A survey of MSM and transgender women found that diverse formulations and regimens for PrEP, such as long-acting injectables and “on-demand” PrEP, could increase uptake and persistence.
Pre-exposure prophylaxis (PrEP) for HIV has the potential to significantly reduce the number of new HIV transmissions. Despite this potential, mechanisms that are used to monitor PrEP expansion and identify gaps in care such as population-level indicators of the PrEP continuum are lacking.
Through the use of a mobile survey, a team of investigators set out to assess the continuum of PrEP in the San Francisco Bay Area among men who have sex with men (MSM) and transgender women. Conclusions from the survey were presented in a poster presentation at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019).
A total of 460 participants took part in the survey between June and September of 2018, all of whom were not infected with HIV, were 18 years of age or older, were sexually active with a male or trans partner in the past year, and were residents of the San Francisco Bay Area. These participants were recruited through ads placed on social media and “sexual networking” sites, and through printed ads and phone call outreach.
The survey was classified as a Qualtrics mobile survey, which was used to evaluate PrEP awareness, implementation of a PrEP regimen, and adherence. From there, multivariable logistic regression was conducted to identify factors associated with initiation and adherence of PrEP.
The median age of the 460 participants was 30; and 46% were white, 22% were Latinx, 15% were Asian, 13% were black, and 4% self-reported as other. A total of 86% of the participants were men, and the remaining 14% were transgender women or non-binary.
Through self-reported information, the investigators determined that, the mean number of anal/vaginal sex partners over the previous 6 months was 7. Additionally, 74% of the participants reported engaging in condomless sex in the past 6 months and 25% reported a sexually transmitted infection in the previous year.
Overall, 96% of the participants had heard of PrEP and 47% had initiated PrEP at some point. Moreover, 33% of participants were currently on PrEP and 32% reported high levels of adherence to the regimen.
Of the 244 patients who had never taken PrEP, 81% reported interest in taking the daily oral tablets. However, only 61% were aware of where to get PrEP, and only 36% of participants had talked with a health care provider about PrEP.
The multivariable analyses found that PrEP initiation was associated with a higher education degree, having a primary provider, and recreational drug use. On the other hand, “younger age, other race, and transgender women/non-binary were associated with lower persistence.” The number of sex partners per participant was associated with initiation and persistence.
For the 63 individuals that discontinued PrEP use, median duration of use was 7 months and the most common reasons for stopping PrEP included not feeling at risk for HIV, difficulty accessing PrEP, side effects/concerns, and travel.
According to a “substantial proportion” of individuals who had never used PrEP or discontinued use, they would consider starting or restarting PrEP if offered on-demand PrEP (84% of non-users/73% of discontinued users), long-acting injectable PrEP (56%/68%), or a pericoital rectal formulation (32%/46%). These findings suggest that novel PrEP regimens and formulations could increase uptake and persistence of PrEP.
“While PrEP initiations are relatively high in the [San Francisco Bay Area], disparities in persistence exist, particularly in youth and [transgender women/non-binary]. Efforts to address cost/access barriers are critical to reversing disparities. Novel PrEP regimens and formulations could increase PrEP uptake and persistence,” the authors concluded.
The poster, “Assessing the PrEP Continuum in the San Francsico Bay Area: The Quickie Mobile Survey,” was presented at CROI 2019 in Seattle, Washington.