Persistent PrEP Coverage Suboptimal in Young, Black MSM in Atlanta

The incidence rate of HIV among young black MSM (YBMSM) in the United States is high and pre-exposure prophylaxis (PrEP), when taken consistently has the ability to reduce new infections.

While PrEP scale up is occurring across this population, high incidence rates of HIV are still observed in YBMSM in Atlanta, Georgia. According to investigators from a study presented in a poster presentation at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019) an interim estimate of 6% of HIV incidences per year occurred in a cohort of YBMSM with access to PrEP services enrolled in the EleMENt study.

As a result, the investigators comprised of experts from Emory University, the State University of New York at Albany, Kaiser Permanente, Atlanta, and the Orlando Immunology Center set out to learn more about the patterns of PrEP persistence and discontinuation among YBMSM.

The EleMENt study was designed to be an observational cohort study that examined the relationships between substance use and HIV risk behavior among nearly 300 participants between the ages of 18-29 in Atlanta. The participants were all YBMSM who were HIV-negative at the point of enrollment.

According to the investigators, each participant was offered optional PrEP at each study visit over the 24-month follow-up, with clinic visits, transportation, and labs along with manufacturer assistance plans (MAP) to obtain PrEP at little to no cost for the participant provided as part of the study.

The study team accounted for initiators, by recording time on and off PrEP based on “study surveys, prescription records, dates of MAP approvals, counseling notes, and other participant contacts.” The investigators note that PrEP discontinuation events were defined as a ≥2 week lapse in use of PrEP, with time to first PrEP discontinuation assessed with the Kaplan-Meier method and a Cox proportional hazard model used to identify factors associated with discontinuation.

After 483 person-years of follow up, a total of 125 of the 33 participants (42%) initiated PrEP through the EleMENt program. The study team observed that the participants who initiated PrEP maintained the regimen for 69% of possible person-time after initiation.

In total, 79 of the 125 individuals (63%) discontinued PrEP at least once during study follow-up, and 54 of the 79 (68%) individuals who discontinued PrEP use subsequently restarted PrEP. Moreover, 27 of the 125 individuals (22%) discontinued PrEP use 2 or more times.

Furthermore, the median time to first PrEP discontinuation was 219 days (95% CI 181-280).

“Persistent PrEP coverage in this cohort of YBMSM was suboptimal and discontinuations, including multiple discontinuations, were common despite additional support services available through the study,” the study investigators wrote in the abstract.

The authors further indicate that interventions to support PrEP persistence, especially for younger YBMSM and those who use substances will be necessary in order for the full effectiveness of PrEP to be achieved. In the future, regimens that do not require daily oral ART could potentially facilitate PrEP persistence in YBMSM.

The study, “PrEP Persistence and Discontinuations in a Cohort of Young Black MSM in Atlanta, GA,” was presented in a poster session on Wednesday March 6, 2019 at CROI 2019 in Seattle, Washington.