Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago

Lancki, Nicola; Almirol, Ellen; Alon, Leigh; McNulty, Moira; Schneider, John A.

doi:10.1097/qad.0000000000001710

Cited by 70 publications

(68 citation statements)

References 26 publications

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“…Stigma reinforced by the association of PrEP with risky behaviour contributed to the decision of several of the participants to stop PrEP. Unfortunately, for many populations, HIV risk is driven not by behaviour but by one’s sexual network and/or one’s partners’ sexual network [42,43]. For this reason and others, the CDC guidelines predict HIV risk poorly among key populations such as black MSM and heterosexual women [42,43].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, for many populations, HIV risk is driven not by behaviour but by one’s sexual network and/or one’s partners’ sexual network [42,43]. For this reason and others, the CDC guidelines predict HIV risk poorly among key populations such as black MSM and heterosexual women [42,43]. In addition to removing barriers to PrEP delivery, PrEP should be normalized as a routine preventive health procedure for people potentially exposed to HIV.…”

Section: Discussionmentioning

confidence: 99%

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Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

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Introduction Pre‐exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in‐depth interviews with people who HIV seroconverted after using PrEP. Methods We identified individuals who initiated PrEP in an integrated safety‐net public health system and performed in‐depth chart review to determine person‐time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention’s Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in‐depth interviews with those who seroconverted. Results Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person‐years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5‐fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on‐demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP’s benefit versus self‐perceived risk; and entering a primary partnership. The individual who developed HIV using on‐demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. Conclusions HIV incidence during gaps in PrEP use was nearly eight‐fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non‐daily PrEP may require additional education and support in the United States.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

et al. 2020

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“…PrEP is recommended for populations with an HIV incidence above 2% per year (evidence rating AIII) and for HIV-seronegative partners of HIV-infected persons who are not consistently virally suppressed. 127,128 Unlike condoms, PrEP does not prevent other STIs. For people who inject drugs, clean injection equipment and access to substance use treatment should be available.…”

Section: Preventionmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Saag

Benson

Gandhi

et al. 2018

JAMA

518

287

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IMPORTANCE Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. OBJECTIVE To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. EVIDENCE REVIEW New evidence collected since the International Antiviral Society–USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. FINDINGS ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. CONCLUSIONS AND RELEVANCE Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.

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“…Several factors have been shown to limit PrEP uptake among YBMSM. They include decreased access and involvement with the health care system, low rates of providers prescribing PrEP (Eaton et al, 2015;Getting to Zero Illinois, 2019;Lancki, Almirol, Alon, McNulty, & Schneider, 2018), lack of PrEP awareness, perceived impact of side effects, and perceived inability to pay for PrEP, along with social barriers such as stigma around PrEP (Getting to Zero Illinois, 2019). Some of these barriers may be due to the disconnect between the CDC's PrEP guidelines and YBMSM.…”

mentioning

confidence: 99%

“…Some of these barriers may be due to the disconnect between the CDC's PrEP guidelines and YBMSM. One study showed that nearly half of Black gay, and bisexual men and other men who have sex with men (BMSM) who seroconverted did not meet CDC's PrEP eligibility criteria (Lancki et al, 2018). This is concerning because BMSM are reported to be equally or more willing to utilize PrEP for HIV prevention than their White counterparts (Lelutiu-Weinberger & Golub, 2016).…”

mentioning

confidence: 99%

The Motivational PrEP Cascade Guides Interpretation of Early PrEP Linkage to Care for Young Black Men Who Have Sex With Men: The Case of Chicago's PrEPLine

Dehlin

Issema

Eavou

et al. 2019

AIDS Education and Prevention

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Pre-exposure prophylaxis (PrEP) uptake remains low among Black men who have sex with men (BMSM). PrEPLine, launched in August 2015, based in Chicago, was designed to support PrEP linkage among BMSM. PrEPLine moves clients through the Motivational PrEP Cascade, addresses barriers, and tracks outcomes. Study findings suggest that three variables (i.e., being gay/same gender loving, living more than 15 miles from a clinic location, rescheduling an appointment) demonstrated a significant positive association with initiating PrEP. A subanalysis of BMSM found that two variables (i.e., living on the West Side of Chicago relative to those living on the South Side, and among those living in communities with a higher rate of poverty [more than 30%], relative to those living in communities with a lower rate of poverty [less than 20%]) demonstrated a significant negative association with initiating PrEP.

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Preexposure prophylaxis guidelines have low sensitivity for identifying seroconverters in a sample of young Black MSM in Chicago

Cited by 70 publications

References 26 publications

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

Missed opportunities to prevent HIV infections among pre‐exposure prophylaxis users: a population‐based mixed methods study, San Francisco, United States

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

The Motivational PrEP Cascade Guides Interpretation of Early PrEP Linkage to Care for Young Black Men Who Have Sex With Men: The Case of Chicago's PrEPLine

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