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ATN 110: PrEP Adherence Challenges of Young Black Gay Men

, by Emily Newman

BETA is attending and reporting from the 2015 International AIDS Society Conference on HIV Pathogenesis, Treatment & Prevention this week in Vancouver—bringing you the latest news, updates, and research on HIV treatment and prevention.

Because young black gay men in the U.S. are affected by HIV at much higher rates than other groups of people, PrEP may be an especially useful prevention strategy for people in this demographic group.

Sybil Hosek, PhD

Sybil Hosek, PhD

Yesterday, at the 2015 International AIDS Conference, Sybil Hosek, PhD, of Stroger Hospital, Chicago, presented results from a PrEP demonstration project—ATN 110—that measured PrEP adherence and safety among young men who have sex with men. The study highlighted the fact that—while PrEP may be attractive and feasible for some young men—there is still much to learn about how PrEP can be used to lessen the HIV health disparities faced by young black gay men.

The ATN 110 study enrolled 200 young men, age 18 to 22, into an open-label adherence, safety and acceptability PrEP study. The men were believed to be at high risk of HIV: at baseline, about a third had ever been paid for sex (29%), over three-quarters (81%) had condomless sex in the past six month, and over half (58%) had condomless receptive anal sex with their last partner. Twenty-two percent tested positive for an STI at baseline.

The researchers measured adherence to the daily PrEP regimen by measuring blood drug levels throughout the study.

As other open-label PrEP studies have found, ATN 110 demonstrated that participants that engage in higher risk HIV activities more frequently are more adherent to PrEP. In this study, participants that reported engaging in condomless sex and who had condomless receptive anal sex with their last partner had higher drug concentrations in their system—i.e., took PrEP more often and consistently—than other participants.

Four HIV seroconversions happened during the study, and all had undetectable levels of PrEP drug in their system when they seroconverted. STI diagnoses, already high at baseline, remained stable during the study and did not increase.

A little over half (53%) of ATN 110’s participants were black; 21% were white, and 17% were Latino. Drug adherence differed across racial and ethnic groups. “We had some pretty striking racial and ethnic differences,” said Hosek.

Adherence in ATN 110 by Race/Ethnicity

Adherence in ATN 110 by Race/Ethnicity

Hosek and her team used a measure of PrEP “coverage” equal to blood levels corresponding to about four Truvada tablets per week—a dose considered to be protective for men who have sex with men. While the white, Latino and mixed-raced groups of participants largely reached this level, the group of African American men showed much lower levels of adherence. For all participants, adherence decreased as study visits became less frequent.

“Our African American participants, on average, did not reach the highly protective levels that PrEP can afford them at all across the course of the study,” Hosek explained.

Hosek said her study team has planned a qualitative study so that they can ask their participants about barriers and facilitators to using PrEP, like social support and their beliefs about how well PrEP works. She said there were no differences across groups in terms of education, housing status or markers of socioeconomic status, but many of the men in the study had limited access and experience with the health care system. “Most did not have a primary care provider, and considered being in our study as ‘getting health care.’ I think that’s a really critical point.”

Commenting on the low adherence by black men in the study, Hosek said, “Unfortunately, this is consistent with recent research which has really shown that those that are at highest risk, in this country, which are young black MSM, have low levels of exposure to HIV preventions—both behavioral and biomedical. And really, a continued call for us as researchers, advocates, and policymakers to really dig deep and try to figure out how we can make this work so that we’re not expanding the already large gap in health disparities that we see particularly in the United States.”

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