HIV Prevention For MSM Research Articles

Mobile Technology Use and Acceptability of mHealth for HIV Prevention Among Men Who Have Sex With Men in Malaysia

Background The growth in mobile technology access, utilization, and services holds great promise for facilitating HIV prevention efforts in Malaysia. Despite these promising trends, there is a dearth of evidence on the use of mobile health (mHealth) platforms to address the HIV prevention needs of Malaysian men who have sex with men (MSM). Objective The goal of this study was to gain insights into (1) the access and utilization of communication technology (eg, landline phone, internet, and cell phone), (2) the acceptability of mHealth-based interventions for HIV prevention services, and (3) preferences regarding the format and frequency of mHealth interventions among Malaysian MSM. Methods A cross-sectional survey of 376 Malaysian MSM was conducted between July 2018 and March 2020. Participants were recruited using respondent-driven sampling in the Greater Kuala Lumpur region, Malaysia. Participants completed a self-administered assessment of participant demographics, HIV risk-related behaviors, access to and frequency of the use of communication technology, and the acceptability of mHealth for HIV prevention. Results Almost all participants owned or had access to a smartphone with internet access (97.9%) and accessed the internet daily (99.2%), mainly on a smartphone (88.8%). Using a 5-point scale, participants on average used smartphones primarily for social networking (mean 4.5, SD 0.8), followed by sending or receiving emails (mean 4.0, SD 1.0) and searching for health-related information (mean 3.5, SD 0.9). Further, the results indicated the high acceptance of mHealth for HIV prevention, that is, receiving HIV prevention information (91.8%), receiving reminders to take medications (89.4%), tracking sexual activity (81.4%), tracking drug use (74.7%), and monitoring drug cravings (74.5%), with the most preferred method being the smartphone app for all activities. Conclusions The findings from this study provide support for developing and deploying mHealth strategies for HIV prevention in MSM by using a smartphone app, which are crucial for a key population with suboptimal engagement in HIV prevention and treatment. Conflicts of Interest None declared.

Pre-exposure Prophylaxis Uptake, Adherence, and Persistence: A Narrative Review of Interventions in the U.S.

Since 2012, HIV pre-exposure prophylaxis (PrEP) has been available to prevent HIV transmission; yet, uptake, adherence, and persistence to PrEP have been suboptimal. This narrative review examines the latest interventions and programs to improve all 3 stages of PrEP adherence and reviews ongoing studies to promote effective PrEP use. From 2017 to 2020, a total of 20 studies analyzed different individual- and structural-level approaches to increase PrEP adherence, including behavior change interventions, technology-based interventions (e.g., short message service messages and mobile applications), and alternate delivery strategies (e.g., pharmacy-based PrEP, integration with other services, and home delivery). Most published interventions involved men who have sex with men, although 3 assessed women (2 transgender, 1 cisgender). Randomized, controlled data support 3 behavioral change interventions and 1 technology-based intervention. Alternate delivery strategies seem promising, although more robust study designs are generally needed. In addition, data on the alignment of ongoing HIV risk and PrEP persistence (i.e., prevention-effective adherence) were limited. The authors also identified 20 ongoing studies that are promoting PrEP adherence. Future work should be inclusive of all at-risk groups in the U.S., including African American and Latinx heterosexual populations and people who inject drugs. Proven and promising approaches may work well in combination and may also need to be adapted with the introduction of long-acting pre-exposure prophylaxis formulations. Collectively, this body of work indicates considerable progress toward understanding the role PrEP adherence will play in Ending the HIV Epidemic in the U.S. that will be bolstered by the outcomes of ongoing trials.

What Can Urine Tell Us About Medication Adherence?

What Can Urine Tell Us About Medication Adherence?

Plasma Tenofovir Levels to Support Adherence to TDF/FTC Preexposure Prophylaxis for HIV Prevention in MSM in Los Angeles, California.

Tenofovir disoproxil fumarate/emtricitabine preexposure prophylaxis (PrEP) is effective against HIV acquisition when taken as prescribed. Strategies that identify and intervene with those challenged by adherence to daily medication are needed. PATH-PrEP was an open-label single-arm interventional cohort study conducted at 2 community-based clinical sites in Los Angeles, CA. We enrolled self-identified men who have sex with men and transgender women ≥18 years of age at an elevated risk of HIV acquisition. Participants received a postexposure prophylaxis (PEP)-based or PrEP-based HIV prevention package for at least 48 weeks. Plasma tenofovir levels from each PrEP visit assessed as below the limit of quantitation (<10 ng/mL) triggered increased adherence support. Three hundred one participants enrolled. Forty-eight-week retention in the PrEP cohort was 75.1%. Biomarker evidence of PrEP adherence consistent with ≥4 doses per week at weeks 4, 12, 24, 36, and 48 was found in 83.1%, 83.4%, 75.7%, 71.6%, and 65.5% of participants, respectively; younger and African American participants were less likely to have protective drug levels. Most of those with suboptimal adherence had adherence improvement after brief intervention. One seroconversion occurred in a participant who discontinued PrEP. Nearly half (46.4%) of participants were diagnosed with at least 1 incident sexually transmitted infection during 48 weeks of study follow-up. PrEP was acceptable and well tolerated in a diverse population of men who have sex with men in Los Angeles. A brief intervention triggered from biomarkers of poor adherence was associated with improved adherence. Drug level monitoring has the potential to allow targeting of additional adherence support to those struggling with daily tablet adherence.

Nondaily preexposure prophylaxis for HIV prevention.

To discuss nondaily preexposure prophylaxis (PrEP) modalities that may provide advantages compared with daily PrEP in cost and cumulative toxicity, but may have lower adherence forgiveness. Animal models have informed our understanding of early viral transmission events, which help guide event-driven PrEP dosing strategies. These models indicate early establishment of viral replication in rectal or cervicovaginal tissues, so event-driven PrEP should rapidly deliver high mucosal drug concentrations within hours of the potential exposure event. Macaque models have demonstrated the high biological efficacy for event-driven dosing of oral tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) against both vaginal and rectal virus transmission. In humans, the IPERGAY study demonstrated 86% efficacy for event-driven oral TDF/FTC dosing among men who have sex with men (MSM), while no similar efficacy data are available on women or heterosexual men. The HPTN 067 study showed that certain MSM populations adhere well to nondaily PrEP, whereas other populations of women adhere more poorly to nondaily versus daily regimens. Pharmacokinetic studies following oral TDF/FTC dosing in humans indicate that TFV-diphosphate (the active form of TFV) accumulates to higher concentrations in rectal versus cervicovaginal tissue, but nonadherence in trials complicates the interpretation of differential mucosal drug concentrations. Event-driven dosing for TFV-based PrEP has promise for HIV prevention in MSM. Future research of event-driven PrEP in women and heterosexual men should be guided by a better understanding of the importance of mucosal drug concentrations for PrEP efficacy and its sensitivity to adherence.

Feasibility of a Combination HIV Prevention Program for Men Who Have Sex With Men in Blantyre, Malawi.

The use of combination HIV prevention interventions (CHPI) now represent the standard of care to minimize HIV acquisition risks among men who have sex with men (MSM). There has been limited evaluation of these approaches in generalized HIV epidemics and/or where MSM are stigmatized. A peer-based CHPI program to target individual, social, and structural risks for HIV was developed for MSM in Blantyre, Malawi. To test the feasibility of CHPI, adult MSM were followed prospectively from January 2012 to May 2013. Participants (N = 103) completed sociobehavioral surveys and HIV testing at each of the 3 follow-up study visits. Approximately 90% of participants attended each study visit and 93.2% (n = 96) completed the final visit. Participants met with peer educators a median of 3 times (range: 1-10) in the follow-up visits 2 and 3. Condom use at last sex improved from baseline through follow-up visit 3 with main (baseline: 62.5%, follow-up 3: 77.0%; P = 0.02) and casual male partners (baseline: 70.7%, follow-up 3: 86.3%; P = 0.01). Disclosure of sexual behaviors/orientation to family increased from 25% in follow-up 1 to 55% in follow-up 3 (P < 0.01). Participants maintained a high level of retention in the study highlighting the feasibility of leveraging community-based organizations to recruit and retain MSM in HIV prevention and treatment interventions in stigmatizing settings. Group-level changes in sexual behavior and disclosure in safe settings for MSM were noted. CHPI may represent a useful model to providing access to other HIV prevention for MSM and aiding retention in care and treatment services for MSM living with HIV in challenging environments.

Scaling up of HIV treatment for men who have sex with men in Bangkok: a modelling and costing study

Despite the high prevalence of HIV in men who have sex with men (MSM) in Bangkok, little investment in HIV prevention for MSM has been made. HIV testing and treatment coverage remains low. Through a pragmatic programme-planning approach, we assess possible service linkage and provision of HIV testing and antiretroviral treatment (ART) to MSM in Bangkok, and the most cost-effective scale-up strategy. We obtained epidemiological and service capacity data from the Thai National Health Security Office database for 2011. We surveyed 13 representative medical facilities for detailed operational costs of HIV-related services for sexually active MSM (defined as having sex with men in the past 12 months) in metropolitan Bangkok. We estimated the costs of various ART scale-up scenarios, accounting for geographical accessibility across Bangkok. We used an HIV transmission population-based model to assess the cost-effectiveness of the scenarios. For present HIV testing (23% [95% CI 17-36] of MSM at high risk in 2011) and ART provision (20% of treatment-eligible MSM at high risk on ART in 2011) to be sustained, a US$73·8 million ($51·0 million to $97·0 million) investment during the next decade would be needed, which would link an extra 43,000 (27,900-58,000) MSM at high risk to HIV testing and 5100 (3500-6700) to ART, achieving an ART coverage of 44% for MSM at high risk in 2022. An additional $55·3 million investment would link an extra 46,700 (30,300-63,200) MSM to HIV testing and 12,600 (8800-16,600) to ART, achieving universal ART coverage of this population by 2022. This increased investment is achievable within present infrastructure capacity. Consequently, an estimated 5100 (3600-6700) HIV-related deaths and 3700 (2600-4900) new infections could be averted in MSM by 2022, corresponding to a 53% reduction in deaths and a 35% reduction in infections from 2012 levels. The expansion would cost an estimated $10,809 (9071-13,274) for each HIV-related death, $14,783 (12,389-17,960) per new infection averted, and $351 (290-424) per disability-adjusted life-year averted. Spare capacity in Bangkok's medical facilities can be used to expand ART access for MSM with large epidemiological benefits. The expansion needs increased funding directed to MSM services, but given the epidemiological trends, is probably cost effective. Our modelling approach and outcomes are likely to be applicable to other settings. World Bank Group and Australian National Health and Medical Research Council.

Incorporating couples-based approaches into HIV prevention for gay and bisexual men: opportunities and challenges.

Thirty years after the beginning of the HIV epidemic, gay, bisexual, and other men who have sex with men (collectively called MSM) bear a disproportionate burden of HIV in the United States and continue to acquire a distressingly high number and proportion of new infections. Historically, HIV prevention for MSM has been focused on individual-level behavior change, rarely intervening with MSM as part of a couple. Yet, an estimated 33–67% of HIV infections among MSM are acquired from primary sexual partners, suggesting that work with MSM as couples could be an important contributor to prevention. Given the emergence of high impact combination HIV prevention, it is timely to consider how work with the broad variety of male couples can improve both personal and community health. Couples HIV testing and counseling for MSM is an important advance for identifying men who are unaware that they are HIV-positive, identifying HIV-discordant couples, and supporting men who want to learn their HIV status with their partner. Once men know their HIV status, new advances in biomedical prevention, which can dramatically reduce risk of HIV transmission or acquisition, allow men to make prevention decisions that can protect themselves and their partners. This paper highlights the present-day challenges and benefits of using a couples-based approach with MSM in the era of combination prevention to increase knowledge of HIV status, increase identification of HIV discordant couples to improve targeting prevention services,and support mutual disclosure of HIV status.

Social and structural risks for HIV among migrant and immigrant men who have sex with men in Moscow, Russia: Implications for prevention

Moscow has a large population of immigrants and migrants from across the Former Soviet Union. Little is studied about men who have sex with men (MSM) within these groups. Qualitative research methods were used to explore identities, practices, and factors affecting HIV prevention and risks among immigrant/migrant MSM in Moscow. Nine interviews and three focus group discussions were conducted between April–June 2010 with immigrant/migrant MSM, analyzed as a subset of a larger population of MSM who participated in qualitative research (n=121). Participants were purposively selected men who reported same sex practices (last 12 months). Migrants were men residing in Moscow but from other Russian regions and immigrants from countries outside of Russia. A socioecological framework was used to describe distal to proximal factors that influenced risks for HIV acquisition. MSM ranged from heterosexual to gay-identified. Stigma and violence related to homophobia in homelands and concerns about xenophobia and distrust of migrants in Moscow were emerged as key themes. Participants reported greater sexual freedom in Moscow but feared relatives in homelands would learn of behaviors in Moscow, often avoiding members of their own ethnicity in Moscow. Internalized homophobia was prevalent and linked to traditional sexual views. Sexual risks included sex work, high numbers of partners, and inconsistent condom use. Avoidance of HIV testing or purchasing false results was related to reporting requirements in Russia, which may bar entry or expel those testing positive. HIV prevention for MSM should consider immigrant/migrant populations, the range of sexual identities, and risk factors among these men. The willingness of some men to socialize with immigrants/migrants of other countries may provide opportunities for peer-based prevention approaches. Immigrants/migrants comprised important proportions of the MSM population, yet are rarely acknowledged in research. Understanding their risks and how to reach them may improve the overall impact of prevention for MSM and adults in Russia.

STUDYING OF KNOWLEDGES, ATTITUDES AND PRACTICES (KAP) TOWARD HIV PREVENTION IN MSM IN KHANH HOA PROVINCE 2010

Objectives: Man who have sex with man (MSM) group is a high risk group of HIV infection. There are very rare studies about HIV infection in this group. Aims: Study knowledge, attitudes and practices (KAP) toward HIV prevention in MSM in Khanh Hoa province in 2010. Methods: A cross-sectional study among MSM over 16 years aged living in Khanh Hoa in which data were collected from June 2010 to June 2011. Results: Knowledge: Most of MSM have good knowledge about the ways of HIV transmission in which 47.5% have right answers to 14-15 questions about HIV prevention. Attitudes: 98.5% MSM are ready to do voluntary tests for HIV. 61.5% MSM did not discuss to male partners about HIV or STDs. Practices: 99.1% have used condom but 67.5% did not use condoms in the last contact with female partners. Only 19.6% MSM have received consultations about HIV. Conclusions: Most of MSM have good knowledge about the ways of HIV transmission. 98.5% MSM are ready to do voluntary tests for HIV. 99.1% have used condom. Only 19.6% MSM have received consultations about HIV.

Interim CDC Guidance on Pre-Exposure Prophylaxis for HIV Prevention in MSM

The iPrEx study recently demonstrated proof-of-principle for the efficacy of oral chemoprophylaxis in preventing HIV infection among men who have sex