HIV pre-exposure prophylaxis persistence and adherence among men who have sex with men in 4 U.S. cities

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) persistence and adherence are critical to ending the HIV epidemic in the United States. SETTING: In 2017 National HIV Behavioral Surveillance, HIV-negative men who have sex with men (MSM) in 4 U.S. cities completed a survey, HIV testing, and dried blood spots (DBS) at recruitment. METHODS: We assessed three PrEP outcomes: persistence (self-reported PrEP use at any time in the past 12 months and had tenofovir, emtricitabine, or tenofovir diphosphate (TFV-DP) detected in DBS), adherence at ≥4 doses/week (self-reported past-month PrEP use and TFV-DP concentration ≥700 fmol/punch), and adherence at 7 doses/week (self-reported past-month PrEP use and TFV-DP concentration ≥1250 fmol/punch). Associations with key characteristics were examined using log-linked Poisson regression models with generalized estimating equations. RESULTS: Among 391 MSM who took PrEP in the past year, persistence was 80% and was lower among MSM who were younger, had lower education, and had fewer sex partners. Of 302 MSM who took PrEP in the past month, adherence at ≥4 doses/week was 80% and adherence at 7 doses/week was 66%. Adherence was lower among MSM who were younger, were Black, and had fewer sex partners. CONCLUSIONS: Although persistence and adherence among MSM were high, 1 in 5 past-year PrEP users were not persistent and 1 in 5 past-month PrEP users were not adherent at levels that would effectively protect them from acquiring HIV (i.e., ≥4 doses/week). Efforts to support PrEP persistence and adherence should include MSM who are young, are Black, and have less education

Additional file 3 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 3: Appendix 3 Figure. Conceptual diagram of multivariable generalized hierarchical linear model combining individual and site factors

Additional file 2 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 2: Appendix Table 2. HIV-specific criminalization laws – National HIV Behavioral Surveillance, 9 U.S. sites, 2017

Additional file 1 of Associations between HIV testing and multilevel stigmas among gay men and other men who have sex with men in nine urban centers across the United States

Additional file 1: Appendix Table 1. Sexual behavior stigma scale items and responses by associated factors