Background: Young men who have sex with men, particularly racial minority YMSM, are the only group in the United States whose HIV infection rates continue to increase. Pre-exposure prophylaxis (PrEP), which has been shown to reduce the risk of HIV acquisition, may be an ideal prevention method for these young men. Data on interest in open label PrEP use among MSM from the iPrEx trial have been presented, yet YMSM in the United States were not included in those analyses. Understanding the interest, uptake, and adherence to PrEP among U.S. YMSM is critical for designing PrEP implementation programs domestically.
Methodology: All 68 YMSM previously enrolled in ATN 082, a randomized pilot trial of PrEP feasibility and acceptability, were eligible to enroll in the open label extension of the iPrEx trial (iPrEx OLE). All HIV-uninfected participants were offered daily PrEP (TDF/FTC) along with a comprehensive package of HIV/STI testing and integrated risk reduction/adherence counseling. All participants taking PrEP were tested for tenofovir levels via plasma. Participants completed detailed computer assisted self-interviews on reasons for study participation, knowledge of PrEP efficacy, PrEP adherence and sexual behavior. We compared rates of self-reported adherence, tenofovir drug levels, and sexual risk behavior between the ATN 082 and iPrEx OLE.
Results: Forty-six YMSM (68% of total eligible; mean age 21; 52% Black, 37% Latino) enrolled in iPrEx OLE. Of those, 69.6% chose to take PrEP. The most common reasons for study participation were to help fight the HIV epidemic (74%), to get tested for HIV (59%) and to protect against HIV (59%). Tenofovir detection during the first 12 weeks of iPrEX OLE was 58.3% – up from 45% during the same timeframe of ATN 082. Self-reported adherence (64.8%) was consistent with tenofovir detection. Most common reasons for missing doses were not having pills with them (28%), schedule changes (24%) and forgetting (22%). Perceptions of PrEP efficacy increased significantly (p<.001) across study visits, while number of recent sex partners and episodes of unprotected anal receptive sex decreased. Participants reported multiple social benefits from study participation and 70% stated they would take PrEP in the future if available.
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