: INCREASING PREP UPTAKE, PERSISTENT DISPARITIES, IN AT-RISK PATIENTS IN A BOSTON COMMUNITY HEALTH CENTER - (04/5/18)
CROI: Seroconversion on PrEP [4th case]: A Protocol for Untangling Adherence vs. Resistance Failure - (04/4/18)
CROI: A Public Health Approach to Viremic Individuals With PrEP-resistant Virus - (04/4/18)
CROI: HCV RNA and Antigen Detection for Diagnosis of Acute Hepatitis C Among MSM on PreP..... In the ANRS IPERGAY PrEP trial among high risk MSM - (03/29/18)
CROI: HCV incidence in HIV-infected and in PrEP-using MSM - New HCV Rate Similar in HIV+ MSM and HIV- MSM on PrEP in France - (03/27/18)
CROI: Low Prevalence of Hepatitis C Virus Among New York City MSM Initiating PrEP and PEP, 2016-2017 at NYC Sexual Health Clinics (03/15/18)
CROI: A treatment as prevention trial to eliminate HCV in HIV positive men who have sex with men: The Swiss HCVree Trial - e-health assisted behavioral intervention to reduce risk in HCV re-infection in MSM - (03/15/18)
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