Abstract
The effectiveness of oral HIV preexposure prophylaxis (PrEP) strongly depends on maintaining adherence. We investigated the association between substance use and PrEP adherence, as well as incident sexually transmitted infections (STIs) in a high-risk cohort of 394 participants (391 men who have sex with men and 3 transgender women) who were enrolled in a PrEP demonstration project. We assessed baseline and ongoing substance use over a 48-week period for stimulants and nonstimulant substances and for each substance separately. We measured PrEP adherence by using dried blood spots to obtain levels of tenofovir diphosphate. No differences in these levels were found between substance users and nonsubstance users. Baseline stimulant use was strongly associated (odds ratio 3.4; p<0.001) with incident STIs during the study. Thus, PrEP adherence was not decreased by substance use. Because substance users had increased rates of STIs, indicating higher-risk behavior, they might be excellent candidates for PrEP.
Highlights
We investigated the association between substance use and preexposure prophylaxis (PrEP) adherence, as well as incident sexually transmitted infections (STIs) in a high-risk cohort of 394 participants (391 men who have sex with men and 3 transgender women) who were enrolled in a PrEP demonstration project
The objective of our study was to investigate the association between substance/alcohol use and adherence to PrEP, as well as sexually transmitted infections (STIs) and study completion, in a well-characterized high-risk cohort of men who have sex with men (MSM) and transgender women who participated in the California Collaborative Treatment Group (CCTG) 595 Study
In the Cox regression model adjusting for study arm (Table 4), we found that frequent baseline substance use was significantly associated with study completion (HR for early study termination 0.541; p = 0.036) compared with persons who had no substance use; 86% of persons who had frequent substance use completed the study compared with 81% who had some substance use and 76% who had no substance use)
Summary
In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)TM. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: [1] review the learning objectives and author disclosures; [2] study the education content; [3] take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/eid; and [4] view/print certificate. Distinguish rates of substance use and PrEP adherence in the current cohort of predominantly men who have sex with men (MSM)
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