Abstract
ObjectivesClinical trials are currently investigating the safety and efficacy of long-acting injectable (LAI) agents as HIV pre-exposure prophylaxis (PrEP). Using National HIV Behavioral Surveillance data, we assessed the self-reported willingness of men who have sex with men (MSM) to use LAI PrEP and their preference for LAI versus daily oral PrEP.MethodsIn 2014, venue-based sampling was used to recruit MSM aged ≥18 years in Washington, DC. Participants completed an interviewer-administered survey followed by voluntary HIV testing. This analysis included MSM who self-reported negative/unknown HIV status at study entry. Correlates of being “very likely” to use LAI PrEP and preferring it to daily oral PrEP were identified using multivariable logistic regression.ResultsOf 314 participants who self-reported negative/unknown HIV status, 50% were <30 years old, 41% were non-Hispanic Black, 37% were non-Hispanic White, and 14% were Hispanic. If LAI PrEP were offered for free or covered by health insurance, 62% were very likely, 25% were somewhat likely, and 12% were unlikely to use it. Regarding preferred PrEP modality, 67% chose LAI PrEP, 24% chose oral PrEP, and 9% chose neither. Correlates of being very likely versus somewhat likely/unlikely to use LAI PrEP included age <30 years (aOR 1.64; 95% CI 1.00–2.68), reporting ≥6 (vs. 1) sex partners in the last year (aOR 2.60; 95% CI 1.22–5.53), previous oral PrEP use (aOR 3.67; 95% CI 1.20–11.24), and being newly identified as HIV-infected during study testing (aOR 4.83; 95% CI 1.03–22.67). Black (vs. White) men (aOR 0.48; 95% CI 0.24–0.96) and men with an income of <$20,000 (vs. ≥$75,000; aOR 0.37; 95% CI 0.15–0.93) were less likely to prefer LAI to oral PrEP.ConclusionsIf LAI PrEP were found to be efficacious, its addition to the HIV prevention toolkit could facilitate more complete PrEP coverage among MSM at risk for HIV.
Highlights
In the United States (US), the HIV epidemic continues to disproportionately affect men who have sex with men (MSM), younger men and Black and Latino/Hispanic men [1]
In 2012, the US Federal Drug Administration (FDA) approved daily oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for HIV prevention based on results of the iPrex study, which found that PrEP reduced HIV incidence by 44% among MSM [2]
The Centers for Disease Control and Prevention (CDC) have since defined indications for PrEP use by HIV-uninfected adult MSM who are not in a monogamous relationship with a recently tested HIV-uninfected partner, recommending PrEP for MSM in an ongoing sexual relationship with an HIV-infected male partner or for MSM who have had any anal sex without a condom in the last six months or any sexually transmitted infection (STI) diagnosed or reported in the last six months [3]
Summary
In the United States (US), the HIV epidemic continues to disproportionately affect men who have sex with men (MSM), younger men and Black and Latino/Hispanic men [1]. In 2012, the US Federal Drug Administration (FDA) approved daily oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) for HIV prevention based on results of the iPrex study, which found that PrEP reduced HIV incidence by 44% among MSM [2]. Low adherence has prevented participants in various studies from achieving protection from HIV infection using PrEP, as its effectiveness is limited by one’s willingness and ability to take a daily pill [4]. Oral drug regimens can be challenging in general due to pill fatigue and the ongoing need to remember to take medication daily [7], among younger populations, as PrEP adherence was found to be low in one PrEP trial of young MSM [9]
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